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Pathology

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Liver & Gall Bladder

Question
22 out of 45
 

Mr Satish a 58-year-old man with known case of hepatitis C and cirrhosis complains of worsening confusion over the past 5 days. He has had ascites that has been refractory to high-dose oral diuretic use. He also reports that over the past 48 hours he has had a declining urinary output. Lab results reveal a WBC of 4600, BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary sodium is less than 10 mEq/L. Most appropriate treatment for his elevated BUN and creatinine is? (AIIMS Nov 2013)



A Large volume paracentesis

B Hemodialysis

C Mesocaval shunt

D Liver transplantation

Ans. D Liver transplantation

a. This patient with well advanced cirrhosis and portal hypertension has developed the onset of renal insufficiency consistent with hepatorenal syndrome.

b. This occurs during the end stages of cirrhosis and is characterized by diminished urine output and low urinary sodium.

c. In the setting of end-stage liver disease, renal vasoconstriction occurs, and the distal convoluted tubule responds by conserving sodium.

d. Liver transplantation will reverse this vasoconstriction and kidney function will return to normal.

e. A large volume paracentesis may relieve the ascites but will have no significant benefit on the impaired renal function.

f. Renal transplantation is of no value in this patient since the underlying lesion is in the liver; the kidneys will return to normal function if there is improvement in hepatic function.

Liver & Gall Bladder Flashcard List

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