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A 40-year-old woman presents with acute onset of upper abdominal pain and ascites

40 years old | Female

Vignette:

A 40-year-old woman presents with acute onset of upper abdominal pain and ascites. She has been on the combined oral contraceptive pill for 7 years. On exam she has tender hepatomegaly. There is no hepatojugular reflux and no lower limb edema. Cardiovascular exam revealed no medical abnormalities. She is known to have polycythemia vera of 10 years' duration.

Summary:

acute onset | upper abdominal pain | ascites | oral contraceptive pill | liver tenderness | hepatomegaly | polycythemia vera

Dx:

Budd Chiari syndrome

Ref:

https://online.epocrates.com/diseases/87422/Budd-Chiari-syndrome/Common-Vignette

Rank

Disease

Weight

1 Primary sclerosing cholangitis 284.0
2 Amebic Liver Abscess 262.0
3 Biliary cirrhosis 256.0
4 Primary biliary cirrhosis 251.0
5 Acute Cholecystitis 241.0
6 Tuberculous Peritonitis 238.0
7 Liver Cirrhosis 237.0
8 Hereditary hemochromatosis 230.0
9 Budd Chiari Syndrome 200.0
10 Ruptured ectopic pregnancy 199.0
11 Emphysematous cholecystitis 196.0
12 Chronic heart failure 192.0
13 Autoimmune hepatitis 191.0
14 Mesenteric ischemia 190.0
15 Klebsiella pneumoniae liver abscess 187.0
16 Spontaneous bacterial peritonitis 186.0
17 Pyogenic Liver Abscess 178.0
18 Common cutaneous drug reactions 171.0
19 pancreatic cancer 168.0
20 Intestinal Obstruction 168.0
21 Alcoholic hepatitis 166.0
22 Cholangiocarcinoma 159.0
23 Acute Pancreatitis 158.0
24 Gallstone pancreatitis 158.0
25 Extraintestinal Entamoeba histolytica amebiasis 153.0
26 biliary colic 151.0
27 Hepatorenal Syndrome 147.0
28 Hepatocellular carcinoma 146.0
29 Liver Abscess 143.0
30 Acute pericarditis 142.0
31 Alcoholic Fatty Liver 142.0
32 Acute Liver Failure 137.0
33 Aortic Dissection 136.0
34 Acalculous Cholecystitis 136.0
35 chronic acalculous cholecystitis 136.0
36 Choledochal Cyst 133.0
37 Ectopic Pregnancy 133.0
38 Liver disease 131.0
39 Pulmonary Embolism 130.0
40 Splenic Infarction 129.0
41 Wilson disease 129.0
42 Acute Cholangitis 126.0
43 Choledocholithiasis 124.0
44 Alcoholic Liver Disease 123.0
45 Primary Myelofibrosis 121.0
46 Acute Lymphoblastic leukemia in children 121.0
47 Alcoholic Liver Cirrhosis 120.0
48 Hemolytic uremic syndrome 119.0
49 Acute Hepatitis 118.0
50 Acute peptic ulcer 117.0
51 Gastroparesis 117.0
52 Ruptured ovarian cyst 115.0
53 Chronic liver disease 114.0
54 Acute Lymphocytic Leukemia in Adults 113.0
55 Systemic sclerosis 110.0
56 Acute Appendicitis 107.0
57 Anaphylaxis 107.0
58 Sarcoidosis 107.0
59 Acute intermittent porphyria 107.0
60 Deep venous thrombosis 107.0
61 subserosal eosinophilic gastroenteritis 105.0
62 Bacterial pharyngitis 105.0
63 Acetaminophen overdose 104.0
64 Type 2 Diabetes mellitus 103.0
65 Anthrax 103.0
66 Erythema nodosum 102.0
67 Toxic Megacolon 101.0
68 Gastric Volvulus 100.0
69 Esophagitis 100.0
70 Chronic Renal vein thrombosis 100.0
71 Colorectal cancer 99.0
72 Acute Clonorchiasis 99.0
73 Ovarian and fallopian tube torsion 97.0
74 Foreign body ingestion 97.0
75 Hereditary Angioedema 96.0
76 Ovarian Hyperstimulation Syndrome 93.0
77 Diabetic Neuropathy 92.0
78 mucosal Eosinophilic gastroenteritis 91.0
79 Ovarian Cancer 91.0
80 Gallstones 90.0
81 Acute peritonitis 90.0
82 Muscle Layer Eosinophilic gastroenteritis 89.0
83 Acute heart failure 89.0
84 Central retinal artery occlusion 87.0
85 Giardiasis 87.0
86 Addison Disease 86.0
87 Autosomal Recessive Polycystic Kidney Disease 86.0
88 Anemia of chronic disease 86.0
89 Intraperitoneal bleeding 85.0
90 Food poisoning 85.0
91 Brucellosis 85.0
92 Gastritis 84.0
93 Bell palsy 84.0
94 COPD Exacerbation 84.0
95 Infectious mononucleosis 84.0
96 Acute pelvic inflammatory disease 83.0
97 Kidney stones 83.0
98 Psoas Abscess 83.0
99 Non-alcoholic Fatty Liver Disease 82.0
100 Autosomal Dominant Polycystic Kidney Disease 82.0
101 Intussusception 81.0
102 Lung Cancer 78.0
103 Short bowel syndrome 78.0
104 Rocky Mountain spotted fever 78.0
105 Hyperprolactinemia 78.0
106 Chronic Clonorchiasis 77.0
107 Gallbladder cancer 77.0
108 Diabetic Ketoacidosis 76.0
109 Hypothyroidism 76.0
110 Alopecia areata 76.0
111 Zollinger-Ellison Syndrome 75.0
112 Pneumonia 75.0
113 Cataract 75.0
114 Eosinophilic gastroenteritis 74.0
115 Diverticulitis 74.0
116 Portal hypertension 73.0
117 Campylobacter infection 73.0
118 Chronic Hepatitis 72.0
119 Familial Mediterranean fever 72.0
120 Cholecystitis 72.0
121 Chronic Cholecystitis 71.0
122 Motion Sickness 70.0
123 Mitral Stenosis 69.0
124 Non-small cell lung cancer 69.0
125 Non-ST-elevation myocardial infarction 69.0
126 Angle Closure Glaucoma 68.0
127 Ankylosing spondylitis 68.0
128 Inflammatory Bowel Diseases 67.0
129 Aortic coarctation 67.0
130 Chronic Milk-alkali syndrome 67.0
131 Acute Milk-alkali syndrome 67.0
132 Epiploic appendagitis 66.0
133 Polyarteritis nodosa 66.0
134 Malaria 66.0
135 Chronic Myeloid Leukemia 66.0
136 Torsion of appendix of testis 65.0
137 Croup 65.0
138 Shigellosis 65.0
139 Ulcerative Colitis 64.0
140 Peritoneal dialysis associated peritonitis 64.0
141 Chronic Mitral regurgitation 63.0
142 Cystic Fibrosis 63.0
143 Clostridium difficile infection 63.0
144 Adrenal crisis 63.0
145 Umbilical hernia 63.0
146 Dyspepsia 62.0
147 Gastric cancer 62.0
148 Acute bacterial meningitis in children 62.0
149 Renal and perinephric abscess 62.0
150 Upper gastrointestinal hemorrhage 62.0
151 Lower gastrointestinal hemorrhage 62.0
152 Gastrointestinal Hemorrhage 62.0
153 Acute perforated appendicitis 61.0
154 Chronic Pancreatitis 61.0
155 Listerial gastroenteritis 60.0
156 Celiac Disease 59.0
157 COVID19 59.0
158 Graves Disease 59.0
159 Ischemic stroke 59.0
160 Sigmoid volvulus 59.0
161 Adrenocortical carcinoma 58.0
162 Acromegaly 58.0
163 Candidal intertrigo 58.0
164 Candida Balanitis 58.0
165 Oropharyngeal and esophageal candidiasis 58.0
166 Vulvovaginal candidiasis 58.0
167 Oral candidiasis 58.0
168 Chronic bacterial prostatitis 57.0
169 Tinea versicolor 57.0
170 Crohn Disease 56.0
171 Autoimmune Pancreatitis 56.0
172 Ileus 55.0
173 Kawasaki disease 55.0
174 Acute Myeloid Leukemia in children 55.0
175 Bacterial gastroenteritis 54.0
176 Churg-Strauss Syndrome 54.0
177 Familial adenomatous polyposis syndrome 54.0
178 Ascites 53.0
179 Carpal Tunnel Syndrome 53.0
180 Musculoskeletal sprains and strains 53.0
181 Transient ischemic attack 53.0
182 Duodenal Ulcer 52.0
183 Gastric Ulcer 52.0
184 Acute bacterial meningitis in adults 52.0
185 Diabetes Mellitus 52.0
186 Analgesic nephropathy 52.0
187 Hypertriglyceridemia 52.0
188 Chronic prostatitis 51.0
189 Ruptured Tuboovarian abscess 51.0
190 Candidiasis 51.0
191 Acute otitis media 50.0
192 Varicocele 50.0
193 Cellulitis 50.0
194 Heparin-induced thrombocytopenia 50.0
195 Stable ischemic heart disease 50.0
196 Clonorchiasis 49.0
197 Charcot-Marie-Tooth Disease 48.0
198 Endometriosis 48.0
199 Granulomatosis with polyangiitis 47.0
200 Acne fulminans 47.0
201 Fibromyalgia 47.0
202 Pancreatic Pseudocyst 46.0
203 Rheumatoid Arthritis 46.0
204 Typhoid infection 46.0
205 Lactose intolerance 46.0
206 Recurrent aphthous stomatitis 46.0
207 Foodborne E coli infection 46.0
208 Type 1 Diabetes mellitus 45.0
209 Intestinal Entamoeba histolytica amebiasis 45.0
210 Irritable Bowel Syndrome 44.0
211 Chronic Kidney Diseases 44.0
212 Amyloidosis 44.0
213 Viral Gastroenteritis 44.0
214 Salmonella infection 44.0
215 Hiatus hernia 43.0
216 Annular pancreas 42.0
217 Acute fatty liver of pregnancy 42.0
218 Hemorrhagic stroke 42.0
219 Acute Bacterial Prostatitis 42.0
220 Chronic pelvic pain in women 42.0
221 Empyema 41.0
222 Chlamydia pneumoniae infection 41.0
223 Insect bites and stings 41.0
224 biliary SOD 40.0
225 Amphetamine use disorder 40.0
226 Meckel diverticulum 40.0
227 Acute Myeloid Leukemia in adults 40.0
228 ST-elevation myocardial infarction 40.0
229 Intra-abdominal abscess 39.0
230 Panic disorder in adults 39.0
231 Multiple endocrine neoplasia 2B 39.0
232 Gastroenteritis 38.0
233 Thrombotic thrombocytopenic purpura 38.0
234 Multiple endocrine neoplasia 2A 38.0
235 Biliary cyst 38.0
236 Gastric Outlet Obstruction 38.0
237 Intestinal malrotation 38.0
238 Cushing syndrome 37.0
239 Mirizzi Syndrome 37.0
240 Splenic Rupture 37.0
241 Glomerulonephritis 37.0
242 Guillain-Barre syndrome 37.0
243 Peutz-Jeghers Syndrome 37.0
244 Intestinal Pseudo Obstruction 37.0
245 Leiomyomas 36.0
246 Diabetic Amyotrophy 36.0
247 Prostatitis 36.0
248 Peptic Ulcer 35.0
249 Cholera 35.0
250 Adrenal Suppression 35.0
251 Pheochromocytoma 35.0
252 Hepatic Encephalopathy 34.0
253 Splenic abscess 34.0
254 Tuboovarian abscess 34.0
255 Acute pyelonephritis in adults 34.0
256 Gallbladder Dyskinesia 33.0
257 Eclampsia 33.0
258 Chronic Lymphocytic Leukemia 33.0
259 Obstructive Sleep Apnea 33.0
260 Acute viral meningitis 32.0
261 Preeclampsia 32.0
262 Abdominal compartment syndrome 32.0
263 Non-cholera Vibrio infections 31.0
264 Endometritis 31.0
265 Systemic lupus erythematosus 30.0
266 Breast Cancer 30.0
267 Urinary Tract Obstruction 29.0
268 Hyperparathyroidism 29.0
269 Secondary Peritonitis 29.0
270 Multiple Sclerosis 28.0
271 Abetalipoproteinemia 27.0
272 Hyperthyroidism 26.0
273 Gilbert syndrome 26.0
274 Stevens-Johnson syndrome 26.0
275 Renal vein thrombosis 26.0
276 Acute Renal vein thrombosis 26.0
277 anterior ischemic optic neuropathy 25.0
278 Inguinal hernia 25.0
279 Pelvic inflammatory disease 25.0
280 Dubin-Johnson syndrome 25.0
281 Malt lymphoma 24.0
282 Cystitis 24.0
283 Pyelonephritis 24.0
284 Hypogammaglobulinemia 24.0
285 Acute atrial fibrillation 24.0
286 Bladder Cancer 24.0
287 Globus Sensation 24.0
288 Gastroesophageal reflux disease 23.0
289 Systemic vasculitis 23.0
290 Aseptic meningitis 23.0
291 Fungal meningitis 23.0
292 Rumination Syndrome 23.0
293 Renal Cell Carcinoma 22.0
294 Hypercalcemia 22.0
295 Gout 22.0
296 Chronic fatigue syndrome 22.0
297 Papilledema 22.0
298 Tetanus 22.0
299 Hyperosmolar Hyperglycemic state 22.0
300 Acute bacterial meningitis in neonates 21.0
301 Stroke 20.0
302 Amebiasis 20.0
303 Kartagener syndrome 19.0
304 Primary ciliary dyskinesia 19.0
305 Common cold(adults) 18.0
306 Allergic rhinitis 18.0
307 Uveitis 18.0
308 Anterior uveitis 18.0
309 Intermediate uveitis 18.0
310 Posterior uveitis 18.0
311 Pan uveitis 18.0
312 Balanitis 18.0
313 Multiple Myeloma 18.0
314 Hypoparathyroidism 17.0
315 iritis 17.0
316 Epilepsy 17.0
317 Herpes pharyngitis 17.0
318 STI HIV Pharyngitis 17.0
319 Viral pharyngitis 17.0
320 Pharyngitis 17.0
321 Genital herpes 17.0
322 Ischemic optic neuropathy 17.0
323 posteriorischemic optic neuropathy 17.0
324 Travelers diarrhea 17.0
325 Ovarian Torsion 17.0
326 Insomnia in adults 17.0
327 Disseminated intravascular coagulation 17.0
328 Premature labor 17.0
329 Chronic meningitis 17.0
330 Premenstrual syndrome 17.0
331 Milk-alkali syndrome 17.0
332 Non-diabetic hypoglycemia 17.0
333 Henoch-Schonlein purpura 17.0
334 Animal bites 16.0
335 Cholangitis 16.0
336 Pancreatitis 16.0
337 Acute Rhinosinusitis 16.0
338 Acute viral rhinosinusitis 16.0
339 Acute bacterial rhinosinusitis 16.0
340 Sphincter of Oddi Dysfunction 16.0
341 pancreatic SOD 16.0
342 Atopic dermatitis 16.0
343 Influenza 15.0
344 Simple kidney cyst 15.0
345 Prolactinoma 15.0
346 Subdural hematoma 15.0
347 Chronic pyelonephritis 15.0
348 Urinary tract infection 14.0
349 Labyrinthitis 14.0
350 Phenylketonuria 14.0
351 Aortic stenosis 14.0
352 Mallory-Weiss syndrome 14.0
353 Intrahepatic cholestasis of pregnancy 14.0
354 Blepharitis 14.0
355 Enterovesical fistula 14.0
356 Cryptococcosis 13.0
357 Psoriasis 13.0
358 Optic neuritis 13.0
359 Neuropapillitis 13.0
360 Anaplastic thyroid cancer 13.0
361 Rotator Cuff Tears 13.0
362 Exocrine pancreatic insufficiency 13.0
363 Common cold(children) 12.0
364 Gingivitis 12.0
365 Acute disseminated encephalomyelitis 12.0
366 Peritonitis 12.0
367 Acute Cystitis(Women) 12.0
368 Viral conjunctivitis 12.0
369 Bacterial conjunctivitis 12.0
370 Osteomyelitis 12.0
371 Nasal polyps 12.0
372 Temporomandibular joint syndrome 12.0
373 Bruxism 12.0
374 Dermatophyte infections 11.0
375 Acute Cystitis(Men) 11.0
376 Angiodysplasia of the colon 11.0
377 Endometrial cancer 11.0
378 Gestational diabetes mellitus 11.0
379 Vaginitis 11.0
380 Urethritis 11.0
381 Phimosis 11.0
382 Paraphimosis 11.0
383 Achalasia 10.0
384 Bed bugs 10.0
385 Central hypothyroidism 10.0
386 Diabetic Kidney Disease 10.0
387 Limited cutaneous systemic sclerosis 10.0
388 Bullous pemphigoid 10.0
389 Secondary hyperparathyroidism 10.0
390 Menopause 10.0
391 Psychogenic polydipsia 9.0
392 Sunburn 9.0
393 Chronic atrial fibrillation 8.0
394 Scleritis 8.0
395 Anterior scleritis 8.0
396 Posterior scleritis 8.0
397 Epididymo-orchitis 8.0
398 Medullary thyroid cancer 8.0
399 Extrahepatic Cholestasis 8.0
400 Intrahepatic Cholestasis 8.0
401 Von willebrand disease 8.0
402 Periorbital and orbital cellulitis 7.0
403 Herpes zoster 7.0
404 Miliaria 7.0
405 Pseudohypoparathyroidism 7.0
406 Male factor infertility 6.0
407 Atypical pneumonia 6.0
408 Acute epididymitis 6.0
409 Migraine headache in adults 5.0
410 Hemorrhoids 5.0
411 Immune thrombocytopenia 5.0
412 Acute respiratory failure 5.0
413 Sialadenitis 5.0
414 Acute Bronchitis 3.0
415 Thyroid lymphoma 3.0
416 Testicular cancer 3.0
417 Hyperaldosteronism 1.0
418 endocarditis 1.0
419 Essential Tremor 0.0
420 Trachoma 0.0
421 Prinzmetal angina 0.0
422 Myasthenia Gravis 0.0
423 Neonatal Myasthenia Gravis 0.0
424 Congenital Myasthenic Syndromes 0.0
425 Musculoskeletal lower back pain 0.0
426 Acne conglobata 0.0
427 Osteoarthritis 0.0
428 Penis Carcinoma 0.0
429 Goiter 0.0
430 Meniere disease 0.0
431 Oropharyngeal cancer 0.0
432 Obstructive cervical goiters 0.0
433 Toxic multinodular goiter 0.0
434 Diffuse nontoxic goiter 0.0
435 Cervical goiter 0.0
436 Pulmonary regurgitation 0.0
437 Hodgkin lymphoma 0.0
438 Myoclonus 0.0
439 Discogenic low back pain 0.0