Fibrolamellar carcinoma of the liver

Q) Fibrolamellar Carcinoma of the liver 

a) Occurs in the setting of cirrhosis

b) Has worse survival than Hepatocellular carcinoma

c) Can be followed up for long time

d) Seen in young females

Answer

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

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

 

Hemodynamic changes after pedicular clamping of Portal structures

Q) Which of the following hemodynamic  happens during pedicular clamping in liver transaction? 

a) Systemic vascular resistance decreases by 20%

b) Mean arterial pressure decreases

c) Cardiac index decreases by 10%

d) Preload to the heart increases

c-  Cardiac index decreases by 10%

Portal triad clamping is done to decrease blood loss during hepatic transaction. With the advancement in techniques in donor resection in living donor liver transplants, many centers are shifting away from this but in most centers this is still practiced.

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Contraindication of liver transplantation

Q)Contraindications of liver transplantation have changed over the years. Which is an absolute contraindication of  liver transplantation

a) Previous breast cancer

b) Portal vein thrombosis

c) Active tuberculosis

d) Active substance abuse

d

Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.

IN portal vein thrombosis, inflow to the new liver can me taken in many ways

a) thrombectomy

b) Jump grafts from Superior mesenteric vein 

c) Anastomosis have been done from big collaterals

Active tuberculosis can be managed after transplant.

Modified ATT regimens without INH and Rifampicin are being  used.  Any kind of active substance abuse alcohol,  drugs etc are absolute contraindications for liver transplant because the disease will recur.