Reprezinta un tromb in venele Hepatice

Obstructie vasculara posthepatica

-> Boala venoOclusiva
-> Tromboza venoasa hepatica = Budd-Chiari

Cauze de Budd-Chiari:
Primara = Tromboza (Interna)
Secundara = Compresie (tumora) (Externa)

Triada Vircow's = Staza + Leziuni Endoteliale + HiperCoagulare

Cauze Primare:
-> Policitemia Vera (prima cauza)
-> OCP = oral contraceptive pills = hipercoagulare
-> Sarcina = hipercoagulare
-> PNH = Paroxistic Nocturnal HemoGlobinurie = are risc de tromboza (?)
-> Lupus anticoagulat = procoagulare
-> Neoplasm hepatic

Cauze secundare:
-> Neoplasm extern sau hepatic

Mecanisme:
Blocaj -> Dilatare V. centrolobulara -> Necroza + Steatoza + Normal
(morfopat, ficat pestrit)
Blocaj -> HT portala -> Splenomegalie / ascita / +anastomoze portocave ->
esofag, ombilic, canal anal (hemoroizi)
Blocaj -> Sdr hepatoRenal

Semne clinice:
-> Dureri abdominale
-> Ascita
-> Hepatomegalie cu durere (capsula are terminatii nervoase si megalia duce
la durere)

Diagnostic:
-> Clinic = triada
-> Enzime hepatice
-> Analize sange coagulare
-> Creatinina, uree, electroliti, LDH (pentru ficat/renal)
-> UltraSunet + Doppler puls -> Vene hepatice obliterate + Stenoza/Tromboza +
Retele de vase
-> Angiografie/Venografie

-> Biopsie in suspectare de hepatocarcinom

Tratament:
-> Anticoagulante
-> Dieta fara sare + diuretice
-> Chirurgical = Bypass? Shunt? = TIPS sau DIPS (manevre chirurgicale)

TIPS = Transjugular - IVC - Portal - Stent

DIPS = Direct - IVC - Portal - Stent (V. femurala)

-> Trombolitice direct in vene

-> Transplant de ficat

75% mortalitate in primul an fara tratament