Clinical Not Emphasized In Path

Question 1

Hemolysis Diagnostic Process (2)

Answer 1

CBC to look for anemia/thrombocytopenia

Check Haptoglobin, LDH and Reticulocyte count

Question 2

Gilbert Syndrome

Inheritance, Prognosis, Features (2)

Answer 2

Autosomal recessive
Benign

Slightly decreased UGT1A1 activity
Mildly increased unconjugated bilirubin

Question 3

Fulminant Hepatitis

Definition, Clinical Features (3) and Treatment (3)

Answer 3

Massive hepatic necrosis with encephalopathy within 8 weeks of onset

Rapidly rising bilirubin
PT/INR prolongation
Decreasing AST/ALT

Prophylactic antibiotics and Meticulous intensive care
Oral lactulose/neomycin
Liver transplant

Question 4

Ulcerative Colitis Extraintestinal Symptoms (6)

Answer 4

Pyoderma Gangrenosum
Ankylosing Spondylitis
Primary Sclerosing Cholangitis
Erythema Nodosum
Iritis/Uveitis
Oral Aphthous Ulcers

Question 5

Wernicke Korsakoff Syndrome

Etiology, Clinical Features (3), Prevention

Answer 5

Vitamin B1 (Thiamine) deficiency from alcoholism

Abnormal eye movements
Ataxia
Memory issues

Vitamin replacement prior to administering glucose to an alcoholic suffering from malnutrition

Question 6

Alcoholic Liver Disease

Adverse Prognostic Criteria (3) and Resultant Treatment

Answer 6

Maddrey’s Discriminant Function > 32
MELD Score > 20

Glucocorticoid treatment if either of above criteria met

Question 7

Shock Liver

Diagnostics (4), Etiology and Morphology

Answer 7

Increased BNP
Elevated AST/ALT
Elevated LDH
Hepatojugular reflex present

Congestive Heart Failure

Nutmeg liver

Question 8

Non-Cirrhotic Portal Hypertension

Etiologies (3) and Diagnosis

Answer 8

Portal V Thrombosis
Splenic V Obstruction
Schistomsomiasis

Ultrasound with contrast

Question 9

Ascites

Description (2), Diagnosis and Treatment

Answer 9

Pathologic accumulation of peritoneal fluid
At least 500 mL to be detected

Ultrasound with contrast

Paracentesis
(Also diagnostic for spontaneous bacterial peritonitis)

Question 10

Spontaneous Bacterial Peritonitis

Description (2), Diagnosis (2), Treatment (2)

Answer 10

Translocation of enteric bacteria
Monobacterial infection

> 250 PMN in ascites fluid
Most important test is WBC count with differential

Liver transplant (most effective)
Empiric antibiotics

Question 11

Budd Chiari

Pathogenesis (2), Morphology (2), Clinical Features (2) Diagnosis

Answer 11

Hepatic Vein obstruction from thrombosis
Causes outflow obstruction

Nutmeg liver
Caval webs

Associated with Hypercoagulable states
Tender hepatomegaly (RUQ pain)

Contrast enhanced Ultrasound