Hepatobiliary patho

Question 1

Consequences of liver failure?

Answer 1

ABCDE !
Ammonia - Hepatic encephalopathy -> Asterixis, Confusion

Bile retention - Cholestasis -> Hepatic jaundice

Coagulopathy - Easy bruising

Distension - Ascites (portal HTN -> Splenomegaly / Varices)

Estrogen - Hyperestrogenemia -> Gynecomastia

Question 2

Similarities between Hep A & E?

Answer 2

AcutE fEcAl !!
Acute hepatitis
Fecal-oral transmission [others BCD all parenteral]

Question 3

What causes chronic hepatitis?

Answer 3

B & C (&D)
E if immunocompromised

Question 4

What hepatitis virus has vaccine?

Answer 4

Hep A & hep B
but vax for hep B is protective for hep D (bc HepD only infects those already with HepB infection)

Question 5

Are hepatitis viruses ssRNA or dsDNA?

Answer 5

All ssRNA except Hep B is dsDNA

Question 6

Hep C vs Hep B

Answer 6

Hep** C** higher percentage of Carriers
-> Higher risk of Cirrhosis & liver Cancer (hepatocellular carcinoma)

Question 7

Treatment for hepatitis?

Answer 7

Hep C : antiviral agents
Hep B : prophylactic vaccination against Hep A

others : NA, mostly recovers spontaneously

Question 8

Serology diagnosis for hepatitis?

Answer 8

Hep A : Anti-HAV IgM

Hep B : HBsAg, anti-HBcAg IgM

Hep C : Anti-HCV IgG, RT-PCR

Hep D : Anti-Delta

Hep E : Anti-HEV IgM, IgG, RT-PCR

RT-PCR : presence of RNA = confirm current infection, not past

Question 9

What causes colicky pain worse with fatty food?

Answer 9

Biliary colic
Cholelithiasis (GB stone)

Question 10

What gives positive Murphy’s sign? (RUQ pain on palpation + during inspiration)

Answer 10

Cholecystitis (GB cystic duct inflammation)
- fever & leukocytosis too (inflammation)

Question 11

What BT patho causes obstructive jaundice?

Answer 11

Choledocholithiasis (CBD stone)
Cholangitis (bile ducts inflammation)

Question 12

What gives positive Charcot’s triad? [RUQ + Jaundice + Fever]

Answer 12

Cholangitis

Question 13

Autoimmune cholangiopathies :
Difference between Primary sclerosing cholangitis (PSC) & Primary biliary cholangitis (PBC) ?

Answer 13

PSC : Intrahepatic & Extrahepatic.
- IBD

PBC : Intrahepatic ducts only.
- Sjogren’s syndrome
- AMA+
- non-caseating granulomas

Question 14

Cholangitis vs Cholecystitis?

Answer 14

Cholangitis
- inflammation of BT
- due to choledocholithiasis
- obstruction -> jaundice
- Charcot’s triad : obstructive jaundice + RUQ pain + fever

Cholecystitis
- inflammation of GB
- due to cholelithiasis
- bile can still flow -> unlikely to have jaundice
- Murphy’s sign : Right subcostal pain on palpation, during inspiration

Question 15

What leads to pale stools & tea-coloured urine?

Answer 15

Obstructive jaundice
Hepatitis / BT obstruction

Question 16

How does head of pancreas cancer present?

Answer 16

Painless progressive jaundice due to obstruction of common bile duct

Question 17

How does pancreatitis present?

Answer 17

Acute, severe epigastric pain
Radiate to the back (bc retroperitoneal)
Nausea, vomitting
pain better if lean forward

Question 18

Which hepatitis worst for pregnant women?

Answer 18

Hep E.
Transplacental transmission of HEV in the third trimester of pregnancy