hepatic and biliary disorders
Budd Chiari Syndrome
Treatment of Budd Chiari Syndrome
Supportive care Restoration and maintenance of adequate venous outflow Treatment varies according to onset (acute vs chronic) and severity (fulminant liver failure vs decompensated cirrhosis or stable/asymptomatic). The cornerstones of management are Giving supportive therapy directed at complications (eg, Ascites , Decompressing the congested liver (ie, maintaining venous outflow) Preventing propagation of the clot Aggressive interventions (eg, thrombolysis, stents) are used when the disease is acute (eg, within 4 weeks and in the absence of cirrhosis). Thrombolysis can dissolve acute clots, allowing recanalization and so relieving hepatic congestion. Radiologic procedures, such as angioplasty, stenting, and/or portosytemic shunts, can have a major role. For caval webs or hepatic venous stenosis, decompression via percutaneous transluminal balloon angioplasty with intraluminal stents can maintain hepatic outflow. When dilation of a hepatic outflow narrowing is not technically feasible, transjugular intrahepatic portosystemic shunting (TIPS) and various surgical shunts can provide decompression by diverting blood flow into the systemic circulation. Portosystemic shunts are typically not used if Portosystemic Encephalopathy is present; such shunts may worsen liver function. Further, clots may form in shunts, especially if patients have a hematologic or thrombotic disorder. Long-term anticoagulation is often necessary to prevent recurrence. Liver Transplantation may be lifesaving in patients with fulminant disease or decompensated cirrhosis. 