gastro

Question 1

Indications for TIPS (What is it? How it works)

Answer 1

Oseophageal varices in an otherwise healthy candidate
Ascites refractory to diuretics
Trasnjugular intrahepatic portosystemic shunt. Access IVC to place shunt between hepatic vein and portal vein- decreases pressure in portal vein

Question 2

Kings College criteria for liver transplant

Answer 2

If Paractemaol OD:
pH100 s, Grade IV /IV encephalopthay; And Creat>300
If non paracetamol liver failure:
PT>100s, or any 3 of Age (less than 10 or greater than 40), jaundice before encephalopathy of >7 days, unfavourable diease eitology (non hep viral, drug reaction etc), PT>50,Bili >300

Question 3

MELD score- Use? Components?

Answer 3

Initially developed as system to predict survialv after TIPS. Now used to prioritise who should get Liver trnaspant and prognosis of liver disease
Bili; INR; Creat

Question 4

Octreotide versus terlipressin in liver cirrhosis

Answer 4

Inidcations: esophageal varices
octreotide: somatostatin analog- inhibits release of glucagon (which is a vasodilatory hormone)
terlipressin: appears to have more sustained hemodynamic effect- both for stable varice and bleeding varices.

Question 5

Type 1 versus type 2 hepatorenal syndrome

Answer 5

Type 1: two fold increase in serum creatine in less than 2 weeks
Type 2: renal impairment less severe than in type 1. Ascites resistant to diuretics

Question 6

What was child pugh score created For ? Components of Child Pugh Score

Answer 6

Initially to asses risk of non-shunt surgery. Now used to predict mortality (Child A- 100%, Child C- 45% at one year)
INR/PT, Bilirubin, Creatinie, Ascites, Encephalopathy