Haemodynamics: Budd-Chiari syndrome: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haemodynamics: Budd-Chiari syndrome

Sample item

A 32-year-old woman with polycythaemia vera develops painful hepatomegaly and rapidly accumulating ascites. Doppler shows no flow in the hepatic veins. Which histological finding is expected in the liver?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Centrilobular congestion with sinusoidal dilatation and haemorrhagic necrosis

Hepatic vein thrombosis obstructs outflow, so blood backs up into the central veins and zone 3 sinusoids. Centrilobular congestion, hepatocyte atrophy and haemorrhagic necrosis follow, and fibrosis develops with time. Myeloproliferative disorders such as polycythaemia vera and paroxysmal nocturnal haemoglobinuria are important causes.

Option by option

  • A. Centrilobular congestion with sinusoidal dilatation and haemorrhagic necrosis (correct)

    Correct. Outflow obstruction produces a centrilobular congestive and haemorrhagic pattern.

  • B. Loss of interlobular bile ducts with granulomatous cholangitis

    Bile duct loss with granulomatous cholangitis is primary biliary cholangitis, not a thrombotic disorder.

  • C. Periportal piecemeal necrosis with a dense plasma-cell infiltrate

    Piecemeal necrosis with plasma cells is autoimmune hepatitis, a periportal inflammatory disease.

  • D. Periportal Mallory-Denk bodies with micronodular cirrhosis

    Mallory-Denk bodies with cirrhosis indicate alcoholic liver disease, which is not suggested by the history.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Centrilobular congestion with sinusoidal dilatation and haemorrhagic necrosis. Hepatic vein thrombosis obstructs outflow, so blood backs up into the central veins and zone 3 sinusoids.

Why is "Loss of interlobular bile ducts with granulomatous cholangitis" not the answer?

Bile duct loss with granulomatous cholangitis is primary biliary cholangitis, not a thrombotic disorder.

Why is "Periportal piecemeal necrosis with a dense plasma-cell infiltrate" not the answer?

Piecemeal necrosis with plasma cells is autoimmune hepatitis, a periportal inflammatory disease.

Why is "Periportal Mallory-Denk bodies with micronodular cirrhosis" not the answer?

Mallory-Denk bodies with cirrhosis indicate alcoholic liver disease, which is not suggested by the history.

What concept does this question test?

It tests Haemodynamics: Budd-Chiari syndrome in Pathology. Centrilobular congestion, hepatocyte atrophy and haemorrhagic necrosis follow, and fibrosis develops with time. Myeloproliferative disorders such as polycythaemia vera and paroxysmal nocturnal haemoglobinuria are important causes.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haemodynamics: Budd-Chiari syndrome?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.