Hepatic vein obstruction (Budd-Chiari)

Definition

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

Alternative Names

Budd-Chiari syndrome; Hepatic veno-occlusive disease

Causes, incidence, and risk factors

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 obstruction is the most common cause of Budd-Chiari syndrome.

Symptoms

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

Signs 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.

Medical treatments:

• Blood-thinning (anticoagulation) medications
• Clot-busting drugs (thrombolytic treatment)
• Treatment for the liver disease, including ascites

Surgical treatments:

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

Support Groups

Expectations (prognosis)

Complications

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

Calling your health care provider

Call your health care provider if:

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

Prevention

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References

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 146.