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Veno-occlusive liver disease: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Venousocclusion disease of the liver (sinusoidal occlusive syndrome) is caused by obstruction of terminal hepatic venules and sinusoids of the liver, rather than hepatic veins or inferior vena cava.
Causes of Venous Acute Liver Disease
Venous congestion causes ischemic necrosis, which can lead to cirrhosis of the liver and portal hypertension. The main causes include radiation, graft versus host disease after bone marrow transplantation (or hematopoietic cells), pyrrolizidine alkaloids of Crotalaria and Senecio plants (eg, medicinal teas) and other hepatotoxins (eg, nitrosodimethylamine, aflatoxin, azathioprine, some antineoplastic agents).
Symptoms of Venous Acute Liver Disease
Initial symptoms of veno-occlusive disease include sudden jaundice, ascites and hepatomegaly - the liver is enlarged, painful on palpation, smooth. In bone marrow recipients, the disease develops within the first 2 weeks after transplantation. In some cases, recovery occurs spontaneously within a few weeks (patients with mild cases may respond to the intensification of immunosuppression), in others - patients die from fulminant liver failure. The remaining patients develop recurrent ascites, portal hypertension and, ultimately, cirrhosis of the liver.
Where does it hurt?
Diagnosis of veno-occlusive disease of the liver
Diagnosis can be expected in the development of typical signs, especially in recipients after bone marrow transplantation. Functional liver tests, ultrasound and MI / INR are needed. Classical disorders include increased levels of aminotransferases, bound bilirubin and PV / INR in the case of severe disease. Ultrasound demonstrates retrograde blood flow in the portal vein. In patients with typical clinical and laboratory signs, as well as ultrasound, especially after bone marrow transplantation, there is no need for further studies. However, if the diagnosis is unclear, a liver biopsy or a pressure difference in the hepatic veins and portal vein is necessary. The difference in pressure is more than 10 mm Hg. Art. Confirms veno-occlusive disease.
What do need to examine?
How to examine?
Treatment of veno-occlusive disease of the liver
Treatment of veno-occlusive disease of the liver includes the elimination of the etiologic factor, symptomatic supportive therapy and transureular intrahepatic stenting in the case of portal hypertension. The last treatment is liver transplantation. The use of ursodeoxycholic acid can be useful in the prevention of graft-versus-host disease after bone marrow transplantation.