GI

Question 1

BMR Values

Answer 1

BMR 25 kcal/kg/day
Man 1750 kcal (2z00 with DIT + stress factor/exercise)
Women 1400 kcal (1800)

Question 2

DIT (dietary induced thermogenesis)

Answer 2

Additional energy need for eating, absorption, metabolism and distribution

Question 3

Macronutrients %

Answer 3

Carbohydrates - 50%
Fat - 30%
Protein - 20%

Question 4

Saturated vs unsaturated fats

Answer 4

Unsaturated fats don’t have C=C double bonds

Question 5

Micronutrients

Answer 5

Vitamins
Electrolytes
Trace elements - selenium, zinc, phosphate

Question 6

Liver functions

Answer 6

Nutrition/Metabolic
   – stores glycogen (glucose chains)
   – releases glucose
   – absorbs fats, fat soluble vitamins and iron
   – manufactures cholesterol

Bile Salts
– dissolves dietary fats (detergent)

Bilirubin
– breakdown product of haemoglobin

Clotting Factors
– manufactures most clotting factors

Immune function
– Kupfer cells engulf antigens (bacteria)

Detoxification
– drug excretion (sometimes activation)
– alcohol breakdown

Manufactures Proteins
– albumin
– binding proteins

Question 7

Acute liver injury/disease

Answer 7

• No pre-existing liver disease
• Resolves in 6 months
  •Hepatitis A, E, CMV, EBV
  •Drug induced liver injury (DILI)

Question 8

Chronic liver disease

Answer 8

• Starts with acute liver disease (often asymptomatic)
• Ongoing effects beyond 6 months.
• May lead to cirrhosis and its complications (genetics important).
  •Alcohol
  •Hepatitis C
  •Nonalcoholic steatohepatitis
  •Autoimmune liver disease (PBC/PSC/AIH)

Question 9

Causes of cirrhosis

Answer 9

Commonest

• Alcohol
• Nonalcoholic fatty liver / Nonalcoholic steatohepatitis
• HBV, HCV

Rarer

• Alpha- 1 – antitrypsin deficiency
• Methotrexate

Question 10

Causes of cirrhosis

Commoner in women

Answer 10

Autoimmune Hepatitis

Primary biliary cholangitis/cirrhosis (PBC)

Question 11

Causes of cirrhosis

Commoner in men

Answer 11

Primary Sclerosing Cholangitis (PSC) associated with IBD

Question 12

Causes in cirrhosis

Occurs earlier in men

Answer 12

Haemochromatosis (iron overload)

Menstrual periods are protective in women

Question 13

Causes of cirrhosis

Occurs only in adolescents and early 20s

Answer 13

Wilsons disease (copper overload)
Anti LKM autoimmune hepatitis

Question 14

Common presentations of chronic liver disease

Answer 14

➢Asymptomatic with abnormal liver blood tests.
➢Tiredness
➢Itch
➢Arthralgia
➢Jaundice (painful/painless)
➢Fluid retention (Abdominal swelling / Oedema)
➢Upper GI bleed
➢Confusion and drowsiness

Question 15

Risk factors of liver disease/failure

Answer 15

➢Blood transfusions prior to 1990 in UK.
➢IVDU.
➢Operations / vaccination with dubious sterile procedures.
➢Sexual exposure.
➢Medications (prescribed / self prescribed).
➢FH of liver disease, Diabetes, IBD
➢Obesity and other features of metabolic syndrome.
➢Alcohol (?dependent).
➢Foreign travel?

Question 16

Stigmata of chronic liver disease

Answer 16

➢None
➢Spider naevi
➢Leukonychia
➢Clubbing
➢Dupuytren’s contracture
➢Parotid swelling
➢Testicular atrophy
- Loss of secondary sexual characteristics
- Gynaecomastia
- Loss of male distribution of hair
➢Prominent superficial veins over abdomen
➢Cachexia
➢Mild splenomegally
➢(Liver size irrelevant (can be large or small))