Color Tie Goes Grey Shirt

Hepatology


Which of the following parameters NO is an indicator of severity in acute hepatitis?:

1. total bilirubin greater than 15 mg / dL.
2. prothrombin time more than 4 seconds the normal limit.
3. hepatic encephalopathy.
4. hypoglycemia.
5. transaminase, alanine aminotransferase (ALT)

This question is important to note asking us indicators of severity in acute hepatitis. The Child-Pugh criteria included serum bilirubin, prothrombin time, presence of encephalopathy of hepatic origin, serum albumin levels, degree of ascites, and NOT include hypoglycemia or transaminase levels among their criteria, but CARE : ChildPugh NO is a classification of severity of acute hepatitis, but chronic liver diseases. It is unclear what type of acute hepatitis are speaking: viral, alcoholic, toxic ... In acute alcoholic hepatitis using the Maddrey index to discriminate patients who benefit from treatment with corticosteroids. Including prothrombin time and bilirubin levels. Hepatic encephalopathy revealed severe acute hepatitis, and gravity data. Hypoglycaemia in acute hepatitis liver failure data, and often appears in acute fulminant hepatitis, then if that criterion is likely to be considered seriously. Transaminase levels do not reveal more severe acute hepatitis. (Option 5 FALSE) .


Sick of 48 years diagnosed with alcoholic liver cirrhosis we have been monitoring for years. Has failed stop drinking alcohol. 2 years ago ascites, worsening responds to diuretics. At the present time takes 120 mg / day of furosemide, 300 mg / day of spironolactone and has tense ascites. Stresses analytically Na 121 mEq / l, K 4.7 mEq / L and creatinine 1.6 mg / dl. What is the most correct therapeutic approach at the present time?:

1. propose dispatching priority liver transplant program.
2. Establish a system of regular evacuatory paracentesis with colloid replacement.
3. insert a TIPS.
4. To further doses of diuretics.
5. Manage overload to force hypertonic saline diuresis.

Question challenged. In a patient who drinks alcohol can certainly make periodic paracentesis but increase more TIPS survival much more effectively and try ascites. There bibilografía that supports the superiority of TIPS over the serial paracentesis. RIGHT at the end were for option 2. Option 1 is FALSE because transplantation is contraindicated if you are still drinking the shortage of organs and the possibility of improvement of portal hypertension with abstinence from alcohol. The withdrawal does not, however, no contraindication to the performance of a TIPS.


(questions 40 and 41 of simulation 4. Amir.)