Question 22.1

Created on Sun, 05/24/2015 - 21:55
Last updated on Sat, 10/24/2015 - 23:02
Pass rate: 49%
Highest mark: ?

Other SAQs in this paper

Other SAQs on this topic

A 45 year old man received an allogeneic bone marrow transplant for Acute Lymphatic Leukaemia. 26 days after the transplant the patient developed severe gastroenteritis and a maculopapular skin rash and respiratory insufficiency.
The following investigations were performed:

Hb

94 G/L

(110-150

Na (mmol/L)

132

135-145

WCC

2.3 x 109/L

(4.0-10.0)

K ( mmol/L)

3.4

3.5-.5.0

Platelets

54  x 109/L

(150-300)

Urea (mmol/L)

8.2

4.0-6.0

Creatinine (mmol/L)

0.1

0.04-0.12

Bilirubin (micromol/L)

67

<25

Alkaline phosphatase

265

<125

ALT

51

<40

AST

40

<40

Coagulation profile - normal

Stool:              Microscopy: WCC ++            Cultures: No growth
C.difficile  toxin- Not detected

a) List 3 possible diagnoses.

Over the next 3 weeks, the patient developed generalized oedema predominantly in the trunk and lower extremities. An ultrasound Doppler study of the abdomen revealed dilated  portal vein and inferior vena cava. The right atrial pressures were normal.

Portal pressure 18 mm Hg (8 – 10)

Infrahepatic IVC 20 mm Hg (9-11)

Hepatic  vein 8 mm Hg (9-10)

Suprahepatic IVC 8 mm Hg (7-8)

Right atrium    6 mm Hg

b) What  is the likely explanation for these findings?

c) Name 2 treatment measures for the diagnosis in b)

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College Answer

a) List 3 possible diagnoses.

Sepsis CMV GVH

b) What  is the likely explanation for these findings?

Veno-occlusive disease of the liver

c) Name 2 treatment measures for the diagnosis in b)

TIPS procedure
Diuretics 
Fluid restriction

Discussion

This question closely resembles Question 26.2 from the first paper of 2013.