Budd-Chiari for Quiz 5

Question 1

What is a syndrome?

Answer 1

The consequences of a disease / a group of symptoms that consistently occur together or a condition characterized by a set of associated symptoms

Question 2

What does Budd-Chiari (BCS) consist of?

Answer 2

A group of disorders w/obstruction of hepatic venous outflow leading to increased hepatic sinusoidal pressure and hypertension

Question 3

What can cause secondary BCS?

Answer 3

IVC thrombus extending into the hepatic veins

Question 4

Is BCS prevalent in Western populations?

Answer 4

No it’s rare

Question 5

What is the most common cause of BCS?

Answer 5

Thrombosis (in hepatic veins)

Question 6

What is the clinical presentation of BCS?

Answer 6

Clinical triad: ascites, hepatomegaly and abdominal pain (non-specific conditions, could be anything)

Question 7

Most cases of BCS are cause by thrombosis, but where does 25% of the cases arise from?

Answer 7

External compression that results in obstruction

Question 8

What are one-third of the cases of BCS?

Answer 8

Idiopathic

Question 9

Can BCS be congenital?

Answer 9

Yes

Question 10

What hepatic vein or IVC issue can occur with BCS?

Answer 10

Webbing

Question 11

What can happen to the diaphragm with BCS?

Answer 11

Interruption

Question 12

What is venous thrombosis secondary to?

Answer 12

Dehydration

Question 13

What OB-related issues can happen with BCS?

Answer 13

Pregnancy and post-partem state, oral contraceptive pill use

Question 14

What infection and disease can cause BCS?

Answer 14

Septicemia and sickle cell disease

Question 15

Can thrombocytosis be involved with BCS?

Answer 15

Yes

Question 16

What can occur with BCS secondary to phlebitis?

Answer 16

Injury and/or inflammation, bone marrow transplant and chemoradiotherapy autoimmune disease

Question 17

Which tumor invasions can occur with BCS?

Answer 17

Renal cell carcinoma, HCC, adrenal carcinoma, leiomyosarcoma of IVC

Question 18

Which two ways can presentation be?

Answer 18

Acute or chronic

Question 19

What does acute presentation with BCS result from?

Answer 19

Acute thrombosis of the main hepatic veins or IVC

Question 20

How do patients present with acute BCS?

Answer 20

May present with rapid onset ascites

Question 21

What does chronic presentation with BCS result from?

Answer 21

It is related to fibrosis of the intrahepatic veins, presumably related to inflammation

Question 22

In acute BCS, what are ultrasound findings related to the liver?

Answer 22

Hepatomegaly

Question 23

In acute BCS, what are ultrasound findings related to the spleen?

Answer 23

Splenomegaly

Question 24

In acute BCS, what are ultrasound findings related to the echotexture?

Answer 24

Heterogeneous

Question 25

In chronic BCS, what are ultrasound findings for caudate lobe?

Answer 25

Hypertrophied

Question 26

In chronic BCS, what are ultrasound findings of affected regions?

Answer 26

Peripheral atrophy

Question 27

In chronic BCS, what are ultrasound findings of nodules?

Answer 27

Regenerative

Question 28

In chronic BCS, what are ultrasound findings of gallbladder?

Answer 28

Wall thickening

Question 29

In chronic BCS, what are ultrasound findings that may occur around the liver?

Answer 29

Ascites

Question 30

With BCS and color doppler, how is flow in the right hepatic vein or a part of it?

Answer 30

No flow or inappropriately directed flow

Question 31

With BCS and color doppler, how is flow between the main hepatic vein and the IVC?

Answer 31

Discontinuity

Question 32

With BCS and color doppler, how is flow in hepatic veins and intra/extrahepatic collaterals?

Answer 32

Reversed flow

Question 33

With BCS and color doppler, how does portal vein change?

Answer 33

Hepatorfugal flow

Question 34

With BCS and color doppler, how is flow in the IVC?

Answer 34

Low/absent flow or balanced bidirectional flow

Question 35

With BCS and color doppler, what can be within the IVC?

Answer 35

Bland thrombus or tumour thrombus

Question 36

With BCS and color doppler, what happens to the resistive index within the hepatic artery?

Answer 36

Increased > 0.75