Question

42 year old woman comes to office due to worsening abdominal pain and dissension. It began 4wks ago and has become progressively distended. She also notes generalized pruritus worsened by water contact. BP is high. PE shows facial plethora and mild scleral icterus. Neck veins are flat. Abdomen is distended with flank dullness to percussion and hepatoslenomegally. No skin rashes or edema. Labs show increased Hb, total bill, Alk phos, AST and ALT . Best next step>

- Abdominal Doppler US for Budd Chiari Syndrome
aquagenic pruritus, facial plethora, and dramatic polycythemia vera (may also have erythomelalgia, vision loss, thrombosis) PV increases the risk of Budd Chiari

Answer 1

The best next step in the management of this patient is an abdominal Doppler ultrasound to assess for Budd-Chiari Syndrome, given the clinical presentation and elevated liver function tests.

Step-by-step explanation:

The patient's symptoms, including abdominal pain, distension, pruritus, facial plethora, and elevated blood pressure, along with physical exam findings such as hepatosplenomegaly and elevated liver function tests, are concerning for Budd-Chiari Syndrome (BCS). BCS is a condition characterized by the obstruction of hepatic venous outflow, leading to liver congestion and dysfunction. In this case, the patient's clinical presentation and laboratory abnormalities, including polycythemia vera, raise suspicion for BCS.

Abdominal Doppler ultrasound is a non-invasive imaging modality that can help evaluate the patency of hepatic vessels and identify any obstructive lesions, aiding in the diagnosis of BCS. Given the potential complications and the need for prompt intervention in BCS, timely diagnosis is crucial for appropriate management.

Budd-Chiari Syndrome is a rare but serious condition that requires prompt diagnosis and intervention. Understanding the diagnostic approach, including the use of imaging modalities such as abdominal Doppler ultrasound, is essential for clinicians managing patients with suspected BCS.