Gastroenterology and Hepatology

Question 1

Liver functions

Answer 1

nutrition: stores glycogen, releases glucose, absorbs fats, manufactures cholesterol
bile salt production: dissolves dietary fats
handles bilirubin + detoxifies blood (inc drugs)
manufactures clotting factors, albumin and plasma proteins
site of Kupffer cells (immune function)

Question 2

causes of acute liver failure

Answer 2

hepatitis A, E
CMV
EBV
Drug induced liver injury

Question 3

causes of chronic liver failure

Answer 3

ALF
alcohol
hepatitis C
nonalcoholic steatohepatitis
autoimmune liver disease

Question 4

commonest causes of cirrhosis

Answer 4

alcohol
nonalcoholic fatty liver
HBV / HCV
(rare = alpha 1 antitrypsin deficiency / methotrexate)
Other: PBC, PSC with IBD, haemachromatosis, Wilson’s disease

Question 5

chronic liver disease presentation

Answer 5

asymptomatic + deranged LFTs

tiredness, itch, arthralgia, jaundice, fluid retention, upper GI bleed, confusion / drowsiness

Question 6

RF of liver disease

Answer 6

blood transfusions < 1990 in UK
IVDU
operations abroad / dubious 
sexual exposure
Fx: liver disease, IBD, DM
obesity
alcohol
travel

Question 7

ascites features and mortality

Answer 7

v albumin + v JVP
1/2 of compensated cirrhotics > ascites
1/2 cirrhotics + ascites > death in 2 years

Question 8

complications of liver failure

Answer 8

infection (bacterial 80%)
cerebral oedema
bleeding
multi-organ failure
hypoglycaemia

Question 9

Primary biliary cholangitis features

Answer 9

dx = anti-mitochondrial Ab (AMA) + IgM
= progressive inflammation + scarring of intrahepatic ducts
more common in women

Question 10

primary sclerosing cholangitis features

Answer 10

autoimmune, dx = MRCP
= progressive cholestaasis + fibrosis of intrahepatic and extra hepatic ducts
more common in men + pt with IBD

Question 11

drugs > drug induced liver disease

Answer 11

NSAIDs
Abx = augmente / flucloxacillin
ACEi

Question 12

clinical features of liver failure

Answer 12

hepatic encephalopathy
abnormal bleeding
ascites
jaundice

Question 13

hepatic encephalopathy pathophysiology

Answer 13

^^ ammonia (nitrogenous waste) crosses BBB and is broken down into glutamine
+ water movement IN due to ^ osmotic P
=> cerebral oedema
= confusion, drowsiness, LOC

Question 14

hepatic encephalopathy treatment

Answer 14

lactulose (loses nitrogenous waste via bowels)
IV mannitol (v ICP)

Question 15

liver failure bleeding treatment

Answer 15

vitamin K

fresh frozen plasma

Question 16

liver failure peritonitis treatment

Answer 16

board spectrum Abx

Question 17

renal dysfunction treatment

Answer 17

RRT - haemodialysis

Question 18

Budd Chiari triad

Answer 18

pain
ascites
hepatomegaly

Question 19

what investigations can be used to diagnose acute liver failure

Answer 19

deranged clotting factors - INR

low albumin

Question 20

why is INR increased in (chronic) liver failure

Answer 20

dietary vitamin K deficiency

cirrhosis > abnormal clotting factor production

Question 21

complications of liver failure to be screened for

Answer 21

hepatocellular ca
oesophageal varices
osteoporosis
ascites recurrence   
splenomegaly

Question 22

cause of malnourishment for pts w liver failure

Answer 22

satiety: ascites
alcohol intake ^ fullness
alcohol abuse = v £ for food
cirrhosis > accelerated starvation mechanism (v glycogen stores)

Question 23

tumor marker raised in pancreatic cancer

Answer 23

Ca 19-9