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Budd-Chiari syndrome — SCE Acute Medicine MCQ

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EasyAcute Gastrointestinal PresentationsBudd-Chiari syndromeSCE Acute Medicine

A 45-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show hepatic vein thrombosis with painful hepatomegaly and ascites. What is the most likely diagnosis?

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Correct answer: D — Budd-Chiari syndrome

The key discriminator is that hepatic vein thrombosis with painful hepatomegaly and ascites, which makes Budd-Chiari syndrome the single best answer. Acute pancreatitis is less appropriate because it does not address the dominant acute risk in the vignette; Aortic dissection would fit a different presentation or later stage of care. Toxic drug ingestion and Acute coronary syndrome are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG vascular liver disease guidance