BUDD CHIARY SYN

Budd chiary synd. is characterised by obstructiön in d large hepatic veins. It comprises:
Abdo. Pain
Ascites
Hepatomegaly
Hepatic histology showing centrizonal sinusodal distension n pooling.

Causes
1. Hep. Vein obstruction
a)venous thrombosis
-polycythemia vera
-antiphospholipid synd.
-pregnancy n postpartum period
-oral contraceptives
-sickle cell disease
b)compression
-liver abscess
-hydatid cyst
c)radiation injury
d)webs
2.inf. vena cava obst.
a)congenital webs n diaphragms
b)renal cell ca,hepatoma
c)Behcets synd.
d)idiopathic



C/f
1. Acute form
-follows sudden venous occlusion
-abdominal pain.vomiting.tender hepatomegaly.ascites.mild jaundice.
-delirium,coma,liver failure.
2.chronic form
-icterus is mild or absent
-pain abdo,hepatomegaly,ascites
-negative hepatojugular refluy.
-portal hypertension n splenomegaly
-enlarge caudate lobe of liver

Investigations
-LFT shows mild hyperbilirubinemia,raise alkaline phosphatase,low serum albumin n raisd transaminase.
-ascitic fluid exam shows protein>2.5g/dl.
-ultrasound
-doppler ultrasonography
-liver biopsy
-isotope imaging
-CT or MRI hepatic venography.

Management
-predisposing causes should be removed or treated
-transjugular intrahepatic portosystemic shunt may be useful in opening of hepatic veins.
-recent thrombosis is treated wid streptokinase followed by heparin n warfarin
-cong. web can b surgically resected.
-ascites treated wid low salt diet.diuretics.
-liver transplant.