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
Autoimmune
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
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Infections
Inherited (hereditary) or acquired problems with 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:

CT scan or MRI of the abdomen
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
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MRI of the abdomen
An abdominal magnetic resonance imaging scan is an imaging test that uses powerful magnets and radio waves. The waves create pictures of the inside ...
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Doppler ultrasound of the liver veins
Liver biopsy
Liver biopsy
A liver biopsy is a test that takes a sample of tissue from the liver for examination.
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Liver function tests
Liver function tests
Liver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...
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Ultrasound of the liver
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
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Treatment

Treatment varies, depending on the cause of the blockage.

Your health care provider may recommend the following medicines:

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

Surgery may be recommended. This may involve:

Angioplasty and stent placement
Angioplasty
The blood vessels that bring blood to your brain and face are called the carotid arteries. You have a carotid artery on each side of your neck. The...
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Stent
A stent is a tiny tube placed into a hollow structure in your body. This structure can be an artery, a vein, or another structure, such as the tube ...
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Transjugular intrahepatic portosystemic shunt (TIPS)
TIPS
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to create new connections between two blood vessels in your liver. You may need ...
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Venous shunt surgery
Liver transplant

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

Open References

References

Kahi CJ. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 134.

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

A Closer Look

Talking to your MD

Self Care

Tests for Hepatic vein obstruction (Budd-Chiari)

Review Date: 5/4/2022

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. 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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Health Library

Hepatic vein obstruction (Budd-Chiari)

Hepatic

Causes

Tumor

Autoimmune

Symptoms

Exams and Tests

Ascites

CT scan

MRI of the abdomen

Liver biopsy

Liver function tests

Ultrasound

Treatment

Angioplasty

Stent

TIPS

Possible Complications

Cirrhosis

When to Contact a Medical Professional

References

Digestive system - illustration

Digestive system

Digestive system organs - illustration

Digestive system organs

Blood clot formation - illustration

Blood clot formation

Blood clots - illustration

Blood clots

Hepatic venous circulation - illustration

Hepatic venous circulation