Hepatic disease due to circulatory disturbance

There are many hepatic disease caused due to disturbance of blood circulation to hepatic cells, few of them are explained below

Hepatic venous obstruction

In the normal liver, there are no anostomoses between hepatic vein and portal veinbut in cirrhotic liver there are such anostomoses. Two uncommon diseases produced due to obstruction of hepatic veins are Budd-Chiari syndrome and hepatic veno-occclusive disease.

Budd-Chiari syndrome (hepatic vein thrombosis)

It is in complete form a slowly developing thrombosis of hepatic veins and adjacent inferior vena cava.

Etiology

In some cases it is known to be idiopathic while in some cases causes associated with increased thrombotic tendencies are attributed such as due to polycythaemia vera, paroxysmal nocturnal haemoglobinuria, oral contraceptives, post partum state, intra abdominal cancer, chemotherapy, radiation and myeloproliferative diseases.

Pathological changes

Grossly the liver is enlarged, swollen, red purple and has a tense capsule.

Clinical features

Budd-Chiary syndrome is clinically characterized byeither an acute form or chronic form depending upon the speed of occlusion.

  • In acute form the features are abdominal pain, vomiting, enlarged liver, ascites and mild icterus
  • In more usual chronic form, the patient present with pain over enlarged tender liver, ascites and other features of portal hypertension

Hepato veno-occlusive disease

Hepatic veno-occclusive disease consists of intimal thickening, stenosis and obliteration of terminal central veins and medium sized hepatic veins.the venous occlusion results in pathological changes similar to those of Budd-Chiari syndrome.

Portal venous obstruction

Obstruction of portal vein may occur in the intrahepatic course or in extrahepatic site.

Intrahepatic cause

  • Hepatic cirrhosis
  • Tumour invasion
  • Congenital hepatic fibrosis
  • Schistomiasis
  • Intra abdominal cancers
  • Intra abdominal sepsis
  • Direct invasion by tumour
  • Myeloproliferative disorders
  • Upper abdominal surgical procedures followed by thrombosis

Extrahepatic cause

Hepatic arterial obstruction

Rarely accidental ligation of main hepatic artery or its branch to rightlobe may be followed by fatal infraction.

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