GIT and Hepatology

Question 1

Definition of jaundice (2)

Answer 1

1. Yellowish discolouration of skin, sclera, mucosae
2. Increase plasma bilirubin > 35umol/L

Question 2

Classification cause of jaundice (3)

Answer 2

Pre-hepatic​

• Hemolysis, reduced liver uptake, reduce conjugation, physiological in neonatal

Hepatocellular

• ​Viruses (CMV,EBV), drugs, alcoholic, liver cirrhosis, abscess, autoimmune hepatitis, septicemia, Budd-Chiari syndrome, WIlson’s disease

Post-hepatic

• ​Cholestatic/obs jaundice
• Gallstone, pancreatic ca [4], cholangiocarcinoma, primary sclerosing cholangitis, primary biliary cirrhosis, choledochal cyst, biliary atreasi [infant], Mirizzi syndrome

Question 3

Common sites of varices (5)

Answer 3

1. Lower esophageal
2. Stomach
3. Umbilicus
4. Rectum
5. Liver

Question 4

Causes of portal hypertension (3)

Answer 4

Pre hepatic

Portal vein thrombosis, splenic vein thrombosis

Intrahepatic

Cirrhosis, schistosomiasis, sarcoidosis, myeloproliferative disease, congenital hepatic fibrosis

Post hepatic

Budd Chiari Syndrome, RSHF, constrictive pericarditis, veno-occlussive disease

Question 5

Chronic liver disease stigmata (11)

Answer 5

1. Jaundice
2. Clubbing
3. Spider naevi
4. Hair loss
5. Xanthomata
6. Asterixis
7. Gynecomastia
8. Palmar erythema
9. Dupuytren contracture
10. Caput medusae
11. Fetor hepaticus (ammonia smell)
12. Leuconychia
13. Scratch mark

Question 6

SAAG > 1.1 g/dl causes(4H)

Answer 6

• portal Hypertension
• congestive Heart failure
• Hepatic vein thrombosis
• Heart constriction (Constrictive pericarditis)

*High gradient= Non-peritoneal causes.

*Since serum albumin > ascites albumin

Question 7

SAAG < 1.1 g/dl causes (low gradient)

Answer 7

• Nephrotic syndrome
• Infection (TB)
• Malignancy (Peritoneal carcinomatosis)
• Biliary ascites
• Pancreatitis ascites

*Low gradient= Peritoneal causes