New Criteria for HRS 1. Cirrhosis with ascites 2. Serum creatinine >1.5mg/dl 3. No sustained improvement in renal function after 2 days of diuretic withdrawl (if on diuretics) and volume expansion with albumin infusion at 1 gm/kg/day upto a maximum of 100 gm/day. 4. No evidence of shock 5. No…
Tag: Gastrointestinal system
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Ascitic Fluid Analysis : How to come to diagnosis?
We have already discussed about the practical essentials about Ascitic Paracentesis including absolute contraindications, site of needle entry and appropriate volume replacement. Laboratory analysis of ascitic fluid may provide answers to important clinical questions, as its composition varies depending on the underlying cause. Gross Special test WBC (/mm³) – most useful PMN…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Interpreting Hepatitis B Serology in 5 Easy steps
Hepatitis B surface antigen (HBsAg) Appears during incubation period (1-6 months), 2-7 weeks prior to symptoms. Peaks when the patient is most ill. Becomes undetectable in 3-6 months. Indicates infection – recent or chronic. Hepatitis B surface antibody (anti-HBs or HBsAb) Arises once the acute disease has resolved. Sometimes, not…
Clinical Skills and Approaches 
Percussion of Spleen
Traube’s semilunar space Borders: Superiorly: Left 6th rib superiorly Laterally: Left midaxillary line or Left anterior axillary line Inferiorly: Left costal margin Method: Patient’s position: supine with left arm slightly abducted. Percuss: from medial to lateral Interpretation: Resonance (Normal) and Dullness (Splenomegaly) Also: Pleural effusion or mass in stomach may…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Cholangiocarcinoma (Bile Duct Cancer) – Quick Review
This article is in response to the request made by a reader in the comment section. Today, we will try to simplify the biliary tree cancers. Classification of Cholangiocarcinoma Second-order bile ducts act as the separation point between intrahepatic and extrahepatic cholangiocarcinoma. A. Inhtrahepatic – 10 to 20% B. Extrahepatic…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Liver Segments Explained with Mnemonic
Couniaud divided liver into 8 functional segments, each of which is supplied by it’s own portal triad (composed of a portal vein, hepatic artery and a bile duct). Hepatic veins divide the liver in saggital plane: 1. Middle hepatic vein: Divides the liver into right and left functional lobe. 2….
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Child Pugh Score: Mnemonic and Explanation
The Child-Pugh-Turcot (CTP) score consists of 5 clinical features and is used to assess the prognosis of chronic liver disease and cirrhosis. Mnemonic: A BEAP Albumin (gm/dl) Bilirubin (mg/dl) Encephalopathy (Based on West Haven Criteria) Ascites Prothrombin Time (PT) Prolonged or INR Child-Pugh-Turcot Score Factor 1 point 2 points 3…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
TNM and Staging of Gastric Carcinoma Simplified
Unique features of stomach in relation to TNM cancer classification 1. Cancer penetrates the muscular propria and invades the ligaments (gastrohepatic and gastrocolic, i.e. lesser and greater omentum respectively) subserosally without breeching the serosa. Gastric cancer invasion of the lesser and greater omentum is T3, not T4. Perforation of the…