qs

Question 1

PBC ‘M rule’

Answer 1

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

Question 2

what indicates a significant upper GI bleed

Answer 2

HIGH UREA

-an upper GI bleed can act as a ‘PROTEIN MEAL’ + cause a temporary, ISOALTED, disproportionate rise in the blood urea

Question 3

Oral aminosalyclates

Answer 3

• Gastric SEs –> D, N, V + exacerbation of colitis
• Haematological SEs –> agranulocytosis
• In occasional cases, it can cause ACUTE PANCREATITIS. Pancreatitis is significantly more common as a SE with MESALAZINE than SULFASALAZINE

Question 4

What causes pancreatitis more mesalazine or sulfasalazine

Answer 4

7 times more common in patients taking mesalazine than sulfasalazine

Question 5

Hepatorenal syndrome patho

Answer 5

• Vasoactive mediators cause splanchnic vasodilation which in turn reduces the systemic vascular resistance –> ‘underfilling’ of the kidneys.
• This is sensed by the JGA which then activates the RAAS, causing renal VC which is not enough to counterbalance the effects of the splanchnic VD.

Question 6

HRS Type 1

Answer 6

• Rapidly progressive
• Doubling of serum creatinine to > 221 µmol/L or a halving of the creatinine clearance to less than 20 ml/min over a period of less than 2 weeks
• V poor prognosis

Question 7

HRS Type 2

Answer 7

• Slowly progressive

- Prognosis poor, but patients may live for longer

Question 8

HRS Mx

Answer 8

Management options:
-vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use
-They work by causing VC of the splanchnic circulation
volume expansion with 20% albumin
transjugular intrahepatic portosystemic shunt