Hepatic venous disease

Introduction Veso-occlusive disease refers to luminal occlusive lesions that occur in small branches of the hepatic venules and hepatic veins, and does not involve large branches of hepatic veins.

Cause

Causes:

Hepatic vein occlusion can occur anywhere in the hepatic vein, but is common at the entrance of the hepatic vein into the inferior vena cava. Blockage is often caused by a blood clot, but it is sometimes caused by fibrous cords, fibrous webs, and fibrous membranes left by thrombosis or proliferative inflammation. In the acute phase, the liver is swollen with a smooth surface and purple; under the microscope, the liver parenchyma is characterized by severe hepatic sinus congestion and destruction of hepatocyte structure in the hepatic acinar zone III. Fibrosis and nodular regeneration can occur in the chronic phase, resulting in loss of normal liver structure. In addition, portal hypertension can occur leading to splenomegaly and portal shunt, and 20% of patients can have portal vein thrombosis. Since the blood flow of the hepatic caudal lobe directly into the inferior vena cava is usually unaffected, it can be compensated in the later stage.

an examination

Related inspection

Liver, gallbladder, pancreas and spleen MRI examination of liver, gallbladder, spleen CT examination

[clinical manifestations]

Patients often have abdominal pain, hepatomegaly and tenderness, but the surface is smooth, and complicated with a large number of refractory ascites and mild jaundice. Acute onset can cause liver failure and death. But more commonly, Budd-Chiari syndrome turns chronic after several months, and patients have cirrhosis such as blurred abdominal pain and portal hypertension splenomegaly. Due to the enlargement of the caudal lobe, a mass can be touched on the upper abdomen, and the compression of the liver area cannot fill the jugular vein (negative sign of hepatic jugular venous return). Inferior vena cava obstruction can lead to obvious edema of the abdominal wall, accompanied by abdominal varices (blood flow from the pelvic cavity through the umbilical vein into the costal vein) and severe edema of the lower extremities.

[Auxiliary inspection]

Hepatic venography, liver biopsy, ultrasonography, Doppler ultrasonography.

Diagnose based on

Biochemical examination abnormalities have no diagnostic value. Hepatic isotope scintillation scan can be found in the increase of the caudal lobe. Hepatic venography can determine the extent of the thrombus and the involvement of the vena cava. Liver biopsy can be seen in hepatic hyperemia and hepatic acinar zone III hepatocytes disappear. Ultrasonography can detect hepatic venous blood flow abnormalities and The lobes are enlarged, Doppler ultrasound can detect changes in blood flow, and MRI shows abnormalities in the hepatic venous outflow tract and abnormalities in the inferior vena cava or portal vein.

Differential diagnosis

Differential diagnosis of hepatic venous lesions:

Hepatic venous return disorder: Hepatic venous return disorder is one of the symptoms of Budd-Chiari syndrome. Budd-Chiari syndrome refers to a clinical syndrome in which the hepatic vein or (and) the inferior vena cava of the hepatic segment is partially or completely obstructed, resulting in damage to the organ tissue caused by venous return.

Diagnosis of hepatic venous lesions:

[clinical manifestations]

Patients often have abdominal pain, hepatomegaly and tenderness, but the surface is smooth, and complicated with a large number of refractory ascites and mild jaundice. Acute onset can cause liver failure and death. But more common is Budd-Chiari syndrome. After several months, it turned chronic, and the patient had ambiguous abdominal pain and portal hypertension splenomegaly and other liver cirrhosis. Due to the enlargement of the caudal lobe, a mass can be touched in the upper abdomen, and the compression of the liver can not fill the jugular vein ( Negative hepatic jugular venous return. The inferior vena cava obstruction can cause obvious edema of the abdominal wall, accompanied by abdominal varices (blood flow from the pelvic cavity through the umbilical vein into the costal vein) and severe edema of the lower extremities.

[Auxiliary inspection]

Hepatic venography; liver biopsy; ultrasonography; Doppler ultrasonography.

Diagnose based on

There is no diagnostic value for biochemical examination. Hepatic isotope scintillation scan can be found in the increase of caudal lobe. Hepatic venography can determine the extent of thrombus and whether the vena cava is involved. Hepatic biopsy can be seen in hepatic hyperemia and hepatic acinar zone III hepatocytes disappear. Ultrasonography can be used. Hepatic venous blood flow abnormalities and caudal lobe enlargement were found. Doppler ultrasound can detect changes in hemorrhage. MRI showed abnormalities of hepatic venous outflow tract and abnormalities of inferior vena cava or portal vein.

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