Hepatic vein obstruction (Budd-Chiari)

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 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)

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 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

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 health care provider if:

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

Alternative Names

Budd-Chiari syndrome; Hepatic veno-occlusive disease

References

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.