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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
    • 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
  • 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.