Budd-chiari

[DrPak]

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Wouldn't Budd-chiari syndrome cause an increase in LFTs? I got a question on Qbank where a patient has polycythemia vera and gradually developed hepatomegaly and ascites. The answer was Budd-chiari, but what threw me off was the question said the LFTs were "near normal". Also, isn't doesn't posthepatic obstruction present more fulminantly than a "gradual" hepatomegaly and ascites?

 

[Hernandez]

Wouldn't Budd-chiari syndrome cause an increase in LFTs? I got a question on Qbank where a patient has polycythemia vera and gradually developed hepatomegaly and ascites. The answer was Budd-chiari, but what threw me off was the question said the LFTs were "near normal". Also, isn't doesn't posthepatic obstruction present more fulminantly than a "gradual" hepatomegaly and ascites?

LFTs do not always correlate with the amount of liver inflammation or obstruction, probably the best example of this would be Nutmeg liver from RHF, the LFTs are elevated, but mildly. and the most common presentation of Budd-chiari is actually an insidious onset, and not fulminant.

 

[Idiopathic]

Wouldn't Budd-chiari syndrome cause an increase in LFTs? I got a question on Qbank where a patient has polycythemia vera and gradually developed hepatomegaly and ascites. The answer was Budd-chiari, but what threw me off was the question said the LFTs were "near normal". Also, isn't doesn't posthepatic obstruction present more fulminantly than a "gradual" hepatomegaly and ascites?

All you needed to know was that, for boards, hypercoagulopathic states combined with clinical signs of liver disease equals the very rare Budd-Chiari unless you have radiographic evidence to say otherwise. LFT's can be +/-