achilles
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A 58-year-old man with known hepatitis C and cirrhosis complains of worsening fatigue and confusion over the past 5 days. He has been admitted three times in the past 4 months for variceal bleeding and 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. On physical examination, he is gaunt and jaundiced. He has tense ascites and a liver span of 7 cm in the midclavicular line. Laboratory results reveal a white blood cell count of 4600/mm3, a hemoglobin of 9.4 g/dL, and a hematocrit of 29%. His electrolytes reveal a BUN of 34 mg/dL and a creatinine of 3.1 mg/dL. A urinary sodium is less than 10 mEq/L. Which of the following is the most appropriate treatment for his elevated BUN and creatinine?
A. Large volume paracentesis
B. Hemodialysis
C. Mesocaval shunt
D. Kidney transplantation
E. Liver transplantation
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| guayoman
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B.
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| Isther
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Well... for hepatorenal syndrome acute treatment will be with B.-hemodialysis... but the problem will recur until he gets a E.-Liver transplant... Can't decide among those.
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| Jinx
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this is hepatorenal syndrome which will not improve till the underlying cause--liver failure is treated
so answer is e--liver transplant
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| guayoman
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Which of the following is the most appropriate treatment for his elevated BUN and creatinine? The question is whether they need to know the most appropriate treatment or the most appropriate treatment at this time?
Remember that what the Q is saying is more important than what you think they mean. Most apropriate does not mean definitive. At least not in this case. I guess?
Edited by guayoman on 05/28/06 - 10:17 AM
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| wyvern
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Well definitive would be liver transplant but i think they mean what would you do now by most appropriate and that would be hemodialysis
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| guayoman
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I went to mother of all knoledge (Mrs. Harrison) and she said:
TREATMENT
Treatment is usually unsuccessful. Although some patients with hypotension and decreased plasma volume may respond to infusions of salt-poor albumin, volume expansion must be undertaken with caution to avoid precipitating variceal bleeding. Vasodilator therapy, including intravenous infusions of low dose dopamine, is not effective. While TIPS has been reported to improve renal function in some patients, its use can not be recommended. In appropriate candidates, the treatment of choice for hepatorenal syndrome is liver transplantation.
Copyright© 2001 McGraw-Hill. All rights reserved.
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| guayoman
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and in e-medicine they mention lots of vasoconstrictor treatments, some Surgical procedures included TIPS and tranpant as the definitive treatment.
I guess we were all wrong...ñuk ñuk ñuk
No hemodyalisis for hepatorenal sd.
Answer is E. Liver transplant
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| Isther
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Jejeje... thanks for the nice review guayoman... don't worry better to screw up here than in the hospital right? =D As long as the lesson in learned...
And I deserve at least 1/2 point...lol
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| achilles
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you guys came to the right answer to this one too. sorry guys for the late answers but i could'nt login yesterday.
the answer is e-liver transplantation and the explanation has already been given by guayoman.
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