This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Liver, Subject name: Surgery
[{'content': 'A young female who is a known case of myeloproliferative disorder presents with a 3 day history of progressive abdominal discomfort and ascites. Which of the following is the possible diagnosis \nSelect and explain. \nA. Budd Chiari syndrome, B. Hepatitis A, C. Perforation peritonitis, D. Acute pancreatitis', 'role': 'user'}, {'content': "Answer: A \nExplanation: Ans. is 'a' i.e., Budd Chiari Syndrome * Young female with myeloproliferative disorder - points towards a procoagulant state* Presentation of acute onset abdominal discomfort and ascites mostly points to involvement of hepatic vein - probably thrombosis of hepatic vein due to the procoagulant state ->> so the most probable diagnosis is - Budd Chiari Syndrome.Budd Chiari syndrome* This is a condition principally affecting young females, in which the venous drainage of the liver is occluded by hepatic venous thrombosis or obstruction from a venous web.* Asa result of venous outflow obstruction, the liver becomes acutely congested, with the development of impaired liver function and, subsequently, portal hypertension, ascites and oesophagealvarices.* In an acute thrombosis, the patient may rapidly progress to fulmi- nant liver failure but, in the majority of cases, abdominal discomfort and ascites are the main presenting features.* If chronic, the liver progresses to established cirrhosis.* The cause of the venous thrombosis needs to be established, and an underlying myeloproliferative disorder or pro-coagulant state is commonly found, such as anti-thrombin 3, protein C or protein S deficiency.* The diagnosis is commonly suspected in a patient presenting with ascites, in whom a CT scan shows a large congested liver (early stage) or a small cirrhotic liver in which there is gross enlargement of segment I (the caudate lobe). This feature results from preservation and hypertrophy of the segment with direct venous drainage to the I VC in the face of atrophy of the rest of the liver due to venous obstruction.* IVC compression or occlusion from the segment I hypertrophy is also a common feature, as is thrombosis of the portal vein.* Confirmation of the suspected diagnosis is by hepatic venography via a transjugular approach, which demonstrates occlusion of the hepatic veins and may allow a transjugular biopsy.", 'role': 'assistant'}]