Hepatic vein obstruction (Budd-Chiari)

Alternative Names: 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 of Hepatic vein obstruction (Budd-Chiari)

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.

Hepatic vein obstruction (Budd-Chiari) Symptoms

• Abdominal swelling or stretching
• Pain in the right upper abdomen
• Vomiting blood
• Yellowing of the skin (jaundice)

Tests and Exams

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 of Hepatic vein obstruction (Budd-Chiari)

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)
• Venous shunt surgery

Potential Complications

Hepatic vein obstruction can get worse and lead to liver failure, which can be life-threatening.

When to Contact a Health 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

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 146.

Digestive system	Digestive system organs

Review Date: 7/7/2010
Reviewed 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., Inc.

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