vascular disorders of the liver Flashcards
what are the vascular diseases of the liver divided into ?
disorders of portal venous inflow
disorders of hepatic venous outflow
what is budd chiari ?
obstruction of one or more major hepatic veins and is characterized by hepatomegaly, ascites and abdominal pain
this includes the IVC and smaller hepatic venules
which myeloproliferative disorder is associated with budd chiari ?
polycythemia vera
what are the clinical features of the acute form of budd chiari ?
abdominal pain
nausea and vomiting
tender hepatomegaly
ascites
what are the clinical features of the chronic form of budd chiari ?
enlargement of the liver
mild jaundice
sudden onset ascites
negative hepatojugular reflux
splenomegaly with portal hypertension
what is the most common cause of budd chiari ?
hepatic venous thrombosis
what are the risk factors of budd chiari ?
any hypercoagulable state and thrombosis
why is there caudate lobe hypertrophy ?
because the caudate lobe drains directly into the inferior vena cava and is not affected by hepatic venous thrombosis
when is liver transplantation indicated in budd-chiari syndrome ?
in chronic budd chiari and in the fulimant form
what investigatiion is mmandatorry in budd-chiari ?
thrombophilia screening
what are the features of the ascitic fluid associated with budd-chiari?
high total protein content
elevated albumin levels
what is the management for acute BCS ?
anticoagulants and thrombolytic therapy can be given
ascites should be treated with diuretics
treat underlying cause
TIPS
Angioplasty
what must be screened for in chronic BCS ?
hepatocellular carcinoma
what is the lifelong management after TIPS and transplantation ?
life long anti coagulants
what are the risk factor for portal venous thrombosis ?
local factors and general factors
local factors : malignant tumors within the venous territory , cirrhosis
general factors : inherited or acquired hypercoaguable states
