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In this video, we delve into what causes portal vein thrombosis (PVT), a condition diagnosed in approximately 1 in 10,000 individuals annually, particularly affecting those with liver disease and thrombophilia. We explore the clinical scenario where PVT should be suspected, such as sudden abdominal pain in patients with liver disease or known thrombophilia. Lab indicators like a positive D-dimer during acute thrombosis and imaging findings like splenomegaly on abdominal ultrasound will be discussed. The long-term outcomes of chronic PVT include complications like portal hypertension, leading to severe conditions like ascites and hepatic encephalopathy. Given the potential risk of gastrointestinal bleeding from anticoagulation in these patients, treatment decisions should be made carefully. While PVT itself doesn't cause pulmonary embolism, it may indicate a hypercoagulable state that predisposes to such complications. For more comprehensive information, consult trusted medical databases like PubMed and guidelines from hepatology societies.