Spider web of collateral veins in the liver

[K06100]

A 59-year-old woman with renal cell carcinoma presents to the emergency department with severe right upper quadrant (RUQ) pain. She is afebrile, acutely tender in the RUQ, and has shifting dullness and a palpable liver edge. Murphy’s sign is negative. Laboratory studies show:
Na+: 138 mEq/L
K+: 3.6 mEq/L
Glucose: 80 mg/dL
Aspartate aminotransferase: 50 U/L
Alanine aminotransferase: 43 U/L
Alkaline phosphatase: 138 U/L
Total protein: 6.4 g/dL
Albumin: 3.8 g/dL
Total bilirubin: 1.1 mg/dL
Imaging demonstrates a spider web of collateral veins in the liver. Although extensive measures are taken, the patient dies 6 hours after arriving.

Which of the following was the most likely initial treatment?

(A) β-Blocker followed by lactulose
(B) Cholecystectomy
(C) Endoscopic retrograde cholangiopancreatography with dilation of the common bile duct
(D) Exploratory laparotomy
(E) Tissue plasminogen activator followed by anticoagulation

[Novobiocin]

(E) Tissue plasminogen activator followed by anticoagulation

Fulminant Budd-Chiari syndrome

Laprotomy before liver failure develops.

Liver transplant once liver fails.

Whatever you do the prognosis is very poor.

[K06100]

Correct Answer is E