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Hepatic vein obstruction (Budd-Chiari)

Budd-Chiari syndrome; Hepatic veno-occlusive disease

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 excessive blood clotting
  • Oral contraceptives
  • Pregnancy

Hepatic vein blockage is the most common cause of Budd-Chiari syndrome.

Symptoms

Symptoms include:

  • Abdominal swelling or stretching due to fluid in the abdomen
  • 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:

Treatment

Treatment varies, depending on the cause of the blockage.

Your health care provider may recommend the following medicines:

  • Blood thinners (anticoagulants)
  • Clot-busting medicines (thrombolytic treatment)
  • Medicines to treat the liver disease, including ascites

Surgery may be recommended. This may involve:

Possible Complications

Hepatic vein obstruction can get worse and lead to cirrhosis and liver failure. This can be life threatening.

When to Contact a Medical Professional

Contact your provider if:

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

References

Kahi CJ. Vascular diseases of the gastrointestinal tract. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 129.

Nery FG, Valla DC. Vascular diseases of the liver. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 85.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

  • Blood clot formation

    Blood clot formation - illustration

    Blood clotting normally occurs when there is damage to a blood vessel. Platelets immediately begin to adhere to the cut edges of the vessel and release chemicals to attract even more platelets. A platelet plug is formed, and the external bleeding stops. Next, small molecules, called clotting factors, cause strands of blood-borne materials, called fibrin, to stick together and seal the inside of the wound. Eventually, the cut blood vessel heals and the blood clot dissolves after a few days.

    Blood clot formation

    illustration

  • Blood clots

    Blood clots - illustration

    Blood clots (fibrin clots) are the clumps that result when blood coagulates.

    Blood clots

    illustration

  • Hepatic venous circulation

    Hepatic venous circulation - illustration

    The portal vein drains blood from the intestine, stomach, spleen, pancreas, and gallbladder into the liver. The liver processes the nutrients in this blood and filters out toxic substances. The hepatic veins then carry the blood away from the liver and into the inferior vena cava, which leads to the right atrium, one of the four chambers of the heart.

    Hepatic venous circulation

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    • Blood clot formation

      Blood clot formation - illustration

      Blood clotting normally occurs when there is damage to a blood vessel. Platelets immediately begin to adhere to the cut edges of the vessel and release chemicals to attract even more platelets. A platelet plug is formed, and the external bleeding stops. Next, small molecules, called clotting factors, cause strands of blood-borne materials, called fibrin, to stick together and seal the inside of the wound. Eventually, the cut blood vessel heals and the blood clot dissolves after a few days.

      Blood clot formation

      illustration

    • Blood clots

      Blood clots - illustration

      Blood clots (fibrin clots) are the clumps that result when blood coagulates.

      Blood clots

      illustration

    • Hepatic venous circulation

      Hepatic venous circulation - illustration

      The portal vein drains blood from the intestine, stomach, spleen, pancreas, and gallbladder into the liver. The liver processes the nutrients in this blood and filters out toxic substances. The hepatic veins then carry the blood away from the liver and into the inferior vena cava, which leads to the right atrium, one of the four chambers of the heart.

      Hepatic venous circulation

      illustration


    Review Date: 5/14/2024

    Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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