This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Venoocclusive disease in hepatic vein characterized by:a) Central venous congestionb) Hepatomegalyc) Portal vein obstructiond) Budd chiari syndromee) Hepatic fibrosis \nSelect and explain. \nA. ab, B. ad, C. bc, D. be', 'role': 'user'}, {'content': "Answer: D \nExplanation: Veno-occlusive disease (VOD) now better known as 'Sinusoidal obstruction syndrome' is one of the most frequently encountered serious complications after bone marrow transplantation.\nOther uncommon causes are:\nLong-term immunosuppression with azathioprine in renal and liver transplant patients - Sporadic cases may be due to use of herbal teas (pyrrolizidine alkaloids).\nThe hallmark features of VOD are hyperbilirubinemia, painful hepatomegaly, and fluid retention.\nThe onset of VOD usually occurs within 3 weeks after bone marrow transplantation, with a peak 12 days posttransplantation. However, the onset of VOD has been reported even later.\nAccording to the modified Seattle criteria, 2 or more of the following must be present prior to 20 days after stem cell transplantation for a diagnosis of VOD:\nBilirubin level of more than 2 mg/dL (34 p.mol/L)\nHepatomegaly and upper right quadrant pain of liver origin\nAscites and/or unexplained weight gain of more than 2% above the reference range\nPathophysiology:\xa0The causes of VOD are still unclear, but a combination of pretransplant risk factors and transplant-related conditions are believed to trigger a primarily hepatic sinusoidal injury. This can quickly extend to a hepatocytic and panvasculitic disease.\nThis process eventually leads to complete venular obliteration, extensive hepatocellular necrosis, and widespread fibrous tissue replacement of normal liver. Because of the initiating pathology it is also called sinusoidal obstruction syndrome.\nThe disease has significant morbidity and mortality.\nTreatment is largely supportive.\n\nVOD and Budd-Chiari syndrome\n\nIn VOD hepatic venous outflow obstruction occurs from diffuse involvement of hepatic venules/ vein radicals, whereas in Budd-Chiari syndrome the outflow obstruction is due to involvement of major hepatic veins or the hepatic portion of IVC. In VOD the major hepatic veins are patent.\nTender hepatomegaly with jaundice and ascites is common in both conditions.", 'role': 'assistant'}]