American Board of Pathology (ABPath) 2025 – 400 Free Practice Questions to Pass the Exam

Enlarged hepatic veins are often associated with increased pressure in the venous system, particularly due to conditions affecting the right side of the heart. Right heart failure leads to a backup of blood flow in the venous circulation, which can manifest as congestion in the hepatic veins. This congestion causes the veins to enlarge due to the increased volume and pressure of blood, resulting in a condition known as hepatic venous hypertension.

In contrast, conditions such as annular pancreas, acalculous cholelithiasis, and splenomegaly do not directly impact the venous return or the pressure dynamics in the liver's venous system. While they may be associated with other gastrointestinal or systemic changes, they do not specifically lead to the enlargement of the hepatic veins in the same manner as right heart failure does. Therefore, the condition that most clearly correlates with the enlargement of the hepatic veins is right heart failure, due to its direct influence on venous pressure and blood flow dynamics.