Thrombosis of the hepatic artery. Thrombosis of the hepatic veins

Hepatic veins is a violation of the blood flow under the influence of blood clots in the lumen of the vessels that drain blood from the liver. As a result, they may overlap completely or partially. As a result similar disease not only activities are severely disrupted of cardio-vascular system and also the liver.

Features of the disease

More often similar affliction manifests itself in older adults, but in Lately many doctors sounded the alarm. The disease is much younger.

Signs of hepatic vein thrombosis are observed in some young people, and this cannot but alert doctors. Most often, the disease develops in women, aged from forty to fifty years, in men, the disease is much less common.

What does an incomplete thrombosis look like? portal vein liver, will tell the following video:

Forms

Hepatic vein thrombosis is often classified as Budd-Chiari syndrome. The disease occurs in two forms:

acute. With this disease, the veins are clogged due to the appearance of a blood clot in them. The patient suddenly has severe abdominal pain, vomiting, jaundice. Further, the disease is rapidly gaining momentum: in abdominal cavity accumulates free liquid, legs swell, the veins on the front wall of the abdomen swell and become visible, hematemesis may begin. Lymphedema appears. If doctors do not urgently intervene, then death will occur within a few days;
chronic. It occurs due to inflammation of the hepatic veins and the growth of fibrosis in their cavity. Most patients (about 85%) have chronic form. She may not show up for many years. But over time, all the symptoms that occur in the acute form suddenly appear. Usually accompanied by others chronic diseases against which it develops.

Causes

There may be several reasons for the appearance of the disease. Let's highlight the most important ones:

blood clotting disorder;
myeloproliferative lesions;
severe abdominal trauma;
tumors of the adrenal glands and kidneys;
pancreas;
paroxysmal nocturnal hemoglobinuria;
lupus erythematosus;
taking drugs that increase blood clotting;
pregnancy;
bad heredity.

About the symptoms of thrombosis of the hepatic veins, arteries, read on.

Symptoms of the syndrome (disease) Budd-Chiari

Immediately make a reservation, some general clinical picture Budd-Chiari syndrome does not exist; each patient has an individual disease. But doctors, watching a large number of patients, nevertheless, several of them were identified in the general group:

severe pain in the abdomen. This symptom is noted by almost all patients. Portability pain threshold all people have an individual, but the pains are so strong that they deprive a person of rest and sleep;
enlarged liver and spleen. These factors are clearly evidenced by an enlarged abdomen. The patient is visited by feelings of swelling and heaviness;
jaundice. A symptom that does not always appear;
ascites It is characterized by the accumulation of fluid in the abdomen, increasing its volume;
hepatic encephalopathy. This symptom observed in a small number of patients;
bleeding from . Occurs in a small number of patients;

If you find one or more of the symptoms in yourself, then immediately consult a doctor. He will more accurately determine the symptoms and send you for additional diagnostics.

Diagnostics

Since it is extremely difficult to visually detect an ailment, and symptoms can directly indicate whole line diseases, the most effective method for diagnosing Budd-Chiari syndrome is Doppler ultrasound. It allows you to determine whether there is a disease with a high degree of probability. The examination can detect blood clots in the veins of the liver. And it will be clear what kind they are. That is, whether they are connected to the wall of the vein or not, and if they are connected, then the connective tissue is young or old.
Another effective method for detecting thrombosis is angiography. A catheter with a special substance is inserted into the liver veins and a series of x-rays. Very often, along with a special solution, drugs are introduced that can not only detect, but also destroy a blood clot.
Abdominal MRI, radionuclide study and lab tests and tests will also help doctors make the most accurate diagnosis.

Read more about the treatment of hepatic artery thrombosis.

Treatment

In the treatment of liver thrombosis, complex treatment should be used, since one medication is sometimes not enough. Additional surgery and physiotherapy are often required.

Therapeutic and medicinal methods

In the medical treatment of hepatic vein thrombosis, diuretics, anticoagulants, and thrombolytics are used.

However, treatment is only medicines helps for a short time and leads to the progression of the disease.

Operation

The operation is carried out in three different ways, it all depends on the stage at which the disease is detected:

angioplasty. A special substance is injected into the veins of the liver, which destroys the blood clot. Fulfill this procedure only a trained specialist should, as there is a possibility that blood clot will come off and continue to move along the vein. As a complication, the progression of thromboembolism is possible;
shunting of the liver vessels. Artificial vessels are superimposed, which ensure the outflow of blood from the liver. After similar procedure the patient becomes much better and general state the body improves;
liver transplant. It is necessary for patients with an acute course of the disease. Shown on late stages syndrome and associated complications.

Disease prevention

As such, prevention of hepatic vein thrombosis does not exist. Regular use of blood-thinning drugs is necessary to prevent relapses. At least once every six months, see a doctor and do an ultrasound, preferably with dopplerography.

With the blood entering the portal vein system, the liver also receives oxygen and nutrients.

Thrombosis of the portal vein or pilethrombosis is characterized by the formation of a parietal thrombus, which completely or partially blocks the lumen of the vessel. Impaired blood flow in the liver and gastrointestinal tract develops portal hypertension and cirrhosis. For many years, the disease was considered rare, but with the improvement of diagnostic methods that allow visualization of the blood flow pattern, pylethrombosis is often detected in patients suffering from cirrhosis of the liver.

Causes

According to modern classification, the causes of portal vein thrombosis are usually divided in the following way:

local (inflammatory processes in the abdominal cavity, damage to the portal vein as a result of injuries, medical manipulations);
systemic (thrombophilia - clotting disorders with a tendency to thrombosis, - hereditary and acquired nature).

Indirect causes of hepatic vein thrombosis are malignant neoplasms in the liver and decompensated cirrhosis. There are also risk factors that increase the likelihood of the disease - pancreatitis, cholecystitis and others. inflammatory diseases abdominal organs, especially if their treatment involves surgical intervention.

Clinical picture

According to the nature of the course, thrombosis of the portal vein of the liver can be acute and chronic.

Acute thrombosis is manifested by such signs:

severe abdominal pain that comes on suddenly
increased body temperature, constant fever;
nausea, vomiting, stool disorder;
splenomegaly (enlargement of the spleen).

These symptoms of portal vein thrombosis manifest simultaneously, sharply worsening the patient's condition. A dangerous complication is intestinal infarction, i.e., necrosis of its tissue when mesenteric veins are blocked by blood clots.

The chronic variant may be asymptomatic. In this case, portal vein thrombosis is an incidental finding in studies performed for other abdominal pathologies. The absence of manifestations is the merit of compensatory mechanisms. Among them - vasodilation (expansion) of the hepatic artery and the development of cavernoma - a network of venous collaterals (additional veins that take on an increasing load). Only when the ability to compensate is depleted, characteristic symptoms appear:

General weakness, lethargy, lack of appetite.
Syndrome portal hypertension:
- ascites (accumulation of fluid in the abdominal cavity);
- expansion of the saphenous veins of the anterior wall of the abdomen;
- varicose veins veins of the esophagus.
Sluggish form of pylephlebitis (inflammation of the portal vein):
- dull pain in the abdomen of a permanent nature;
- subfebrile body temperature (37–37.5 degrees Celsius) for a long time.
Hepatosplenomegaly ().

most likely and common complication- Esophageal bleeding, the source of which are varicose veins. progresses chronic ischemia(circulatory failure) and subsequent cirrhosis (replacement connective tissue liver cells), if it was not present before, having played a role in the development of the pathological process.

Diagnostics

Imaging techniques are used to confirm the diagnosis:

Ultrasound of the abdominal organs, dopplerography ( ultrasonography portal vein);
computer and magnetic resonance imaging of the abdominal organs;
angiography of the portal vein (X-ray examination with the introduction of a contrast agent);
splenoportography, transhepatic portography (contrast injection into the spleen or liver);
portal scintigraphy (introduction of a radiopharmaceutical and fixation of its accumulation in the portal vein).

Treatment

The therapy strategy includes several components:

Anticoagulants (heparin, pelentan). They prevent the formation of blood clots and promote recanalization (restoration of patency) of the vessel.
Thrombolytics (streptokinase, urokinase). The indication is portal vein thrombosis, the treatment of which, in fact, is to eliminate the thrombus blocking the lumen.
Surgical treatment (transhepatic angioplasty, thrombolysis with intrahepatic portosystemic shunting).
Treatment of complications - bleeding from the veins of the esophagus, intestinal ischemia. It is carried out in an operative way.

Currently under development effective method thrombosis prevention. As such a means, the method is proposed non-selective beta blockers(obzidan, timolol).

Forecast

The prognosis of portal vein thrombosis largely depends on the degree of disorders that have occurred in the body. An acute episode with failure of thrombolysis requires surgical treatment that in itself is a risk. Chronic thrombosis manifests itself in the form of complications when the process has gone far enough in its development, and its treatment begins with emergency care. The prognosis in these cases is doubtful or unfavorable. Probability successful treatment raises timely diagnosis thrombosis on early stages when compensation mechanisms are able to delay the onset of irreversible changes.

The portal vein is a very important vessel responsible for the functioning of the digestive organs. The formation of a thrombus in it disrupts blood flow, causes the development serious pathologies therefore, liver thrombosis is one of the most dangerous diseases which poses a threat to human life. The occlusion of the vessel is accompanied by characteristic symptoms and requires immediate treatment.

Features of the pathology

With the help of the portal (portal) vein, blood flows to the liver from other organs of the abdominal cavity. It is a blood vessel only 5–7 cm long and up to 2 cm in diameter. The portal vein has many branched vessels in the liver and is responsible for blood detoxification, as well as for the work digestive system generally. None of the pathologies of this vessel passes without a trace and causes serious consequences.
Thrombosis is manifested in the presence of blood clots that prevent its movement towards the liver, while increasing pressure in the vessels, expanding their cavity. Blockage of the vessel can form anywhere in the liver along the entire length of the portal vein.
Thrombi are of various types:

Truncular. Formed in the venous trunk.
Root. Initially occurs in the vessels of the stomach or spleen, and eventually spreads to the portal vein.
Terminal. Its development takes place inside the liver.

There are four stages in the development of thrombosis:

First. No more than half of the venous cavity is blocked, symptoms are practically absent.
Second. The first signs of the disease appear, 60% of the lumen is thrombosed, the blood flow is slightly disturbed.
Third. Many veins of the abdominal cavity are affected, the blood flow is significantly slowed down.
Fourth. Separation or destruction of a blood clot.

In the veins, the blood flow velocity is not as strong as in the arteries, so blood clots do not break off in this case as often. However, if this happens, then the clot can break into several parts and provoke simultaneous blockage of several vessels.
If left untreated, the disease can lead to a number of serious complications. Among them: bleeding, liver coma, varicose veins of the esophagus, peritonitis, intestinal infarction.
All of these pathologies can lead to lethal outcome if you don't start immediately surgical operation or drug therapy.

Signs of thrombosis

By the nature of the manifestation, the disease can be acute and chronic. In the first form of thrombosis, the following manifestations are observed:
sharp pain in the abdomen;

fever, chills;
increased body temperature;
nausea;
stool disorder;
enlargement of the spleen;
yellowness of the skin;
swelling of the lower extremities;
expansion of the veins of the esophagus;
bloating;
hematemesis;
low blood pressure.

Chronic pathology has not such obvious symptoms and on early stages can only be detected by examination. This is due to the fact that additional veins take on the entire load. For chronic thrombosis are characteristic the following signs: poor appetite, weakness, lethargy, regular Blunt pain in the abdomen, enlarged spleen and liver, body temperature in the range of 37–37.5 degrees.

Reasons for the development of thrombosis

In almost half of the cases, the causes of the disease remain unknown. The most common prerequisites for the development of thrombosis are the following factors:

surgical operations;
injuries of the walls of the veins;
squeezing of blood vessels by a tumor of the pancreas;
pancreatic necrosis;
endocarditis;
syphilis;
infections (malaria, Ebola, tuberculosis);
ulcerative colitis;
purulent cholangitis;
Buddy-Chiari disease;
critical form of preeclampsia during pregnancy;
heart failure;
helminthiasis of the liver;
cancer of the liver or intestines;
pancreatitis;
cholecystitis.

Most often, blockage of blood vessels is observed with cirrhosis of the liver. Pathology in this case is chronic and develops for several months and even years. Sometimes the cause of thrombosis can be wrong image the patient's life.

Inactivity and regular work in a sitting or standing position, as well as smoking and frequent use alcohol worsens the condition of the liver.
IN rare cases thrombosis of the portal vein of the liver is found in women after 35-40 years in case of use oral contraceptives. Blockage of blood vessels in newborns can be caused by an infection brought through the umbilical cord. IN childhood thrombosis can be caused by appendicitis. This happens due to infection in the body and subsequent inflammation of the vessel.

Diagnosis of the disease

If a person has symptoms of thrombosis in the veins of the liver, you should consult a specialist. For starters, you can visit a therapist. He will find out the specifics of the disease, conduct an examination, and, if necessary, refer you to the right doctor. If the patient knows that he has a chronic platelet, you should visit a gastroenterologist. There is also a hepatologist who can make a diagnosis using the most modern techniques.
The acute form of the disease is easier to determine than the chronic form. The latter is very similar in character to other liver diseases. Diagnosis usually includes the following examinations:

General blood analysis.
Blood test for clotting.
Ultrasound and CT of the liver.
X-ray of the vessels of the liver.
Laparoscopy.
Biopsy.

These studies help to identify an increase in the diameter of blood vessels, determine the degree of tissue density, assess the nature and localization of the pathology that has developed in the body.

Methods of treatment

The patient is usually prescribed drug treatment which includes taking various drugs, among them: antibiotics, anticoagulants, thrombolytic drugs and plasma substitutes.
The doctor determines the dosage of each drug individually, it depends on several factors: the severity of the disease, the degree of liver damage, comorbidities, age of the patient, drug tolerance.
Usually positive result occurs 1-3 days after the start of taking the drugs. If conservative therapy didn't bring desired effect, and the patient's condition worsened, they resort to surgical intervention. With its help, the branches of blood vessels are recreated in order to renew blood flow. This operation is very dangerous for health, it should be performed by an experienced surgeon. rehabilitation period involves taking medications to reduce blood clotting.
The method of thrombectomy is especially popular, which consists in removing blood clots with a catheter, while the vessel itself is preserved. The diseased vein is cut along the edge of the blood clot and an empty catheter is inserted into the hole. Then, with the help of saline, the formed thrombus is pulled out. Despite the existence various techniques treatment, the outcome of hepatic thrombosis may be the most unexpected.

Preventive measures

As a preventive measure, experts recommend monitoring your health, undergoing an ultrasound scan of the liver every year to monitor the condition of the organ, and visiting a doctor every six months. Do not self-medicate or use folk remedies as the main therapy, it can cause serious complications. At the first symptoms of the disease, you should immediately seek help from a doctor.
The development of blockage of the vein can be avoided if you follow simple preventive measures:

You need to eat right.
You need to give up bad habits.
We must not forget to take medicines that thin the blood, if a person has increased clotting.
Worth taking the time active image life and physical activity.

The main rule in the prevention and treatment of thrombosis is a timely visit to the doctor. To maintain your health, you should contact a medical institution at the first alarming symptoms.

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Everyone knows that blood flows from the organs through the veins. But in our body there is an exception. It's about the portal vein. It is formed by 2 mesenteric and one splenic vein. Collects blood from the digestive tract, then enters the liver.

Portal vein thrombosis is dangerous state when a thrombus forms in the lumen of a vessel. Accordingly, the blood flow is disturbed.

Causes

The disease can develop not only in adults. Even babies are at risk. Portal vein thrombosis is a complication of infection of the umbilical cord stump. Acute appendicitis can also lead to serious consequences.

Consider the main causes of portal vein thrombosis. The German scientist Rudolf Virchow found that in order to implement this disease 3 conditions are required.

Violation of the integrity of the vascular wall. Namely, the endothelium. If the surface does not pathological changes, formed clots move with the blood flow. But in case of injury or inflammatory processes the structure of the endothelium changes. The formed clots settle in these places, gradually accumulating. As a result, an obstruction of the vessel occurs.

Surgical interventions.
Phlebitis.
Arteritis.

Increased blood clotting. The disease can be either genetically determined or acquired.

Etiological factors:

Congenital pathologies (protein S deficiency, antithrombin deficiency, protein C deficiency, antiphospholipid syndrome, hyperhomocysteinemia).
Oncological diseases.
Taking oral contraceptives.
Anticancer drugs.

Increased clotting is also observed in pregnant women. postpartum period also at risk for developing hypercoagulability. This is explained by physiologically substantiated processes: the level of procoagulant factors increases and anticoagulant activity decreases.

Decreased blood flow.

Heart failure.
Pre- and postoperative long-term immobilization.
Passive lifestyle.
Long distance flights.

Main manifestations

The severity of the clinical picture, based on which the doctor can diagnose portal vein thrombosis, depends on the course of the disease (acute or chronic), the localization of the thrombus and the length of the pathological focus.

If acute course, compensatory mechanisms fail to work on time. In the case of combined thrombosis of the portal and mesenteric vein outcome can be fatal.
In a chronic course, changes increase gradually. Collateral blood flow takes over the functions of the lost area. The prognosis is more favorable.

signs

portal hypertension.
Enlargement of the spleen.
Bleeding from dilated veins of the esophagus. At the same time, patients complain about severe pain, black chair. Perhaps the development of vomiting "coffee grounds".
Pain in the intestines, flatulence, intoxication phenomena. The reason for this is paralytic ileus intestines as a result of the lack of blood flow through the mesenteric veins.
Liver enlargement, soreness, chills. Occurs due to purulent pylephlebitis.
Jaundice of the face, sclera.
As a result liver failure encephalopathy may develop.

It should be noted that a heart attack develops not only in the heart muscle. Occlusion of the lumen of the mesenteric vein leads to serious complication- intestinal infarction. And he, in turn, causes peritonitis.

Examination of the patient

For the purpose of diagnosis, both laboratory and instrumental methods research. Let's consider them in more detail.

In the first place, of course, is the ultrasound. The doctor checks not only the lumen of the portal vein (after the introduction of a contrast agent), but also the condition of the liver and all organs of the digestive system. There are cases when it is necessary to conduct a comprehensive examination to identify the root cause. Sometimes during the examination it is possible to detect liver diseases (cirrhosis, malignant neoplasm- hepatocellular carcinoma).
When conducting a coagulogram, thrombosis is indicated by the following signs:

Elevated fibrinogen levels.
Increase in PTI (prothrombin index).
Decreased clotting time.

Angiography. Main instrumental research, confirming not only the diagnosis of “portal vein thrombosis”, but also allowing to identify the exact localization of the thrombus, the extent and even the speed of blood flow both in the portal vein and in the hepatic and porto-caval vessels. This is done in the following way. injected into the portal vein contrast agent. On the monitor of the x-ray machine, the uniformity of blood flow is studied.
With the help of CT and MRI, it is possible to identify not only a blood clot, but it is also possible to fix associated pathological signs. Namely: varicose expansion of porto-caval anastomoses, ascites (accumulation of fluid in the abdominal cavity), enlargement of the spleen.

Treatment

First of all, drug therapy is prescribed. The treatment regimen for patients with a diagnosis of portal vein thrombosis includes:

thrombolytic agents. Fibrinolysin is administered intravenously (using droppers).
Anticoagulants indirect action. Neodicoumarin, Sincumar.
Reopoliglyukin to replenish the required volume of circulating fluid.
Antibiotics are prescribed for the development of purulent complications.

An ambulance for thrombosis is Heparin (Fraksiparin). This drug belongs to the group of direct-acting anticoagulants. Apply in the first hour of the development of signs of the disease.

If during conservative treatment there is no positive dynamics, they resort to surgical intervention. The task of the latter is to recreate collaterals to restore blood flow. As a rule, impose splenorenal anastomosis.

Thrombosis of the portal vein can cause the development of intestinal infarction, peritonitis, massive bleeding, renal and hepatic failure. Therefore, when identifying the first signs, you should consult a doctor. This way you can avoid dangerous complications without resorting to surgical intervention.

Thrombosis of the hepatic veins (Budd-Chiari syndrome) - acute disorder blood circulation in blood vessels liver. The overlap of the lumen can be complete or partial, this causes clinical manifestations pathological condition. It is more common in the elderly, but can also be diagnosed in young people.

Why does

The main cause of the development of pathology is a thrombus in the liver, as a result of which the free flow of blood is disturbed. Various factors can provoke the formation of a clot:

violation of hemostasis in diseases of the cardiovascular system (increased blood clotting and a tendency to thrombosis);
hemolytic anemia, accompanied by accelerated destruction of red blood cells in the liver;
deep vein thrombophlebitis, pericarditis, peritonitis;
blunt abdominal trauma (damage to the abdominal organs);
systemic autoimmune and infectious diseases(lupus erythematosus, tuberculosis, syphilis, etc.);
neoplasms in the pancreas, liver, kidneys, adrenal glands;
long-term use medications (hormonal contraceptives, glucocorticosteroids, etc.);
genetic predisposition.

In children, the onset of the disease can be triggered by congenital narrowing of the veins, infection of blood vessels through the umbilical cord, and a postoperative complication.

Symptoms

Hepatic vein thrombosis may be acute or chronic course. Symptoms depend on the degree of blockage in the lumen of the blood vessel.

Signs of an acute condition:

sharp pain in the abdomen;
nausea;
vomit;
stool disorder (diarrhea);
fever, chills, weakness, sweating;
an increase in the size of the liver and spleen.

With incomplete occlusion develops chronic insufficiency circulation in the liver. At the initial stage of the disease clinical symptoms missing. This is due to the activation of the compensatory collateral circulation, thanks to which oxygen and nutrients enter the tissues in a circular way.

Gradually, weakness and lethargy increase, appetite worsens, signs of portal hypertension appear (increased pressure in the portal vein system). The main manifestations are the development of ascites, an increase in the size of the veins of the anterior abdominal wall, varicose veins of the esophagus, etc. This threatens to rupture blood vessels and develop bleeding.

Chronic inflammation of the portal vein (pylephlebitis), in which there is a narrowing of the vessel along its entire length, is accompanied by constant aching pains in the abdomen, prolonged subfebrile condition. The spleen and liver gradually increase in size, which extends beyond the edge of the costal arch. Increasing tissue ischemia, which provokes a violation of the functioning of hepatocytes. As a complication, hepatitis and cirrhosis of the liver develop.

Diagnostics

Diagnosis of liver thrombosis is extremely difficult. This is due to the absence of specific signs of the disease. The symptoms present may indicate many other pathologies.

Main research methods:

Doppler ultrasound. It makes it possible to detect clots in the blood vessels of the liver, to establish the degree of blood flow disturbance, the nature of blood clots (soldered to the walls or free).
Angiography. Intravenous administration of a special radiopaque agent. After that, a series of pictures is taken, on which it is possible to detect areas where the blockage of the vein has occurred. If similar problem occurs not for the first time, along with a radiopaque agent, drugs are simultaneously administered to dissolve blood clots.

From others additional ways use magnetic resonance imaging, the use of radionuclides, general clinical and biochemical analyzes blood.

Treatment

Thrombosis of the hepatic vessels requires complex treatment. On initial stages pathology, the use of medications is sufficient; in severe cases, surgical intervention is indicated to eliminate occlusion.

Medications

In the treatment of thrombosis, drugs are used to restore normal rheological properties blood, activation of blood flow and elimination of the causes that provoked the development of the disease.

For this use:

Anticoagulants (Clexane, Fragmin, etc.). They inhibit the formation of fibrin filaments, from which clots are subsequently formed. Prevent an increase in the size of existing blood clots, activate natural processes aimed at breaking them down.
Diuretics. They help to remove edema, which are the result of thrombosis. For this purpose, Spironolactone, Furosemide, Veroshpiron, Lasix, etc. are used.
Thrombolytics (Urokinase, Alteplase, Actilyse, etc.). Promote the dissolution of clots, thus restoring free blood flow. The use of thrombolytics is indicated in the initial stages of the development of the disease.

In addition, with increased blood pressure use antihypertensive drugs, with varicose veins and circulatory disorders - venotonics.

Surgery

With the development of acute occlusion, as well as if the Budd-Chiari syndrome is caused by a tumor in the liver, kidneys or pancreas, removal of the formation is indicated. In some cases, a liver transplant may be needed.

With a decrease in the lumen of the inferior vena cava associated with chronic inflammation or education atherosclerotic plaques recommended angioplasty. A stent is then placed to keep the vein wide enough to prevent it from collapsing.

Shunting will help reduce the pressure in the sinusoidal spaces. This method is indicated for the formation of blood clots in the inferior vena cava.