a) ALPPS should not be considered in every patient in whom PVE has failed.
b) CT scan and volumetric assessment is done after POD 7 and proceeded to stage 2 if sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality
c) Indicated for Large CRLM
d) Is a relative contraindication for patients with hilar cholangiocarcinoma
Ans a) ALPPS should be considered in every patient in whom PVE or the classic two-stage approach is not feasible or has failed
The limits for safe hepatic resections are usually considered from 20% to 40%, depending on the quality of liver parenchyma (fibrosis, steatosis,
chemotherapy-related liver injury). The lower limit for FLRV is set at 20% in patients with normal livers, 30% to 35% in patients with chemotherapy-related liver injury, and 40% in patients with chronic liver disease
Cut-off values for proceeding to stage 2, usually after 7 to 14 days, are sFLR greater than 30% (BWR > 0.5%) or 40% (BWR > 0.8%) depending on parenchymal quality. ( Ref BG page 1665)
Currently,CRLM is the most promising indication, especially for bilobar involvement
In hilar cholangiocarcinoma its a relative contraindication as the mortality and morbidity are high
Postoperative pulmonary complications occur in approximately 6% of patients after major abdominal operations and
It includes pneumonia/infection, respiratory failure requiring prolonged ventilation, exacerbation of chronic obstructive pulmonary disease (COPD), and lobar/parenchymal collapse with or without associated effusion.
More recently, standard patient care protocols (e.g., iCough) have been developed to decrease the risk of pulmonary complications, which include incentive spirometry, coughing and deep breathing, oral care
(brushing teeth and using mouthwash), elevating the head of bed,
and getting out of bed three times a day.
Q) Which of the following is not characteristic of Crohn Disease : * (From AIIMS 2020 November GI)
a) Granular mucosa b) Transmural involvement c) Skip lesions d) Giant cell granuloma
Ans a ) Granular Mucosa- This is a feature of ulcerative colitis ( Table 49-7 Sabiston 20)
The typical gross appearance of ulcerative colitis is hyperemic mucosa. Friable and granular mucosa is common in more severe cases, and ulceration may not be readily evident. ( Saby 1340)
IN Crohn disease - Microscopically, there are focal areas of chronic inflammation involving all layers of the intestinal wall with lymphoid aggregates. Non-caseating giant cell granulomas are found in 60% of patients and when present clearly allow a confident diagnosis of CD.
a) It corelates with cirrhosis b)Range of sodium value is 125-137 c)It relates to vasoconstriction d) Used for allocation in DDLT patients
MELD was originally developed to predict three-month mortality following transjugular intrahepatic portosystemic shunt (TIPS) placement and was derived using data from a population of 231 patients with cirrhosis who underwent elective TIPS placement.
Range of MELD score is 6-40
MELD Score = 10 x (0.957 x Ln(serum creatinine mg/dL) + 0.378 x Ln(serum bilirubin mg/dL) + 1.120 x Ln(INR) + 0.643 )
For candidates with an initial MELD score greater than 11, the MELD score is then re-calculated as follows: MELDNa = MELD(i) + 1.32*(137-Na) - [0.033*MELD(i)*(137-Na)]
Sodium values less than 125 mmol/L will be set to 125, and values greater than 137 mmol/L will be set to 137.
It is used for allocation in DDLT to assess wait list mortality
MELD score has also proved to be an effective predictor of outcome in other situations, such as
Patients with cirrhosis going for surgery and patients with fulminant hepatic failure or alcoholic hepatitis.
The MELD score does have limitations in situations where the INR or creatinine may be elevated due to reasons other than liver disease, and its implementation for organ allocation purposes does not take into consideration several conditions that benefit from liver transplantation.
Q) Smoking cessation- Not a first line drug option ?
b) Nicotine replacement (patches)
Ans A) clonidine
NRT , varenicline (Chantix), and bupropion (Zyban) are the three principal firstline pharmacotherapies recommended for use either alone or in combination
Clonidine and nortriptyline—as second-line pharmacotherapies for tobacco dependence typically used when a smoker cannot use first-line medications due to either contraindications or lack of effectiveness.