Upper GI Bleed

Q What is the most common cause of upper GI Bleed in Cirrhotics

a) Portal Hypertension

b) Portal hypertensive gastropathy

c) Peptic ulcer disease

d) Mallory Weiss Syndrome

Answer

c- Peptic ulcer disease

Although patients with cirrhosis are at high risk of developing variceal bleeding, nonvariceal sources account for most upper GI bleeds, even in these patients. It is beacuse of the mortality of variceal bleeding associated with cirrhosis that in all patients with cirrhosis with UGIE early medical treatment is instituted.

In Cirrhosis more than 50% of upper GI bleed is caused by Non variceal cause.

Gastroesophageal varices develop in approximately 30% of patients with cirrhosis and portal hypertension and 30% in this group develop variceal bleeding. Compared with nonvariceal bleeding, variceal hemorrhage is associated with an increased risk of rebleeding, increased need for transfusions, longer hospital stay, and increased mortality.

References- 1. Sabiston textbook of surgery 19th edition

2. Rockey DC: Gastrointestinal bleeding. Gastroenterol Clin North Am 2005; 34:581-588.

Risk factors for alcoholic cirrhosis

Q Which of the following is not a risk factor for developing alcohol related cirrhosis

a) Duration and amount of alcohol

b) Genetic predisposition

c) Associated haemangioma

d) Body Mass Index

Answer

c

A duration of more than 10 years of daily drinking of more than 60 g of alcohol will cause cirrhosis in 10-40% people.

Body Mass Index (BMI) and genetic deficiency of alcohol metabolizing enzymes will speed up the process of developing cirrhosis

Spontaneous Bacterial Peritonitis

Q Which is not an indication to start an antibiotic in a patient with Cirrhosis for Primary Prophylaxis

a) Chronic Liver Failure (CLF) with ascites with ascitic fluid protein less than 1 mg%

b) Serum Bilirubin greater than 3.2 mg%

c) Platelet count more than 98000

d) Child's B cirrhosis

Answers

d) Risk factors for SBP in patients who have CLF include, a prior episode of SBP, an ascitic fluid protein concentration lower than 1.0 g/dL, and variceal hemorrhage.

Child Status alone has no role in dictating the use of primary prophylaxis