Abdo

Question 1

What are the causes of chronic liver disease?

Answer 1

Most common:
1. Alcohol related liver disease
2. Viral hepatitis (Hep B/C, CMV EBV)
3. NAFLD

Others:
Autoimmune: AI hepatitis, PBC
Metabolic: Haemochromatosis, Wilson’s
Drugs: Methotrexate, Amiodarone
Idiopathic

Question 2

Drugs causing chronic liver disease

Answer 2

Amiodarone and Methotrexate

Question 3

What investigations required for chronic liver disease?

Answer 3

FBC, U&E, AST/ALT, GGT, Split bili
Clotting
HepB/C EBV CMV
Ferritin
Autoantibodies: ANA, AMA, AntiLKM, smooth muscle
Caeruloplasmin
Alfa 1 antitrypsin
AFP

Abdominal US
Fibroscan (Elostogram)
MRCP

Question 4

What is the treatment of cirrhosis

Answer 4

Alcohol abstinence
Vitamin/Thiamine
Salt restriction
Diuretics (Spiro + fruse)
Laxative (Lactulose)

Question 5

Complications of chronic liver disease/Cirrhosis

Answer 5

Ascites
SBP
Hepatic encephalopathy
Varices /Variceal bleeding
Hepatorenal syndrome

Question 6

Signs of decompensation in liver disease

Answer 6

Portal hypertension /ascites
bleeding varices
Hepatic encephalopathy (Asterixis)

Question 7

Causes of ascites

Answer 7

1. Chronic liver disease /Cirrhosis
2. Nephrotic syndrome
3. Congestive cardiac failure
4. Malignancy / infection

Question 8

How do you assess ascitic tap result?

Answer 8

Serum ascites albumin gradient
if > 1.1 transudate
if < 1.1 Exudate (Malignancy or infection (TB), pancreatitis)

Question 9

What are the prognostic scores of cirrhosis?

Answer 9

UK MELD
Child-Pugh score

Question 10

Management of ascites refractory to drainage/medical management?

Answer 10

TIPS
Liver transplant

Question 11

Complication of TIPS?

Answer 11

encephalopathy

Question 12

Peripheral signs of chronic liver disease?

Answer 12

Clubbing
Palmar erythema
Dupuytren’s contracture
Jaundice
Spider naevi
Gynaecomastia
Splenomegaly

Question 13

Causes of bilateral enlarged kidneys

Answer 13

ADPCKD
Tuberous sclerosis (angiomyolipomas)
Von hippel lindau syndrome (B/l RCC)

Question 14

What are the side effects of steroids?

Answer 14

cushingoid appearance
thinning of skin
easy bruising
hyperglycaemia

Question 15

Side effects of cyclosporine?

Answer 15

Hirsutism
Gingival hyperplasia

Question 16

Side effects of tacrolimus?

Answer 16

Tremor
Post-transplant diabetes

Question 17

What immunosuppressives are used for kidney transplant?

Answer 17

Steroids
Calcineurin inhibitors (Tacrolimus / ciclosporin)
MMF

Question 18

What are the 2 genes causing ADPCKD

Answer 18

PKD 1 and 2 gene mutations

Question 19

What are the indications of nephrectomy in PKD

Answer 19

recurrent infection
chronic flank pain
renal cell carcinoma

Question 20

Treatment of PKD?

Answer 20

1. BP management (ACE-inh)
2. Sodium restriction
3. Tolvaptan

Question 21

Causes for liver transplant

Answer 21

Cirrhosis of any cause
HCC
Acute fulminant liver failure

Question 22

Contraindications for liver transplant

Answer 22

• Ongoing alcohol intake
• Drug use
• Psych disease could affect compliance with immunosuppression
• Medical conditions that would affect survival ie other malignancy.

Question 23

Criteria to list for liver transplant

Answer 23

1. chronic liver disease AND high UK end-stage liver disease (UKELD) score
2. Low UKELD score AND a specific situation like diuretic resistant ascites

Question 24

Causes of jaundice

Answer 24

1. Pre-hepatic: Haemolysis
2. Hepatic: