Gastroenterology Education and CPD for trainees and specialists

1. Which one of the following statements regarding Hepatorenal syndrome (HRS) is false?

1. HRS only happens on background of chronic liver disease
2. Vasodilatation in splancnic circulation due to NO release
3. Insufficient cardiac output leading to effective hypovolaemia
4. Renal vasoconstrictinon because of activation of renin-angiotensin axis
5. Kidney from patients with HRS can be transplanted successfully

Explanation :Sinusoidal portal hypertension, in the presence of severe hepatic decompensation leads to splanchnic and systemic vasodilatation with release of NO. As a result effective arterial blood volume decreases leading to activation of systemic vasoactive factors, such as the renin-angiotensin system, the sympathetic nervous system, and vasopressin aimed at restoring arterial filling pressure. Renal vasoconstriction occurs which increases concomitantly (leukotrienes and endothelins), counterbalanced by the intrarenal hyperproduction of vasodilating prostaglandins. When this balance is lost renal hemodynamics worsens, and hepatorenal syndrome develops. HRS is a potentially reversible syndrome that occurs in patients with cirrhosis, ascites and liver failure, as well as in patients with acute liver failure or alcoholic hepatitis

2. Which one of the following statements regarding Hepatorenal syndrome (HRS) is true?

1. No improve of creatinine with fluid challenge
2. Both in prerenal azotaemia and HRS -Urinary spot Na remains low <10
3. Urinary spot Na is high in ATN ( acute tubular necrosis) >30
4. Urine sediment test is positive in ATN
5. All of the above

3. Which one of the following statements regarding Hepatorenal syndrome (HRS) is true?

1. Kidneys in HRS are histologically normal
2. Terlipressin only is inferior to terlipressin and albumin in treatment of HRS
3. Albumin administration in SBP (spontaneous bacterial pertonitis) lowers the incidence of HRS
4. Terlipressin may induce ischaemic side effects and arrhythmia
5. All of the above- TRUE

Gastroenterology training and education

MCQ On Hepatorenal syndrome

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