eMedicine Specialties > Gastroenterology > Liver

Budd-Chiari Syndrome: Follow-up

Author: Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Coauthor(s): Abhishek Choudhary, MD, Resident, Department of Internal Medicine, University Hospital of Missouri; Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health; Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine; Gautam Dehadrai, MD, Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital
Contributor Information and Disclosures

Updated: Sep 9, 2008

Follow-up

Further Inpatient Care

  • Gastroscopy should be performed to help rule out the presence of esophageal and gastric varices. If present, they may be obliterated with banding or sclerotherapy. Nonselective beta-blockers (eg, propranolol, nadolol) can be administered for primary prophylaxis against variceal bleeding.
  • Electrolyte levels should be monitored closely because diuretics and other factors can cause electrolyte imbalances.
  • Prothrombin time and activated partial thromboplastin time should be monitored once anticoagulation is started. They should be maintained within the therapeutic range.

Further Outpatient Care

Transfer

  • Once a patient is determined to be a transplant candidate, transfer to a liver transplant unit.

Complications

  • Complications secondary to hepatic decompensation
  • Hepatic encephalopathy
  • Variceal hemorrhage
  • Hepatorenal syndrome
  • Portal hypertension
  • Complications secondary to hypercoagulable state

Prognosis

  • The natural history is not well known. The following factors have been associated with a good prognosis:
    • Younger age at diagnosis
    • Low Child-Pugh score
    • Absence of ascites or easily controlled ascites
    • Low serum creatinine level
  • A formula to calculate the prognostic index has been proposed. A score of less than 5.4 is associated with a good prognosis. The formula to calculate the prognostic index is as follows:
Prognostic index = (ascites score X 0.75) + (Pugh score X 0.28) + (age X 0.037) + (creatinine level X 0.0036)
  • The prognosis is poor in patients with Budd-Chiari syndrome who remain untreated. Death results from progressive liver failure in 3 months to 3 years from the time of diagnosis.
  • The 5-year survival rate is 38-87% following portosystemic shunting. The actuarial 5-year survival rate following liver transplantation is 70%.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform hematological studies to evaluate for a hypercoagulable state
  • Failure to offer long-term anticoagulation if indicated
  • Failure to offer liver transplantation if indicated
  • Failure to decompress the hepatic vasculature if portal hypertension is the cause of symptoms
 


More on Budd-Chiari Syndrome

Overview: Budd-Chiari Syndrome
Differential Diagnoses & Workup: Budd-Chiari Syndrome
Treatment & Medication: Budd-Chiari Syndrome
Follow-up: Budd-Chiari Syndrome
References
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Further Reading

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Keywords

Budd-Chiari syndrome, hepatic vein occlusion, hepatic vein obstruction, hepatic obstruction, liver obstruction, liver disease, hepatic disease, thrombotic hepatic vein obstruction, nonthrombotic hepatic vein obstruction, non-thrombotic hepatic vein obstruction, obliterating hepatic vein endophlebitis, hepatomegaly, ascites, thrombotic diathesis, congestive hepatopathy, hepatic congestion, liver congestion, membranous webs, acute liver disease, subacute liver disease, fulminant liver disease, liver failure

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Contributor Information and Disclosures

Author

Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Praveen K Roy, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and Canadian Association of Gastroenterology
Disclosure: Nothing to disclose.

Coauthor(s)

Abhishek Choudhary, MD, Resident, Department of Internal Medicine, University Hospital of Missouri
Abhishek Choudhary, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine
Jack Bragg, DO, FACOI is a member of the following medical societies: American College of Osteopathic Internists and American Osteopathic Association
Disclosure: Nothing to disclose.

Gautam Dehadrai, MD, Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital
Gautam Dehadrai, MD is a member of the following medical societies: American College of Radiology, Medical Council of India, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Robert J Fingerote, MD, MSc, BSc, FRCPC, Consultant, Clinical Evaluation Division, Biologic and Gene Therapies, Directorate Health Canada; Consulting Staff, Department of Medicine, Division of Gastroenterology, York Central Hospital, Richmond Hill, Ontario
Robert J Fingerote, MD, MSc, BSc, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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