A 34-year-old woman on combined oral contraceptives presents with sudden right upper quadrant pain, tender hepatomegaly, and rapidly accumulating ascites. Doppler ultrasound shows absent flow in the hepatic veins. Liver biopsy would most likely show:

• A Periportal interface hepatitis with plasma cells
• B Centrilobular congestion and necrosis with sinusoidal dilatation ✓
• C Granulomatous destruction of interlobular bile ducts
• D Perisinusoidal zone 3 fibrosis with hepatocyte ballooning

Explanation

This is Budd-Chiari syndrome from hepatic vein thrombosis, for which estrogen exposure, myeloproliferative neoplasms and prothrombotic states are established causes. Obstruction of venous outflow produces severe centrilobular (zone 3) congestion, sinusoidal dilatation and hepatocyte necrosis, with painful hepatomegaly and ascites. Interface hepatitis defines autoimmune hepatitis, granulomatous duct destruction defines primary biliary cholangitis, and ballooning with perisinusoidal fibrosis defines steatohepatitis, none of which produce acute venous outflow obstruction.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.