]> 2026-07-31T09:41:19+00:00 WBR0711 0 en Budd-Chiari syndrome Budd-Chiari syndrome is often caused by hepatic vein thrombosis. One of the most common causes of these thromboses is polycythemia vera. Choledocholithiasis Choledocholithiasis refers to the condition which occurs when gallstones have migrated into the biliary tract. This may lead to obstruction of the biliary tree and infection. Choledocholithiasis may present as acute upper abdominal pain, but it would not cause hepatomegaly and ascites. Nonalcoholic steatohepatitis Nonalcoholic steatohepatitis (NASH) is characterized by inflammation of the liver with concurrent fat accumulation. It may progress to cirrhosis, but it tends to progress silently over many years. A presentation this acute is not consistent with NASH. Pancreatitis Pancreatitis may present with upper abdominal pain radiating to the back, but it would not cause hepatomegaly or ascites. Splenic infarction While splenomegaly is associated with polycythemia vera and splenic infarction has been observed, the triad of abdominal pain, ascites and hepatomegaly is characteristic of Budd-Chiari syndrome. Pathophysiology William J Gibson (Reviewed by Serge Korjian) A 74-year-old woman presents to the emergency department with severe upper abdominal pain for the past four hours. Past medical history is notable for hypertension, diabetes and polycythemia vera for which she receives hydroxyurea. The patient reports being non-compliant with her medications because of their many side effects. On physical examination, the liver can be palpated 5 cm below the costal margin and an abdominal fluid wave is present. What is the most likely diagnosis? A Gastrointestinal Hematology 2020-10-28T01:27:57Z 2459150.5610764 WBR0711