The Budd-Chiari: what is it?
The Budd-Chiari (SBK) is a rare disease that develops at the overlap of the hepatic veins. SBK includes any disease in which impaired diverting blood from the liver into the inferior Vena cava. Another name for this syndrome – thrombosis of hepatic veins.
Reasons SBK can be divided into primary and secondary. The primary form of the disease it may be associated with:
- This polycythemia.
- Postpartum condition.
- Reception of oral contraceptives.
- Paroxysmal nocturnal hemoglobinuria.
- Cancer of the liver.
Secondary SBK is caused by compression of the hepatic veins from the outside – for example, tumor.
SBK also can occur in chronic infection (hydatid cyst, amebic abscess, syphilis, tuberculosis) and inflammatory (sarcoidosis, systemic lupus erythematosus, Sjogren’s syndrome, Behcet’s disease) diseases.
In the early stages of the disease, many patients do not experience any symptoms. The most common symptom of SBK is ascites – accumulation of free fluid in the abdomen. The reason for its appearance is the increased venous pressure created by the overlap of the veins. Sometimes also observed hepatomegaly – enlarged liver in size. Some patients with SBC may have a jaundiced hue of the skin and complain of pain in the right hypochondrium. Other symptoms include:
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- Nausea and vomiting.
- Weight reduction.
- Vomiting with blood.
- The increase in size of the spleen.
- Swelling in the legs.
Often the doctors patients with the described symptoms first suspect cirrhosis of the liver. During the inspection, they can detect enlarged liver, ascites, yellow skin and sclera. Further examination includes:
- Laboratory blood tests that are useful for determining the functional state of the liver.
- Ultrasound examination of the liver, which detects an increase in its sizes, violations of the blood flow through the hepatic veins.
- CT or MRI of the liver.
After the detection of pathology can be conducted an additional examination:
- Liver biopsy in which a doctor takes a sample of her tissue for laboratory examination.
- Catheterization of the hepatic veins, in which the doctor gets them a special tool to measure venous pressure.
Thrombosis of the hepatic veins is necessary to carry out the treatment of the disease, which has caused its development. The goal of treatment of the ACC is to preserve the functional state of the liver and maintaining blood flow. The doctors are trying to achieve this through:
- Eliminate the overlap of the hepatic veins (if possible).
- Prevent recurrence or progression of thrombosis.
- Reduce blood stagnation in the liver.
- Treatment of ascites.
- Prevention of further liver damage, which allows the hepatocytes to recover.
In some cases an acute development of SBK doctors can prescribe drugs that leiroot blood clots (thrombolytics). To prevent recurrent thrombosis is anticoagulation assigned funds. When ascites is prescribed diuretics, and the patient is recommended to limit the intake of water and salt.
Many patients with SBK surgical intervention is necessary, which can be used to remove the occlusion of the hepatic veins. For this purpose, conduct:
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- Angioplasty and stenting of hepatic veins.
- Transjugular intrahepatic portosystemic surgery in which a shunt, diverting blood from the portal vein to the inferior Vena cava, bypassing the liver.
- Venous shunting, which decreases venous pressure in the portal vein.
These surgical operations can be quite effective, however, there is a risk that they can create additional problems. The abstraction of blood from the portal vein into the system of the inferior Vena cava leads to the fact that a lesser quantity passes through the liver and detoxify. As a result, these toxins can accumulate and cause hepatic encephalopathy. The symptoms of this condition include intellectual and behavior, tremor, insomnia. The treatment of hepatic encephalopathy is performed using prenosnih (lactulose) and antibiotics. In the absence of effect of pharmacological and surgical methods of treatment of liver transplantation.