嵐哥英文解析
The main symptoms and manifestations of the patient are RUQ pain, ascites ( indicated by shifting dullness ) , hepatomegaly. Lab examination indicates hyperglobulinemia ( Tp - Alb = Glb 60.2 g/dl ) . Imaging examination shows a spider web of collateral veins in the liver.
First, we can confirm postsinusoidal portal hypertension caused by something obstruct the hepatic vein outflow.
What is the obstruction? Thrombosis. We know that the patient has renal cell carcinoma ( RCC ) history. RCC originates in the lining of the proximal convoluted tubule which reabsorbs β2-microglobulin（β2-MG）. The decreasing GFR causes hyperglobulinemia, and then causes hypercoagulable state.
According to the pathophysiological theory above mentioned, we can get the diagnosis: Budd-Chiari Syndrome, secondary hepatic vein thrombosis caused by a hypercoagulable state, and its mortality is high at 40%~90%.
For internal medcine, the initial treatment is thrombolysis followed by anticoagulation ( Answer E ) . However, transjugular intrahepatic portosystemic shunt ( TIPS procedure ) or hepatic transplantation is a more definitive treatment.
What a pity, the patient dies 6 hrs after arriving because of the circulation failure.
本病例由嵐哥嵐逸筠篁解析。
