A 25-year-old woman develops nausea, vomiting, and abdominal pain. On examination, she has tender hepatomegaly and ascites. She was recently started on oral contraceptives. The clinical diagnosis is?

Ans. A Budd-Chiari syndromeRef: CMDT 2019 page 726Budd-Chiari syndrome occurs from thrombosis of the major hepatic veins and has been associated with oral contraceptives. The main diagnostic features are* Right upper quadrant pain and tenderness* Ascites* Imaging studies show occlusion/absence of flow in the hepatic vein(s) or inferior vena cava* Clinical picture is similar in sinusoidal obstruction syndrome but major hepatic veins are patent.