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Hepatic vein obstruction (Budd-Chiari)

Budd-Chiari syndrome; Hepatic veno-occlusive disease

 

Hepatic vein obstruction is a blockage of the hepatic vein, which carries blood away from the liver.

Causes

 

Hepatic vein obstruction prevents blood from flowing out of the liver and back to the heart. This blockage can cause liver damage. Obstruction of this vein can be caused by a tumor or growth pressing on the vessel, or by a clot in the vessel (hepatic vein thrombosis).

Most often, it is caused by conditions that make blood clots more likely to form, including:

  • Abnormal growth of cells in the bone marrow (myeloproliferative disorders)
  • Cancers
  • Chronic inflammatory or autoimmune diseases
  • Infections
  • Inherited (hereditary) or acquired problems with blood clotting
  • Oral contraceptives
  • Pregnancy

Hepatic vein blockage is the most common cause of Budd-Chiari syndrome.

 

Symptoms

 

Symptoms include:

  • Abdominal swelling or stretching
  • Pain in the right upper abdomen
  • Vomiting blood
  • Yellowing of the skin (jaundice)

 

Exams and Tests

 

One of the signs is swelling of the abdomen from fluid buildup (ascites). The liver is often swollen and tender.

Tests include:

  • CT scan or MRI of the abdomen
  • Doppler ultrasound of the liver veins
  • Liver biopsy
  • Liver function tests
  • Ultrasound of the liver

 

Treatment

 

Treatment varies, depending on the cause of the blockage.

Your health care provider may recommend the following medicines:

  • Blood thinners (anticoagulants)
  • Clot-busting drugs (thrombolytic treatment)
  • Medicines to treat the liver disease, including ascites

Surgery may be recommended. This may involve:

  • Angioplasty and stent placement
  • Transjugular intrahepatic portosystemic shunt (TIPS)
  • Venous shunt surgery
  • Liver transplant

 

Possible Complications

 

Hepatic vein obstruction can get worse and lead to liver failure, which can be life threatening.

 

When to Contact a Medical Professional

 

Call your provider if:

  • You have symptoms of hepatic vein obstruction
  • You are being treated for this condition and you develop new symptoms

 

 

References

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143.

Valla DC. Vascular disease of the liver. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 85.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

  • Blood clot formation

    Blood clot formation - illustration

    Blood clotting normally occurs when there is damage to a blood vessel. Platelets immediately begin to adhere to the cut edges of the vessel and release chemicals to attract even more platelets. A platelet plug is formed, and the external bleeding stops. Next, small molecules, called clotting factors, cause strands of blood-borne materials, called fibrin, to stick together and seal the inside of the wound. Eventually, the cut blood vessel heals and the blood clot dissolves after a few days.

    Blood clot formation

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    • Blood clot formation

      Blood clot formation - illustration

      Blood clotting normally occurs when there is damage to a blood vessel. Platelets immediately begin to adhere to the cut edges of the vessel and release chemicals to attract even more platelets. A platelet plug is formed, and the external bleeding stops. Next, small molecules, called clotting factors, cause strands of blood-borne materials, called fibrin, to stick together and seal the inside of the wound. Eventually, the cut blood vessel heals and the blood clot dissolves after a few days.

      Blood clot formation

      illustration

    A Closer Look

     

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          Tests for Hepatic vein obstruction (Budd-Chiari)

           

             

            Review Date: 5/11/2016

            Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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