Chronic Liver Disease

Question 1

What drugs can raise Gamma GT levels?

Answer 1

NSAIDS

Question 2

What blood tests indicate liver function?

Answer 2

Prothrombin

Albumin

Question 3

What blood test is an indirect marker of portal hypertension?

Answer 3

Platelet count as indicates hypersplenism from cirrhosis

Question 4

What can endoscopic Ultrasound be used for?

Answer 4

Characterising pancreatic masses
Staging of tumours
Fine needle aspirate (FNA) of tumours and cysts
Excluding biliary microcalculi

Question 5

What liver diseases can lead to cirrhosis?

Answer 5

Alcohol
Autoimmune – autoimmmune hepatitis, PBC (Primary Biliary cholangitis), PSC (Primary Sclerosing Cholangitis)
Haemochromatosis
Chronic Viral hepatitis: B & C
Non-alcoholic fatty liver disease (NAFLD)
Drugs (MTX, amiodarone)
Cystic fibrosis, a1antitryptin deficiency, Wilsons disease,
Vascular problems (Portal hypertension + liver disease)
Cryptogenic
Others: sarcoidosis, amyloid, schistosomiasis

Question 6

What tests should initially be done on an abdominal paracentesis of ascites?

Answer 6

Protein & albumin concentration
Cell count and differential
SAAG (serum-ascites albumin gradient)

Question 7

What does a high grade albumin gradient indicate?

Answer 7

>1.1 g/dl
 Portal hypertension
 CHF
 Constrictive pericarditis
 Budd Chiarri
 Myxedema
Massive liver metastases

Question 8

What does a low grade albumin gradient indicate?

Answer 8

< 1.1 g/dl
 Malignancy
 Tuberculosis
 Chylous ascites
 Pancreatic
Biliary ascites
Nephrotic syndrome
 Serositis

Question 9

How are varices managed?

Answer 9

Endoscopic band ligation
Add Terlipressin for control
Sengstaken-Blakemore tube for uncontrolled bleeding
TIPSS for rebleeding after banding

Question 10

What is the tumour marker for hepatocellular carcinoma?

Answer 10

AFP