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Medicine

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Liver & GIT

Question
5 out of 5
 

In Budd Chiari syndrome, the site of venous thrombosis is : (AIIMS Nov 10)



A Intrahepatic inferior vena cava

B Infrarenal inferior vena cava

C Hepatic veins

D Portal veins

Ans. C Hepatic veins

Budd chiari syndrome

Budd chiari syndrome results from the obstruction to hepatic venous outflow. The obstruction can be at 3 sites:

1. Hepatic vein obstruction –(Commonest site)

The causes are:

i. Pregnancy, post partum state

ii. Oral contraceptives

iii. Malignancy – Hepatocellular carcinoma, renal cell carcinoma, colonic carcinoma.Q

iv. Hematological – PNH, polycythemia, sickle cell anemia. Q

v. Sarcoidosis

vi. Vasculitis

vii. Underlying liver disease – cirrhosis, hepatitis

2. Inferior vena cava obstruction – congenital. There is increased association of IVC obstruction with hepatocellular carcinoma.

3. Obstruction of small branches of hepatic veins – veno occlusive disease.

Due to fibrous obliteration of hepatic venules and small hepatic veins.

The causes are:

i. Pyrrolizidine alkaloids in bush tea (Bush Tea disease) Q

ii. Azathioprine Q

iii. III) Graft versus host reaction

iv. Radiation

v. Inflammatory bowel disease

Pathology :

Nutmeg liver Q

Congestive hepatomegaly in early stage and cardiac cirrhosis in late stages.

Clinical features – The onset can be acute, subacute or chronic. The presentations can be:

1. Gross ascites with abdominal pain Q

2. Acute abdominal pain with shock and fulminant hepatic failure.

3. Hematemesis Q

Laboratory features:

U/S with Doppler flow is 1st test is to be done in BC syndrome

a. Hepatic venogram – confirms the diagnosis. b. Inferior venacavography.

Treatment:

a. Surgical correction is the only definitive treatment.

b. Shunt surgery is useful if done early before irreversible hepatic damage and before thrombus extends to involve IVC.