liver and diabetes

Question 1

Blood backing up into the round ligament from portal hypertension ->

Answer 1

caput medusa

Question 2

Patients with ascites and fever in the setting of chronic liver disease have…

Answer 2

spontaneous bacterial peritinitis

Question 3

investigations for suspected spontaneous bacterial peritinitis?

Answer 3

• septic screen
• ascitic fluid (> 250 PMNs)
• Gram stain, C&S, cytology, albumin

Question 4

how to calculate serum ascites albumin gradient?

Answer 4

Serum albumin - ascitic fluid albumin

Question 5

interpretation of serum ascites albumin gradient?

Answer 5

> 11g = high gradient = portal hypertension

<11 g = low gradient = other cause

Question 6

what is terlipressin?

Answer 6

analog of vasopressin

Question 7

managment of acute variceal bleed?

Answer 7

• ABCs
• hemodynamic rescus
• prophylactic anitbiotic (3rd gen cephalosporin)
• upper endoscopy
• Vasoactive meds (terlipressin, somatostatin, ocreotide)
• balloon tamponade

Question 8

management of NON ACUTE portal hypertension gastropathy?

Answer 8

• non selective beta blocker
• TIPSS
• liver transplantation

Question 9

management of ascites?

Answer 9

• diuretics
• sodium/fluid restriction
• paracentesis

Question 10

first line diuretics for ascites?

Answer 10

• spironolactone

- furosemide

Question 11

management of hepatic encephalopathy?

Answer 11

lactulose

rifamixin

Question 12

how do you screen patients with cirrhosis for HCC?

Answer 12

• alpha fetoprotein every 6 months

- liver ultrasound every 6 months

Question 13

what scoring system is used to grade cirhossis?

Answer 13

child pugh score

Question 14

what score on the child pugh indicates need to consider liver transplant?

Answer 14

> 7

Question 15

which scoring system is used to assess need for liver transplant in acute paracetomol overdose?

Answer 15

kings college

Question 16

first line treatment for primary biliary cholangitis?

Answer 16

ursodeoxycholic acid

Question 17

which antibodies are associated with type I diabetes?

Answer 17

anti-GAD65 and anti-islet antibodies

Question 18

normal fasting glucose

Answer 18

< 6

Question 19

impaired fasting glucose?

Answer 19

6-6.9

Question 20

fasting glucose in diabetes?

Answer 20

> 7

Question 21

normal OGTT?

Answer 21

<7.8

Question 22

impaired OGTT?

Answer 22

7.8-11.1

Question 23

diabetes OGTT?

Answer 23

> 11.1

Question 24

normal hba1c?

Answer 24

<41

Question 25

diabetic hba1c?

Answer 25

> 48

Question 26

which diabetes drug is associated with vitamin B12 deficiency?

Answer 26

metformin

Question 27

diagnostic criteria of DKA?

Answer 27

1. glucose > 11.1
2. ketones > 3
3. pH < 7.3 OR venous bicarb < 17

Question 28

when should you start K replacement in a patient with DKA?

Answer 28

when K is less than 5.5

Question 29

at what rate should you aim to decrease glucose in a patient with DKA?

Answer 29

3mmol/hour

Question 30

DKA is a ___coaguable state

Answer 30

hyper

Question 31

diagnosis of HHS?

Answer 31

Plasma Glucose > 33
Plasma osmolarity > 320
pH > 7.3

Question 32

how to calculate serum osmolality?

Answer 32

[2 x Na] + glucose + urea

Question 33

if corrected sodium in HHS is > ___ then use 0.45 % saline instead of normal

Answer 33

152

Question 34

how to get corrected sodium in HHS/

Answer 34

Plasma + glucose/4

Question 35

average fluid deficit in someone with HHS?

Answer 35

8-10 L

Question 36

For patients with HHS and DKA, glucose should be checked ___

Answer 36

hourly

Question 37

initial insulin for DKA or HHS?

Answer 37

actrapid IV 50 units, followed by IV infusion at 3 units/hr