It is hepatic vein thrombosis, leading to backpressure, liver congestion, portal HTN & ascites.
Etiology:
- Hypercoagulation disorders ( Protein C def., Protein S def., antithrombin 3 def. (acquired nephrotic syndrome) , antiphospholipid antibody syndrome)
- Pregnancy, estrogen contraceptives -Z
S/S:
- Painful hepatomegaly
- Portal HTN
- Ascites
- Jaundice
Treatment of Budd Chiari
- Anticoagulation with heparin, followed by warfarin
- Angioplasty
- Stent
- Symptomatic treatment for ascites
- TIPS ( sometimes)
If the risk of thrombosis is going to continue, anticoagulation is given for ever
How to Approach the patient
- Take a detailed history keeping in view the causes of ascites
- Do appropriate examination
- Order investigations
- Give treatment to remove the ascitic fluid
- Treat the cause