Hepatic vein obstruction (Budd-Chiari)
Hepatic vein obstruction is a blockage of the hepatic vein, which carries blood away from the liver.
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)
- Chronic inflammatory or autoimmune diseases
- Inherited (hereditary) or acquired problems with blood clotting
- Oral contraceptives
Hepatic vein obstruction is the most common cause of Budd-Chiari syndrome.
- 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.
- CT scan or MRI of the abdomen
- Doppler ultrasound of the liver veins
- Liver biopsy
- Liver function tests
- Ultrasound of the liver
Treatment varies, depending on the cause of the blockage.
Your doctor may recommend the following medicines:
- Blood-thinners (anticoagulants)
- Clot-busting drugs (thrombolytic treatment)
- Medicines to treat for the liver disease, including ascites
Surgery may be recommended. This may involve:
- Angioplasty and stent placement
- Liver transplant
- Transjugular intrahepatic portosystemic shunt (TIPS)
- Venous shunt surgery
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
Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 145.
Stevens WE, Patil A. Vascular disease of the liver. In: Feldman M, Friedman LS, Brandt LJ eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 83.
Last reviewed 8/10/2012 by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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