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Old 10-17-2012
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Question Polycythemia Liver!

A 39 y/o white woman who suffers from polycythemia vera presents to the clinic complaining of severe and constant right upper quadrant pain over the past 2 days. physical exam reveals an enlarged liver. what other finding would most likely be seen at presentation ?

A ascites
B asterixis
C esophageal varices
D hyperpigmented skin
E spider angiomata
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A. Ascites ??????
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Old 10-17-2012
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D hyperpigmented skin
May be due to histamine degranulation??????????
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Quote:
Originally Posted by koolkiller88 View Post
D hyperpigmented skin
May be due to histamine degranulation??????????
I was also thinking the same but then thought there might be a catch..lol
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Old 10-17-2012
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Default A. Ascites

Budd-Chiari: pain+ascites+hepatomegaly
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Quote:
Originally Posted by Doc4Step1 View Post
I was also thinking the same but then thought there might be a catch..lol
Hahaha. Ya now i am also thinking. It was a catch and i got catched
Ascities Seems more reasonable.
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Old 10-17-2012
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i think A ascites
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Default Budd Chiari

Sounds like Budd Chiari to me, meaning ascites and esophogeal varices are both likely
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hmm..Hyperpigmented skin...may be haemolytic Jundice
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also thinking..D) hyperpigmented skin
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Default my answer :)

A ascites ...
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Old 10-18-2012
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PCV ---->> much RBC for easy clot formtn >>> Thrombs >>> HV obstructn = Budd Chiari syndrome . Two things involve here i guess Possible symptoms V/S acutely presented symptoms especialy in acute form like ths case . All possible , but for 2days RUQ pain ,u most likely see Ascites in PE compared to others , wich also develop but takes time more . like asterixis , varices , jaundice .
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The correct answer is A. This is an acute presentation of Budd-Chiari syndrome, or thrombosis of two or more hepatic veins. This condition is associated with hypercoagulable states such as myeloproliferative disorders, inherited coagulation disorders, intra-abdominal cancers, oral contraceptive use, and pregnancy. The increased intrahepatic pressure leading to ascites is present in 90% of patients with Budd-Chiari syndrome. The disease can also present in a subacute manner or in a chronic manner, and diagnosing this condition may then be more challenging because the classic triad of abdominal pain, hepatomegaly, and ascites may not be present.

Answer B is incorrect. Asterixis is associated with hepatic encephalopathy in the setting of liver failure. The underlying mechanisms linking liver failure to asterixis are not completely understood.

Answer C is incorrect. Esophageal varices are associated with portal hypertension, in which portosystemic shunts occur to bypass the hepatic circulation and return blood to the heart.

Answer D is incorrect. Skin hyperpigmentation can occur in several settings, such as hemochromatosis or Addison's disease (adrenal atrophy), but none of these diseases fit the present clinical picture.

Answer E is incorrect. Spider angiomata are usually associated with cirrhosis; their pathogenesis is not completely understood but they are believed to occur in the setting of defects in the metabolism of sex hormones. They can also be present in pregnant women and malnourished patients.
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The above post was thanked by:
bilal.sheikh (10-18-2012), Doc4Step1 (10-18-2012), drjds (06-30-2016), Janakpriya (10-18-2012)



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