GASTROENTEROLOGY ARTICLE OF THE WEEK
June 5, 2003
Janssen HL, Garcia-Pagan JC, Elias E, et al. Budd-Chiari syndrome: a review by an expert panel. J Hepatol 2003;38:364-371.
1. Ultrasound findings suggestive of Budd-Chiari syndrome include
a. hepatic veins devoid of flow signal
b. spider-web appearance usually near the hepatic vein ostia
c. intrahepatic or subcapsular hepatic venous collaterals
d. lack of flow in the portal vein
True or False
2. MRI is the study of choice when ultrasound is equivocal for the diagnosis of Budd-Chiari syndrome.
3. Primary Budd-Chiari syndrome is associated with an underlying thrombogenic condition in at least 75% of individuals.
4. Budd-Chiari syndrome is defined as hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the IVC and right atrium.
5. Budd-Chiari syndrome usually presents with ascites and a small non-tender liver.
6. A liver biopsy is required in order to assess disease severity and prognosis.
7. Anticoagulation is contraindicated due to increased risk of bleeding from varices.
8. Surgical portosystemic shunt may not be possible if there is significant IVC compression by a hypertrophied caudate lobe.
9. TIPS in Budd-Chiari may be possible by either cannulating the remaining hepatic vein, cannulating the hepatic vein stump or directly puncturing the liver from the intrahepatic portion of the IVC.
10. Portosystemic shunting improves the survival in patients with Budd-Chiari syndrome.
11. Anticoagulation appears to improve the prognosis in Budd-Chiari syndrome