Hepatobilliary

Question 1

In uc and primary sclerosing cholangitis, risk of which cancer, is increased?

Answer 1

Cholangiocarcinoma, ca19-9

Question 2

Ascending cholangitis definitive mx

Answer 2

Biliary drainage either via ERCP with stent in place, or percutaneous transhepatic drainage

Question 3

Mx for ascites in chronic liver disease

Answer 3

Spironolactone

Question 4

Important complication of chronic liver disease

Answer 4

Spontaneous bacterial peritonitis

Question 5

How is SBP diagnosed?

Answer 5

Neutrophil count >200

Question 6

Most common underlying pathogen in SBP

Answer 6

E Coli

Question 7

Mx of SBP

Answer 7

• Prompt drainage via ascitic tap
• Abx: cefalexin or tazocin

(Cipro prophylactically)

Question 8

Anti-smooth muscle AB

Answer 8

Autoimmune hepatitis

Question 9

P-ANCA

Answer 9

PSC

Question 10

Features of PBC

Answer 10

• High BR
• Obstructive LFTs
• Often background autoimmune disease

Question 11

Anti Mitochondrial AB

Answer 11

PBC

Question 12

Mx for gallstones - symptomatic cholelithiasis or cholecystitis

Answer 12

Laparoscopic cholecystectomy

Question 13

Mx for choledocolithiasis or cholangitis

Answer 13

ERCP

Question 14

Which Ix best demonstrates liver synthetic function?

Answer 14

PT (INR)

Question 15

Cholecystitis v cholangitis

Answer 15

Cholecystitis - inflamm of GB
Cholangitis - inflamm + infx of bile duct
- Location: cholecystitis more RUQ and can radiate to shoulder // cholangitis pain more diffuse often epigastric
- Nature: cholecystitis constant // cholangitis colicky
- Jaundice: more of a cholangitis thang

Question 16

Diagnostic ix for PSC

Answer 16

MRCP

Question 17

Which ca is a complx of cirrhosis?

Answer 17

HCC

Question 18

How will a cirrhotic liver appear on USS?

Answer 18

shrunken

Question 19

Which test to assess liver damage in paracetamol overdose?

Answer 19

PT

Question 20

Murphy’s sign
1. What do/how?
2. +ve means?

Answer 20

1. Asking pt inhale and hold whilst palpating the right subcostal area. If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.
2. Cholecystitis

Question 21

What is choledocholithiasis?

Answer 21

Stone in CBD

Question 22

Which tumour marker for HCC?

Answer 22

AFP

Question 23

Common complx of pancreatitis

Answer 23

pancreatic pseudocyst

Question 24

What can be used to improve 1-month mortality for severe alcohol-associated lvier disease?

Answer 24

steroids

Question 25

Most common causes liver cirrhosis in UK

Answer 25

• Alcohol
• NAFLD
• Hep B/C

Question 26

Viral heps route of transmission

Answer 26

• Hep A+E: faecal-oral
• Hep B + C: blood borne
• Hep D: contact w infected bodily fluid

Question 27

Which type of hepatitis is NOT an RNA virus?

Answer 27

Hep C

Question 28

Which hep can you only get along with another hep?

Answer 28

Hep D - only with Hep B

Question 29

Chronic hep B mx

Answer 29

Interferon alpha

Question 30

Which hep is most likely to progress to CLD?

Answer 30

Hep C

Question 31

Mx for hep B + HIV co infx

Answer 31

Tenofovir

Question 32

What is courvoissier’s law?

Answer 32

Painless + palpable GB + jaundice –> Pancreatic ca

Question 33

SBO after cholecystitis

Answer 33

gallstone ileus

Question 34

ERCP shows beads on a string

Answer 34

PSC