ENDEMICITY AND CLINICAL PICTURE OF LIVER-DISEASE DUE TO OBSTRUCTION OF THE HEPATIC PORTION OF THE INFERIOR VENA-CAVA IN NEPAL

Obstructive lesion of the hepatic portion of the inferior vena cava is common in Nepal. The clinical data on 150 patients who were seen at t he Liver Unit, Bir Hospital, Kathmandu, in three years from 1990 to 19 92 were analysed. Although the majority of patients were over 20 years of age, 25 patients were below 10 years of age; there were more males than females in this study. This disease accounted for 17% of 866 pat ients with chronic liver disease and for nearly one quarter of 267 bio psies performed on this patient group during the same period. Obstruct ive lesions of the inferior vena cava seem to be more common among poo r people with malnutrition. Clinically, our patient group could be div ided into acute (n=27), subacute (n=43) and chronic (n=80) cases. The important clinical features are hepatomegaly and/or ascites and, in ch ronic cases, prominent dilated superficial veins over the body trunk w ith cephalad flow. Ultrasound is the most helpful diagnostic procedure , especially in subacute and chronic cases, as it frequently demonstra tes caval obstruction, thrombosis, dilated hepatic veins and intrahepa tic collaterals. Diagnosis is confirmed by cavography, which shows a c aval obstruction of varying lengths at the cavo-atrial junction or a m arked narrowing of the hepatic portion of the vena cava. In subacute a nd chronic cases cavography also demonstrates collateral veins, such a s the ascending lumbar, hemiazygos and azygos that drain into the supe rior vena cava. Chronic cases had periods of exacerbation often associ ated with bacterial infection. The aetiology of inferior vena cava obs truction at its hepatic portion is not known, but there seems to be a frequent association of bacterial infection with the disease.