What are the key clinical features that suggest a diagnosis of Budd-Chiari syndrome in a patient presenting with abdominal pain and ascites?

Key clinical features suggesting Budd-Chiari syndrome in a patient with abdominal pain and ascites include:

• Sudden onset or progressive right upper quadrant or epigastric abdominal pain due to hepatic venous outflow obstruction NICE CG165.
• Ascites, often tense, resulting from impaired hepatic venous drainage and portal hypertension NICE CG165.
• Hepatomegaly, which may be tender, reflecting liver congestion NICE CG165.
• Jaundice may be present, especially in acute or fulminant cases NICE CG165.
• Signs of portal hypertension such as splenomegaly and varices may develop in subacute or chronic presentations NICE CG165.
• Systemic features like fever and malaise can occur but are less specific Parekh et al. 2017.
• Laboratory findings often show elevated liver enzymes, particularly transaminases, and coagulopathy in severe cases Parekh et al. 2017.
• Imaging findings (not clinical but supportive) include hepatic vein thrombosis or obstruction on Doppler ultrasound or cross-sectional imaging, which confirm the diagnosis NICE CG165.

Thus, the combination of abdominal pain, ascites, hepatomegaly, and signs of hepatic venous outflow obstruction strongly suggests Budd-Chiari syndrome in the appropriate clinical context NICE CG165 Parekh et al. 2017.