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 lump (tumor) pressing on the vessel, or by a clot (thrombus) in the vessel.

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

• Abnormal spread of cells from the bone marrow (myeloproliferative disorders)
• Cancers
• Chronic inflammatory or autoimmune diseases
• Infections
• Inherited (hereditary) or acquired problems with blood clotting
• Oral contraceptives and pregnancy

Symptoms

• Pain on the right side of the abdomen
• Vomiting blood
• Yellowing of the skin (jaundice)

Signs and tests

One of the signs is swelling of the abdomen from fluid build-up (ascites)

Tests include:

• CT scan or MRI of the abdomen
• 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)
• Other surgeries

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

References

Zimmerman MA, Cameron AM, Ghobrial RM. Budd-Chiari syndrome. Clin Liver Dis. 2006;10:259-273.