Significance of MELD Scoring in Liver Transplant

Q) The significance of MELD Scoring in Liver transplant is :

a) Less ill patients are given more priority in liver transplant

b) Set threshold for patients who are too ill to undergo transplant.

c) To access  mortality in the waiting list.

d) To list patients in cadaveric deceased donor program

Answer Free 

d

MELD score takes into account  three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS. 
It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).

In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.

Sicker patients are given priority

Duodenal atresia

Question on Duodenal atresia was asked in AIIMS 2017 in April

Q) An infant presents with duodenal atresia. Which of the following is true about this condition?

a) It is the most common GI atresia

b) It presents soon after birth with non bilious vomiting

c) Pre natal detection of duodenal atresia is common

d) Gastro jejunostomy is the procedure of choice to bypass the obstruction

Answer (free) 

C- Commonly detected in the pre natal ultrasound

Duodenal atresia is seen in 1:5000 live births and most common atresia is jejunoileal (1in 2000). It is associated with lot of other congenital malformations like Down's,  prematurity, biliary atresia etc.

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Appendicitis in Pregnacy

Q) Which of the following statement is true about appendicitis in pregnancy?

a) Typical symptoms of appendicitis  are seen in more than 90% of patients.

b) 50% cases of appendicitis occur in 2nd trimester

c) Rate of negative explorations remain low based on clinical presentation alone

d) The sensitivity and specificity of ultrasound diagnosis remain the same in appendicitis in pregnancy

Answer b

Appendicitis  the most common non obstetric emergency in pregnancy. The diagnosis is difficult because the symptoms of pain abdomen, nausea, vomiting, anorexia, raised TLC are common in pregnancy. Appendicitis has a typical presentation in only 50% to 60% cases.

If untreated preterm labor and even fetal loss can occur due to the complications.

Based on clinical presentation alone, the incidence of negative exploration is as high as 25-50%

Ultrasound with graded compression is still a good imaging option but has lower sensitivity and specificity than in normal clinical situation. If ultrasound is equivocal the next best option is MRI which is safe.

Ref Sabiston 20th edition