Budd-Chiari syndrome

A 54-year-old woman is brought to the emergency department by her partner due to altered mental status for the last 2 days. According to her husband, the patient has become increasingly lethargic, disoriented, and agitated. The patient has a history of chronic hepatitis C infection that was diagnosed 14 years ago. She refused all treatment at that time. Temperature is 37.0°C (98.6°F), pulse is 98/min, and blood pressure is 104/74 mmHg. On examination, the patient is lethargic and oriented only to self. When her hands are outstretched in front of her and extended at the wrist, they exhibit a flapping tremor. The abdomen is nontender and mildly distended; shifting dullness to percussion is present. There is no nuchal rigidity. Stool occult blood is positive. Laboratory testing reveals the following findings:

The patient is started on emergent therapy for her symptoms. Which of the following best explains the pathophysiology of this patient’s current condition?

Key Takeaways

Budd-Chiari syndrome is a condition in which the veins that carry blood from the liver are blocked, causing liver congestions. It typically presents with a classic triad of symptoms, that include abdominal pain, ascites, and liver enlargement. There are two types of Budd-Chiari syndrome: primary and secondary. Primary Budd-Chiari syndrome is due to the obstruction to the hepatic veins caused by a venous process like thrombosis or phlebitis. In secondary Budd-Chiari syndrome the obstruction comes from the compression or the invasion of the hepatic vein by a non-venous process, usually by a tumor nearby.

Budd-Chiari syndrome

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