Approach to the patient with liver disease

Question 1

At what level of bilirubin does jaundice appear visible

Answer 1

34-43umol

Question 2

Symptoms of an acute onset may result from what 4 things

Answer 2

Acute vascular event
toxic cause
obstruction of the biliary system
acute infection

Question 3

Symptoms of a more chronic onset may result from what

Answer 3

A chronic inflammatory process

Question 4

If colicky pain is exacerbated by eating what might this indicate

Answer 4

A biliary cause for jaundice

Question 5

What often occurs in alcoholic liver disease, chronic hepatitis and cancer

Answer 5

Gradual onset of anorexia and malaise

Question 6

What 4 symptoms might indicate hepatic encephalopathy

Answer 6

Disturbances of consciousness,
personality changes
intellectual deterioration
changes in speech

Question 7

What increases the risk of steatohepatitis

Answer 7

A history of obesity

Question 8

What increases the risk of steatohepatitis

Answer 8

A history of obesity

Question 9

Are all diseased livers enlarged

Answer 9

No

Question 10

What is a small liver common in

Answer 10

cirrhosis

Question 11

What does a hard and lumpy liver often suggest

Answer 11

Metastases

Question 12

What does a tender liver suggest

Answer 12

Hepatitis
Hepatocellular cancer
hepatic abscess

Question 13

What might enlargement of the spleen and liver suggest

Answer 13

chronic liver disease with portal hypertension, hepatosplenomegaly

Question 14

What should be tested in suspected hepatitis

Answer 14

initial diagnostic serological screen
Heaptits A,B and C serology
Autoimmune screen to include antinuclear antibodies (ANA), antimitochondrial antibodyes (AMA) smooth muscle antibodies (SMA) and liver/ kidney microsomal antibody type 1 in the younger patient

Question 15

What is commonly elevated in alcoholic liver disease

Answer 15

IgA

Question 16

What is commonly elevated in primary biliary cirrhosis

Answer 16

IgM

Question 17

What is the first imaging test used in suspected liver architecture

Answer 17

Ultrasound

Question 18

What is the commonest scoring system used for scoring the severity of liver disease

Answer 18

Child-Pugh scoring system

Question 19

What is the purpose of the Child-Pugh score?

Answer 19

It is predictive of prognosis and useful in determining the required strength of treatment and the necessity of liver transplantation

Question 20

What is the purpose of the Child-Pugh score?

Answer 20

It is predictive of prognosis and useful in determining the required strength of treatment and the necessity of liver transplantation

Question 21

How is the Child-Pugh score calculated

Answer 21

Using the total bilirubin
serum albumin
INR
degree of ascites 
grade of hepatic encephalopathy