Gastrointestinal

Question 1

MELD score components

Answer 1

end-stage liver disease prognosis
bilirubin, creatinine, INR and sodium and dialysis need

Question 3

Liver cirrhosis monitoring

Answer 3

MELD score every 6 months
Ultrasound and alpha-fetoprotein every 6 months for hepatocellular carcinoma
Endoscopy every 3 years for oesophageal varices

Question 4

Ascites in cirrhosis is

Answer 4

transudative (low protein)

Question 5

Managment for ascites due to liver cirrhosis

Answer 5

Low sodium diet
Aldosterone antagonists (e.g., spironolactone)
Paracentesis (ascitic tap or ascitic drain)
Prophylactic antibiotics (ciprofloxacin or norfloxacin) when there is <15 g/litre of protein in the ascitic fluid
Transjugular intrahepatic portosystemic shunt (TIPS) is considered in refractory ascites
Liver transplantation is considered in refractory ascites

Question 6

Managment of hepatic encephalopathy

Answer 6

Lactulose (aiming for 2-3 soft stools daily)
Antibiotics (e.g., rifaximin, metronidazole, neomycin) to reduce the number of intestinal bacteria producing ammonia
Nutritional support (nasogastric feeding may be required)

Question 7

Complications of liver cirrhosis

Answer 7

Malnutrition and muscle wasting
Portal hypertension, oesophageal varices and bleeding varices
Ascites and spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatic encephalopathy
Hepatocellular carcinoma

Question 8

AST:ALT suggestive of alcohol/related liver disease

Answer 8

> 1.5

Question 9

CAGE questions

Answer 9

C – CUT DOWN? Do you ever think you should cut down?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?

Question 10

Alcohol withdrawal complications

Answer 10

6-12 hours: tremor, sweating, headache, craving and anxiety
12-24 hours: hallucinations
24-48 hours: seizures
24-72 hours: delirium tremens