Incidence
Age
Sex
Geography
Aetiology	- occlusion of the hepatic vein -> obstruction to venous outflow of liver - no cause is identified in1/3 of cases - hypercoagulability states e.g. polycythaemia vera, OCP, leukaemia - occlusion of hepatic vein due to posterior abdominal wall sarcoma - renal/adrenal tumours - HCC - hepatic infections, e.g. hydatid cyst - congenital venous webs - radiotherapy - trauma to liver - caudate lobe has separate blood supply and venous drainage
Presentation	Acute - abdominal pain - nausea and vomiting - tender hepatomegaly - ascites Crohnic - enlargement of liver - mild jaundice - ascites - negative hepatojugular reflex - splenomegaly (2º to portal hypertension)
Investigations	Ascitic tap - high protein content in fluid Liver biopsy - histology USS/CT/MRI - hepatic vein occlusion - diffuse abnormal parenchyma; spares caudate lobe - ± compression of IVC Pulsed doppler sonography / doppler ultrasound can show direction of flow in the hepatic vein Investigate cause - e.g. FBC, U&Es, LFTs, clotting Differential diagnosis - IVC obstruction - right heart failure - constrictive pericarditis
Macro
Micro	- centrilobular congestion - hepatocyte atrophy
Staging
Serum markers
Management	- treat underlying cause - treat ascites - side-to side portocaval or splenorenal anastomosis can be use to decompress congested liver - peroitonesl-jugular LeVeen shunt may be useful - liver transplantation is the treatment of choice
Prognosis	- depends on aeitology - some patients can survive for several years
Complications

Hepatobiliary medicine

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