Gastro

Question 1

What are the signs of portal HTN?

Answer 1

Ascites
Splenomegaly
Porto-systemic anastamoses: varices, caput medusae

Question 2

Definition of portal HTN?

Answer 2

Portal pressure >10mmHg

Question 3

What are the causes of portal HTN?

Answer 3

Pre-hepatic = hepatic venous thrombosis

Hepatic = cirrhosis

Post-hepatic = cardiac congestion or Budd-Chiari

Question 4

What factors are calculated to measure the Child-Pugh Score

Answer 4

Albumin
Bilirubin
Clotting
Distension - ascites
Encephalopathy

Question 5

Mx of hepatorenal syndrome

Answer 5

Supportive

• IV albumin and terlipressin
• haemodialysis considered

Definitive
- Liver transplant

Question 6

What do you send off the fluid for in an ascitic tap?

Answer 6

Cytology - Ca + number on PMNs
Chemistry
Microbiology

Serum-Ascites Albumin Gradient (SAAG)

Question 7

Explain the Serum-Ascites Albumin gradient

Answer 7

SAAG >1.1 g/dL = high albumin in serum relative to ascites = transudate = cirrhosis

SAAG

Question 8

Mercedes Benz scar DDx

Answer 8

Liver transplant
Liver segment resection
Whipple’s pancreaticoduodenectomy.

Question 9

Definition of hypersplenism

Answer 9

Pancytopenia due to pooling and destruction within an enlarged spleen.

Question 10

What is the MELD Score?

Answer 10

Score used to stratify CLD for use in transplant planning.

Uses creatinine, bilirubin and INR.

Question 11

What are True-Love & Witts criteria for a severe acute flare of UC?

Answer 11

Symptoms

• > 6 stool movements/day
• PR bleed

Systemic

• temp >37.8
• HR >90

Bloods
- Hb 30

Question 12

Definitive imaging modality for hiatus hernia

Answer 12

Ba swallow