Evaluating Liver Test Abnormalities
Understanding the Pathophysiology of Liver Disease
for Health Care Providers
Acute Budd-Chiari Syndrome
Back to Marked Aminotransferase Elevation
Introduction
Hepatic venous outflow obstruction leads to hepatic congestion, resulting in hepatocellular injury.
History
Budd-Chiari syndrome (BCS) is more prevalent in women. There is an association between hepatic venous thrombosis and an underlying hypercoagulable state. BCS may present acutely with right upper quadrant pain, jaundice, ascites, and in some cases, fulminant hepatic failure.
Physical examination
Possible physical findings include:
- Right upper quadrant tenderness
- Hepatomegaly
- Ascites
- Edema
Patients with evidence of encephalopathy (confusion/asterixis) should be urgently referred to a liver specialist or a transplant center.
Laboratory investigation
In addition to the relevant investigations based on the clinical presentation, the following liver tests should be ordered:
- Doppler ultrasound
- Evaluation for hypercoagulable state