Definition of Hepatic vein obstruction (Budd-Chiari):

Hepatic vein obstruction is a blockage of the hepatic vein, which carries blood away from the liver.

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)
• 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)

Signs 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.

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

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