DIT 2

Question 1

findings in PBC besides fatigue and itching

Answer 1

skin - hyperpigmentaiton, xerosis
xanthomas/xanehtelasma
cirrhosis, jaundice, Malays, steatorrea

Question 2

two rheum markers PBC and lab findings

Answer 2

• antimitochondrial
• ANA
• elevated Alk phos/bili/cholesterol (later disease)

Question 3

PSC associated with….

Answer 3

UC

Question 4

lab markers PSC

Answer 4

pANCA
elevated alk phos
ANA NEGATIVE

Question 5

PSC increases risk for…

Answer 5

cholangiocarcinoma

Question 6

enzyme that conjugates bilirubin

Answer 6

UDPGT

Question 7

adolescent patient, mild asymptomatic jaundice that following exercise…dx and deficiency

Answer 7

Gilbert

increased indirect bilirubin 2/2 mild UDPGT deficiency

Question 8

neonate, severe neonatal jaundice, kernicterus, usually fatal

Answer 8

Crigler Najjar type 1 (evil) …severe UDPGT deficiency

milder form Crigler Najjar type 2 (presents in childhood/adolescence)

Question 9

rx crigler najjar 2

Answer 9

phenobarbital (increases UDGPT)

Question 10

extra hepatic manifestations Hep C

Answer 10

membranoproliferative glomeruloneph
mixed cryoglobulinemia
lymphoma
porphyria cutanea tarda
lichen planus
DM

Question 11

extra hepatic manifestations Hep B

Answer 11

membranous nephropathy

polyarteritis nodosa, aplastic anemia

Question 12

which hepatitis increases risk for HCC

Answer 12

hep B > hep C

Question 13

HbsAg

Answer 13

active infection

Question 14

HbsAb

Answer 14

recovered or vaccinated

Question 15

HbcAb

Answer 15

ANY HISTORY OF HAVING DISEASE
IgM - early
IgG- late

Question 16

HbeAg

Answer 16

active viral replication, HIGH INFECTIVITY

Question 17

HbeAb

Answer 17

low infectivity

Question 18

• HbsAg -HbsAB +IgG HBcAb

Answer 18

active infection window period

Question 19

+ HbsAg -HbsAb +IgG HbcAb, low high Hbv DNA

Answer 19

chronic infection (immune tolerance)
high disease state, no damage

Question 20

pathological development of alcoholic liver disease

Answer 20

steatosis (reversible) -> steatohepatitis -> cirrhosis (increased HCC risk)

Question 21

overweight patient, chronically elevated LFTs, no inflammation on imaging, no hx of alcohol or hepatitis

Answer 21

NAFLD -> NASH

increased risk obesity, DM, metabolic syndrome, insulin resistance

Question 22

rx NASH for T2DM

Answer 22

TZDs (i.e. pioglitazone)

improves LFTs and possible histology

Question 23

hand findings in cirrhotic patient

Answer 23

DUPUYTREN CONTRACTURE
asterexis
palmar erythema
digital clubbing

Question 24

patient with ascites, hepatomegaly, jaundice….acutely can have RUQ pain, hepatomegaly, RAPID DEVELOPMENT jaundice and ascities

Answer 24

think Budd Chari (thrombosis of hepatic vein or intrahepatic/suprahepatic portion of IVC)

Question 25

best initial study for Budd Chiari

Answer 25

US

Question 26

how to differentiate between portal hypertension ascites and something else?

Answer 26

SAAG serum albumin - ascites albumin SAAG >1.1 = portal hypertension

Question 27

Causes of non-portal hypertension ascites

Answer 27

SAAG <1.1 high albumin in ascites - TB, pancreatitis, serositis, infection, heart failure, low albumin - nephrotic syndrome

Question 28

SAAG in SBP?

Answer 28

greater than 1.1 | associated with portal HTN

Question 29

dx SBP

Answer 29

``` ascites gram stain/culture neutrophil ?250 elevate ascites LDH SAAG>1.1 low ascites glucose ```

Question 30

rx SBP

Answer 30

third generation cephalopo (cefotaxime, ceftriaxone) | albumin to maintain plasma volume and preserve renal function

Question 31

manifestations hemocrhomatosis

Answer 31

``` bronze diabetes heart - dilated/restrictive cardiomyopathy liver - hepatomegaly, cirrhosis joints - arthralgia skin - hyperpigmentation pancreas - DM ```

Question 32

rx hemochromatosis (2)

Answer 32

``` serial phlebotomy iron chelators (deferoxamine) ```

Question 33

what test to get to screen for hemochromatosis

Answer 33

ferritin (will be elevated) | transferrin will be elevated too

Question 34

test to get for Wilson's

Answer 34

ceruloplasmin (will be low)

Question 35

rx Wilson's (4)

Answer 35

``` copper chelators (pencil amine + trientene) restrict dietary copper liver transplant zinc supplements (interfere with copper absorption) ```

Question 36

difference between pathologies of Wilson's and hemochromatosis

Answer 36

wilson - LESS SECRETION (of copper) | hemochromatosis - LESS ABSORPTION (of iron)

Question 37

patient comes in with emphysema and cirrhosis | dx and mode of inheritance

Answer 37

a1 antitrypsin deficinecy | CODOMINANT

Question 38

a1 antitrypsin leads to OVERactivity of what

Answer 38

elastase (too much destruction of elastic tissue)

Question 39

anti smooth muscle abx

Answer 39

type 1 AIH

Question 40

liver-kidney microsomal (LKM) antigens

Answer 40

type 2 autoimmune hepatitis

Question 41

liver cytosol antigen

Answer 41

type 2 autoimmune hepatitis

Question 42

young female with vague RUQ comes in, incidentally finds a liver mass on imaging

Answer 42

hepatic adenoma MAIN RISK FACTOR: OCP USE!!!

Question 43

main risk factor for hepatic adenoma

Answer 43

OCP use

Question 44

MCC malignant liver mass

Answer 44

``` LIVER METS! NOT HCC (MCC primary liver tumor) ```

Question 45

next step in patient with incidentally found liver mass with malignant features

Answer 45

ASSESS FOR OTHER CANCERS CT chest, abd, pelvis colonoscopy

Question 46

risk factors for HCC

Answer 46

Hep B Hep C cirrhosis aflatoxin (food infected with aspergillius)

Question 47

what paraneoplastic syndromes can HCC cause (4)

Answer 47

EPO - polycythemia VIP - watery diarrhea PTHr P - hypercalcemia hypoglycemia

Question 48

What cancers can cause polycythemia (4)

Answer 48

``` "Potentially Really High Hct" pheochromocytoma RCC HCC hemangioblastoma ```

Question 49

elevated AFP

Answer 49

HCC