vascular disorders of the liver Flashcards
what can the vascular diseases of the liver be divided into ?
disorders of hepatic inflow
disorders of hepatic venous outflow
what is Budd-Chiari syndrome ?
is a syndrome that results from the obstruction of one or more major hepatic veins
what is Budd-Chiari clinically characterized by ?
hepatomegaly
ascites
abdominal pain
what are the clinical features of the acute form of Budd Chiari ?
abdominal pain nausea, vomiting tender hepatomegaly ascites a fulimant form occurs particularly in pregnant women
what are the clinical features of the chronic form of Budd Chiari ?
there is enlargement of the liver mild jaundice ascites a negative hepatojugular reflux splenomegaly with portal hypertension
what investigations would be required ?
ultrasound
CT or MRI demonstrating hepatic vein occlusion
pulsed doppler sonography
thrombophilia screening is mandatory
what would be the findings in the ascitic fluid ?
high protein content
what is the management of Budd-Chiari?
anticoagulants and thrombolytic therapy ascites to be treated with diuretics treatment of underlying cause TIPS (Transjugular intrahepatic portosystemic shunt) angioplasty
when do we use surgical portocaval shunts ?
reserved for those who fail this treatment provided that there is no caval obstruction
what is the first line management for chronic Budd-Chiari syndrome and for the fulimant form ?
liver transplantation
what life long treatment must be followed after TIPS and transplantation ?
life-long anticoagulant
what are the local factors affecting portal vein thrombosis ?
malignant tumors
cirrhosis
what are the general factors of portal vein thrombosis ?
inherited or acquired hypercoaguable state
how does sinusoidal obstruction syndrome happen?
toxic injury to the sinusoidal endothelium
which patients are more prone to getting SOS ?
bone marrow transplantation patients in the first 20 to 30 days after the procedure
