Budd-Chiari Syndrome

Budd-Chiari syndrome is obstruction of hepatic venous outflow—not simply any cause of a congested liver. When the hepatic veins or inferior vena cava are blocked, blood backs up through the hepatic sinusoids. That congestion produces the clinical pattern of abdominal pain, hepatomegaly, and often disproportionately severe ascites; persistent obstruction adds portal hypertension and progressive hepatocellular injury. For the RN, the central decisions are sequential: recognize the outflow-obstruction pattern, confirm it with Doppler ultrasonography, and treat the thrombotic risk with therapeutic anticoagulation unless it is unsafe. If congestion and liver dysfunction do not improve, the patient may need venous recanalisation, TIPS, or transplantation. A normal blood count does not exclude an underlying myeloproliferative neoplasm, so evaluation for a prothrombotic disorder remains necessary.