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Liver & GIT

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.


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.