Therefore, (D) is the most appropriate medication for prophylaxis in the prevention of variceal rebleeding.


21 C This patient is suffering from drug-induced liver cirrhosis secondary to chronic amiodarone therapy. Amiodarone (C) along with other drugs, such as methyldopa and methotrexate, are known to induce liver cirrhosis. Liver cirrhosis is characterized, histologically, by a loss of the normal hepatic architecture coupled with bridging fibrosis and nodular regeneration. The causes of liver cirrhosis include chronic alcoholism, non-alcholic steatohepatitis, chronic hepatitis B and C infections, autoimmune conditions (e.g. autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis), genetic disorders (e.g. haemachromatosis, Wilson’s disease), cryptogenic (in approximately 20 per cent), Budd-Chiari syndrome. In some cases, patients do not present with clinical signs although LFTs may show derangement. Some patients may show signs of chronic liver disease such as leuconychia, clubbing, palmer erythema, hyperdynamic circulation, Dupuytren’s contracture, spider naevi, xanthelasma, gynaecomastia, atrophic testes, loss of body hair, hepatomegaly (occurs in initial stages then shrinks in late disease).