A 30-year-old woman presents with acute abdominal pain, ascites, and hepatomegaly. She has been taking oral contraceptive pills for 2 years. Liver biopsy shows centrilobular congestion and hepatocyte necrosis. Which is the most likely underlying pathophysiology?
- A Hepatic vein thrombosis ✓
- B Portal vein thrombosis
- C Sinusoidal obstruction syndrome
- D Right-sided heart failure
Correct answer: A. Hepatic vein thrombosis
Explanation
Budd-Chiari syndrome is obstruction of hepatic venous outflow, presenting with the classic triad of abdominal pain, ascites, and hepatomegaly. Risk factors include myeloproliferative disorders, oral contraceptives, and hypercoagulable states. Centrilobular congestion on biopsy is characteristic. Portal vein thrombosis causes portal hypertension without centrilobular congestion. Sinusoidal obstruction syndrome involves hepatic venules, not main hepatic veins.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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