Hepatology Flashcards by Hossain Showkat

Occult blood in stool? Dx?

Ampullary tumor

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Cardinal feature of acute liver failure?

Encephalopathy/cerebral oedema

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Which liver failure has worst outcome?

Subacute Liver Failure

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Late sign of cerebral oedema?

Papilledema

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Sudden onset ascites is a clue of-

Bud chiary syndrome

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Which test has greatest prognostic value in case of acute liver failure?

Prothrombin time

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Cause of massive hepatomegaly without significant weight loss?

neuro endocrine tumor

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MCC of heart failure?

Cirrhosis, intra-abdominal malignancy. heart failure

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Splanchnic arterial vasodilatation is mediated by-

Nitric oxide

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Low ascites glucose concentration suggests-

TB/Malignancy

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TG >1.1 g/L (110mg/dL) suggests-

Chylous ascites (Lymphatic obstruction)

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Painful gynecomastia caused by

Spironolctone

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Multiple organisms on culture suggesting

Perforated viscus

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MCC of portal HTN?

Cirrhosis

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Early sign of CLD?

Palmer erythema

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clubbing in not a feature of CLD?

no, feature of hepatopulmonary syndrome

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Early bruising seen in

Advanced cirrhosis

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Signs of decompensated CLD

Jaundice,
Ascites,
Encephalopathy (Flapping tremor),
Variceal bleeding.

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which one is associated with higher rate of infections, encephalopathy, ascites in case of CLD?

SARCOPENIA (Loss of muscle mass)

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Which one predicts mortality in case of patients awaiting liver transplantation?

MELD-NA score

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Cardinal sign of portal HTN?

Splenomegaly

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Fetor hepaticus is due to-

Mercaptens passing directly into the lungs

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Splenic vein occlusion consequences -

Pancreatitis»»Gastric varices

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Normal AST/ALT ratio?

less than 0.8

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ALT>AST

NASH (Metabolic syndrome)

AST/ALT >2

Alcoholic hepatitis, hep c, advanced fibrosis in NAFLD

Which penia is common in cirrhosis?

Thrombocytopenia, if thrombocytosis- think about Active GI Hge, rarely HCC

Ig A increased in

Alcoholic liver disease, NAFLD

Ig M ass with

PBC, WM

FibroTest combines 5 standard biomarkers

gamma-glutamyltransferase, total bilirubin, alpha-2-macroglobulin, apolipoprotein A1, and haptoglobin

The ELF Test is a non-invasive blood test that measures three direct markers of fibrosis

tissue inhibitor of metalloproteinases 1 (TIMP-1), amino-terminal propeptide of type III procollagen (PIIINP) and hyaluronic acid (HA)

Rx of criggler najar syndrome type 2?

phenobarbital, phototherapy or liver transplant

Hemolysis screen

PBF(RETICULOCYTE COUNT), LDH, HAPTOGLOBULIN

Bud chiary syndrome is a cause of hepatomegaly.

also RHF, myloidosis

Benign ovarian tumor+ rt pleural effusion +- Ascites. (High/low SAAG) Dx?

Meigs Syndrome

T2 HRS

Diuretics resistant ascites

No response after 2 consecutive days of diuretics withdrawal and volume expansion with Albumin. (max 100g), Dx?

HRS-AKI (T1)

PROPHYLAXIS needed for SBP IN CLD? WHEN?

Low ascitic protein <15 g/L, Previous h/o SBP, Childpug score >9, HRS, GI BLEEDING

A patient of CLD with cerebellar dysfunction, parkinsonian syndrome, spastic paraplegia and dementia. dx?

Chr. hepatic enchephalopathy (hepatocerebral degeneration)

Hyperglycemia is a D/D of hep. enchephalopathy? true??

no. hypoglycemia

Snake skin gastropathy seen in-

Portal hypertensive gastropathy (In proximal stomach). propanolol is the best initial mx.

Watermelon Stomach

Gatric antral vascular ectasia (Distal stomach)

Pyogenic Liver abscess management?

Ampicillin gentamicin metronidazole

Nutritional deficiency in excess alcohol consumption?

Thiamine & Folate deficiency.

Alcoholics with accelerated disease progression have coexistent.-

Chr. Hep C/ NAFLD/Haemochromatosis

The most common manifestations of ALD?

Accumulation of TG in hepatocytes(hepatic steatosis) may progress to steatohepatitis

Rapid onset jaundice, tender hepatomegaly , SIRS, coagulopathy, HEAVY ALCOHOL USE. Dx?

Alcoholic hepatitis

Unique feature of alcoholic cirrhosis?

PSG- Palmer erythema. spider naevi, gynecomastia. Macrocytosis in the absence of anaemia, DF>32= Severe disease, Glasgow alcoholic hepatitic score equal or more than 9 also in indicates severity

Carbohydrate deficient transferrin is a biomarker of '

Recent Alcohol excess.

Coffe consumption is protective against -

fibrosis and HCC in NAFLD

NAFLD ASSOCIATION?

Metabolic syndrome, OSA, PCOS

Imaging modality to distinguish between simple steatosis and steatohepatitis?

There is none like this

Characteristic features of NAFLD?

Perisinusoidal Fibrosis

FIB4 SCORE CONSISTS OF

Age AST ALT albumin

Refractory autoimmune hepatitis, Rx?

Tacrolimus

DOC in active autoimmune hepatitis?

Prednisolone, For maintenance (Azathioprine)

Adults patient with autoimmune hepatitis. Antibody?

Anti SLA, In pediatrics- Anti - LKM (More resistant to treatment)

M/C Antibodies in autoimmune hepatitis?

ANA and ASMA

AMA of PBC is directed at

Pyruvate dehydrogenase complex

First line treatment of PBC?

UDCA, Obethicolic acid (second line)

Most reliable marker for declining liver function?

Serum bilirubin

Pruritus in PBC. RX?

Cholestyramine> rifampicin>naltrexone>plasmapheresis.

Coeliac disease incidence is increased in

PBC

Cancer ass with PSC?

Cholangiocarcinoma, GB, Colon

Biopsy finding of autoimmune hepatitis

Portal lymohoplasmocytic hepatitis

Which anca positive in autoimmune haptitis

P anca (50%)

Raised ALP in a patient of Ulcerative colitis. Dx?

PSC

AMA is always negative in PSC/PBC.?

PSC

MRCP is diagnostic test for PSC/PBC?

PSC

PSC Dx done. Next imp investigation?

Colonoscopy

UDCA in PSC? BENIFIT?

Reduce colon carcinoma risk.

Leading cause of death in PSC?

Cholangiocarcinoma

DOC of IgG4 associated cholangitis.

Glucocorticoids.

Major risk factor of HCC.

Chr. Hep B (More in HbeAg positive)

Marker of HCC

Alpha fetoprotein. Also helps in disease progression and response to treatment.

High risk and low risk in HCC

High risk- chr hep B, cirrhosis due to viral hep and hemochromatosis. Low risk- Cirrhosis due to Wilson disease, autoimmune hepatitis.

Which drug helps to prolong survival in HCC

Sorafenib

Hepatic adenoma risk factor?

OCP, Androgen, Anabolic steroid use.

Medical Management of hepatic adenoma?

Avoidance of OCP and weight loss.

MC benign liver tumour.

Hemangioma

Cyst in liver? Next step?

Search also in kidney. Mostly benign

Permanent bile duct loss associated with

Coamoxiclav (cholestatic jundice). M/C drug to cause cholestatic hepatitis. May produce symotoms 10-42 days after it stopped

Chronic overdose of which vit may cause portal HTN?

Vit A