Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

Hepatic Veno-Occlusive Disease 681

■sudden weight gain >2% of baseline body weight

■total serum bilirubin >2.0 mg/dL

■may correlate with subsequent development of renal insufficiency,

pleural effusion, cardiac failure, pulmonary infiltrates, bleeding.

■chronic form: similar to those of chronic BCS

tests

Laboratory

■basic studies: nonspecific elevation of aminotransferases, alkaline

phosphatase bilirubin, prothrombin time

Imaging

■Doppler flow studies: usually normal

■ultrasound: signs of portal hypertension (splenomegaly, ascites)

■hepatic venous pressure (measured by transjugular approach): very

specific for VOD if >10 mmHg

Liver Biopsy

■histologic features:

■nonthrombotic obliteration of small intrahepatic veins

■concentric subendothelial thickening

■thrombosis secondary to sclerosis

■perivenular and sinusoidal fibrosis

■centrilobar hepatocyte necrosis

■no single histologic feature pathognomonic

differential diagnosis

■graft-versus-host disease: rarely occurs before day 15 post-BMT

■drug toxicity: rarely causes ascites and hepatomegaly

■sepsis

■post-transfusion hepatitis: usually occurs later in the course

management

What to Do First

■evaluate pulmonary status and possible need for ventilatory support

■assess patient’s fluid status, possible bleeding and infection

■recognition of possible multiple organ failure

General Measures

■diuresis for fluid overload, platelet and RBCs as necessary

■broad-spectrum antibiotics to treat presumptive infection