Budd-Chiari-Like Syndrome

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Introduction

This condition is an acquired or congenital obstruction to the caudal vena cava affecting venous return to the right side of the heart. The venous obstruction causes increased pressure within the liver allowing for fluid and protein to leak out of the hepatic sinusoids into the surrounding areas.

Signalment

Dogs: Young dogs under two years old; male > female. There have been no reported cases in cats.


Clinical Signs

Clinical signs can be vague and similar to other disease but include ascites (with modified transudate), hepatomegaly, lethargy, abdominal distension and abdominal pain and anorexia.


Diagnosis

Blood tests may reveal elevated liver enzymes and the presence of a stress leukogram. If ascites is present, examination of this will prove it to be a modified transudate. Radiography will show the presence of ascites and an enlarged Caudal Vena Cava. If an electrocardiograph (ECG) is performed, this may demonstrate right atrial enlargement (tall P waves). Echocardiography may show an obstruction. Abdominal ultrasound will also demonstrate ascites, plus hepatomegaly and enlarged hepatic veins. Angiography can be used to visualise blood flow.


Treatment

Surgery is indicated for some cases, but is very risky. Medical treatment to provide supportive therapy, includes regular abdominocentesis, plus the use of drugs, furosemide (a diuretic) and enalapril, an ACE inhibitor.


Prognosis

Excellent with an experienced surgeon, but poor if only medical therapy is used.


References

Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition), W.B. Saunders Company

Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2), W.B. Saunders Company

Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition), Mosby Elsevier

Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial

Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition), Mosby Elsevier.




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