Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive abdominal distension, right upper quadrant discomfort, and lower extremity edema. History significant for chronic hepatic venous outflow obstruction (Budd-Chiari syndrome secondary to membranous web). Symptoms include early satiety, nausea, and occasional jaundice. No history of hematemesis or melena.
Clinical Examination Findings
Physical exam reveals icteric sclera, spider angiomata, and significant ascites with shifting dullness. Hepatomegaly noted on palpation with tenderness in the RUQ. Bilateral pitting edema (1-2+) present in lower extremities. Caput medusae may be visible. Cardiovascular exam unremarkable; lungs clear to auscultation.
Treatment Protocol
Management plan includes initiation of anticoagulation therapy to prevent thrombus propagation. Diuretic therapy (spironolactone/furosemide) for ascites management. Referral for interventional radiology for balloon angioplasty or stenting of the membranous obstruction. Consider TIPS (Transjugular Intrahepatic Portosystemic Shunt) if refractory to initial interventions.