Budd-Chiari syndrome
30 year married old woman complained of 4 days of epigastric abdominal pain. She reported having been healthy all her life. She admitted to having gained, approximately 9 kg over the preceding 6 months, which was unusual. Upon examination bye her physician, she is found to have a distended abdomen that is tender in the area between her ribs at the top of her abdomen. An exploratory laparotomy reveals an enlarged liver and no other disease. A liver biopsy is taken and reportedly shows no significant abnormalities. For unstated reasons, the patient is later taken for a venogram and is found to have thrombosis of her hepatic veins, Budd-Chiari syndrome. She is subsequently referred to a tertiary hospital. Initially, the patient is treated with diuretic medication (spironolactone and furosemide) and intermittent paracentesis. She subsequently undergoes TIPS, and also given warfarin.
What is the probable explanation for her abdominal pain, distension,and weight gain over 6 months and what is the rationale for giving an anticoagulants and how dose warfarin work?
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Filed Under: Discussion
Abdominal pain and distention may be due to stretching of the liver capsule due to enlargement of the liver, cuz might be due to engorgement of the vessels n portal HTN.
and weight gain due to chronic water retention leading to the progressive ascites. If the suspicion is due to coagulation disorder then it is wise to put the patient on anticoagulation like warfarin. warfarin inhibit vit K dependant coagulation pathway like II,VII, IX, X, protein C and S.