Budd-Chiari syndrome

Question 1

Pathophysiology?

Answer 1

It is a hepatic vein thrombosis, usually seen in the context of underlying haematological disease or another procoagulant condition.

Question 2

Causes?

Answer 2

• polycythaemia rubra vera
• thrombophilia: activated protein C resistance, - antithrombin III deficiency, protein C & S deficiencies
• pregnancy
• combined oral contraceptive pill: accounts for around 20% of cases

Question 3

Triad of symptoms?

Answer 3

• abdominal pain: sudden onset, severe
• ascites → abdominal distension
• tender hepatomegaly

Question 4

Investigation?

Answer 4

Ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation