Budd Chiari syndrome Flashcards
causes of Budd Chiari syndrome
myeloproliferative dx (polycythemia vera) malignancy (HCC is most common) OCP Pregnancy or post partum state space occupying liver lesions hypercoagulable states idiopathic
Acute presentation of Budd Chiari syndrome
most common in women
sever right upper quadrant pain, hepatomegaly
rapid development of jaundice or ascites
variceal bleeding encephalopathy ca be seen
Subacute or chronic Budd Chiari syndrome presentation?
asymptomatic for weeks to months
abdominal pain, hepatomegaly, ascites
lower extremity edema, cirrhosis
jaundice and encephalopathy less common
Diagnosis of Budd Chiari syndrome
doppler liver U/S and CT scan or MR angiography showing decreased hepatic vein flow
Elevated SAAG>1.1 g/dl
venography (gold standard) showing venous occlusion or spider web pattern of collaterals
biopsy for inconclusive non invasive investigation
what is budd chiari syndrome
thrombosis of hepatic/intrahepatic veins or suprahepatic inferior vena cava and occurs in women ages 30-40’s
lab findings of acute Budd Chiari?
serum LFTs are elevated but not as high acute viral hepatitis
what happens if Budd Chiari is not treated?
can get encephalopathy or fulminant liver failure
how does Budd Chiari cause ascites?
subacute or chronic Budd Chiari may be asymptomatic for weeks to months due to partial hepatic vein occlusion. Chronic hepatic vein occlusion may lead to hypertrophy of the caudate lobe of the liver, which can compress infrahepatic inferior vena cava to cause ascites and lower extremity edema.
Can develop cirrhosis, portal HTN but rarely see jaundice and encephalopathy
Treatment of Budd Chiari is
diuretics, anticoagulation, angioplasty and stenting for select pts and possible thrombolytics for pts with for acute or subacute dx only.
Who gets TIPS and portosystemic shunts or surgical shunts or liver transplant with Budd Chiari?
those who don’t respond to medical management.
