The Specialty certificate in Gastroenterology SCE covers the whole of the curriculum of the specialty training in gastroenterology in the UK. Preparation for this exam requires a wide breadth of knowledge around the curriculum . As knowledge is constantly advancing , awareness of current and updated guidelines is important.This blog is an attempt to pool all resources in one site with regular updates.
Dr Elmuhtady Said
Curriculum for Specialty Certificate Examination in Gastroenterology
A patient has abnormal aminotransaminase levels and suspected NAFLD based on negative results of serum tests for liver pathogens or other infectious agents and imaging studies to evaluate for other liver diseases. What is the best rationale for performing a percutaneous liver biopsy in this patient?
1-To exclude occult iron overload disorders 2-To counsel the patient on the possible risk of future complications 3-To establish the diagnosis 4-To identify the most appropriate pharmacotherapeutic approach
There is no need for further testing to establish the diagnosis and no pharmacologic intervention is effective in cases of NAFLD. In these cases, biopsy is performed to stage the disease and help establish a prognosis. Large prospective studies are needed to define the natural history of NAFLD, but emerging evidence confirms that NAFLD can be progressive and associated with significant morbidity and mortality in some patients. The risks of liver-related morbidity and mortality are greatest in those with evidence of advanced NAFLD (steatohepatitis with necrosis and fibrosis) on the initial liver biopsy specimen. If clinical and biochemical risk factors for progressive disease can be established, a subset of patients can be identified in whom a liver biopsy will have the greatest prognostic and therapeutic value. For example, older age, obesity, diabetes mellitus, and an AST-to-ALT ratio greater than 1 were demonstrated in one study to be significant predictors of severe fibrosis (bridging/cirrhosis) in patients with NAFLD.
A patient has abnormal aminotransaminase levels and suspected NAFLD based on negative results of serum tests for liver pathogens or other infectious agents and imaging studies to evaluate for other liver diseases. What is the best rationale for performing a percutaneous liver biopsy in this patient?
ReplyDelete1-To exclude occult iron overload disorders
2-To counsel the patient on the possible risk of future complications
3-To establish the diagnosis
4-To identify the most appropriate pharmacotherapeutic approach
There is no need for further testing to establish the diagnosis and no pharmacologic intervention is effective in cases of NAFLD. In these cases, biopsy is performed to stage the disease and help establish a prognosis. Large prospective studies are needed to define the natural history of NAFLD, but emerging evidence confirms that NAFLD can be progressive and associated with significant morbidity and mortality in some patients. The risks of liver-related morbidity and mortality are greatest in those with evidence of advanced NAFLD (steatohepatitis with necrosis and fibrosis) on the initial liver biopsy specimen. If clinical and biochemical risk factors for progressive disease can be established, a subset of patients can be identified in whom a liver biopsy will have the greatest prognostic and therapeutic value. For example, older age, obesity, diabetes mellitus, and an AST-to-ALT ratio greater than 1 were demonstrated in one study to be significant predictors of severe fibrosis (bridging/cirrhosis) in patients with NAFLD.