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Hepatology Flashcards

1
Q

Occult blood in stool? Dx?

A

Ampullary tumor

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2
Q

Cardinal feature of acute liver failure?

A

Encephalopathy/cerebral oedema

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3
Q

Which liver failure has worst outcome?

A

Subacute Liver Failure

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4
Q

Late sign of cerebral oedema?

A

Papilledema

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5
Q

Sudden onset ascites is a clue of-

A

Bud chiary syndrome

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6
Q

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

A

Prothrombin time

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7
Q

Cause of massive hepatomegaly without significant weight loss?

A

neuro endocrine tumor

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8
Q

MCC of heart failure?

A

Cirrhosis, intra-abdominal malignancy. heart failure

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9
Q

Splanchnic arterial vasodilatation is mediated by-

A

Nitric oxide

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10
Q

Low ascites glucose concentration suggests-

A

TB/Malignancy

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11
Q

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

A

Chylous ascites (Lymphatic obstruction)

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12
Q

Painful gynecomastia caused by

A

Spironolctone

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13
Q

Multiple organisms on culture suggesting

A

Perforated viscus

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14
Q

MCC of portal HTN?

A

Cirrhosis

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15
Q

Early sign of CLD?

A

Palmer erythema

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16
Q

clubbing in not a feature of CLD?

A

no, feature of hepatopulmonary syndrome

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17
Q

Early bruising seen in

A

Advanced cirrhosis

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18
Q

Signs of decompensated CLD

A

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

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19
Q

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

A

SARCOPENIA (Loss of muscle mass)

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20
Q

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

A

MELD-NA score

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21
Q

Cardinal sign of portal HTN?

A

Splenomegaly

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22
Q

Fetor hepaticus is due to-

A

Mercaptens passing directly into the lungs

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22
Q

Splenic vein occlusion consequences -

A

Pancreatitis»»Gastric varices

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22
Q

Normal AST/ALT ratio?

A

less than 0.8

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23
Q

ALT>AST

A

NASH (Metabolic syndrome)

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24
Q

AST/ALT >2

A

Alcoholic hepatitis, hep c, advanced fibrosis in NAFLD

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25
Q

Which penia is common in cirrhosis?

A

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

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26
Q

Ig A increased in

A

Alcoholic liver disease, NAFLD

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27
Q

Ig M ass with

A

PBC, WM

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28
Q

FibroTest combines 5 standard biomarkers

A

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

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29
Q

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

A

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

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30
Q

Rx of criggler najar syndrome type 2?

A

phenobarbital, phototherapy or liver transplant

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31
Q

Hemolysis screen

A

PBF(RETICULOCYTE COUNT), LDH, HAPTOGLOBULIN

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31
Q

Bud chiary syndrome is a cause of hepatomegaly.

A

also RHF, myloidosis

32
Q

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

A

Meigs Syndrome

33
Q

T2 HRS

A

Diuretics resistant ascites

34
Q

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

A

HRS-AKI (T1)

35
Q

PROPHYLAXIS needed for SBP IN CLD? WHEN?

A

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

36
Q

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

A

Chr. hepatic enchephalopathy (hepatocerebral degeneration)

37
Q

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

A

no. hypoglycemia

38
Q

Snake skin gastropathy seen in-

A

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

39
Q

Watermelon Stomach

A

Gatric antral vascular ectasia (Distal stomach)

40
Q

Pyogenic Liver abscess management?

A

Ampicillin gentamicin metronidazole

41
Q

Nutritional deficiency in excess alcohol consumption?

A

Thiamine & Folate deficiency.

41
Q

Alcoholics with accelerated disease progression have coexistent.-

A

Chr. Hep C/ NAFLD/Haemochromatosis

42
Q

The most common manifestations of ALD?

A

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

43
Q

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

A

Alcoholic hepatitis

44
Q

Unique feature of alcoholic cirrhosis?

A

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

44
Q

Carbohydrate deficient transferrin is a biomarker of ‘

A

Recent Alcohol excess.

45
Q

Coffe consumption is protective against -

A

fibrosis and HCC in NAFLD

45
Q

NAFLD ASSOCIATION?

A

Metabolic syndrome, OSA, PCOS

46
Q

Imaging modality to distinguish between simple steatosis and steatohepatitis?

A

There is none like this

46
Q

Characteristic features of NAFLD?

A

Perisinusoidal Fibrosis

47
Q

FIB4 SCORE CONSISTS OF

A

Age AST ALT albumin

47
Q

Refractory autoimmune hepatitis, Rx?

A

Tacrolimus

48
Q

DOC in active autoimmune hepatitis?

A

Prednisolone, For maintenance (Azathioprine)

48
Q

Adults patient with autoimmune hepatitis. Antibody?

A

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

49
Q

M/C Antibodies in autoimmune hepatitis?

A

ANA and ASMA

50
Q

AMA of PBC is directed at

A

Pyruvate dehydrogenase complex

51
Q

First line treatment of PBC?

A

UDCA, Obethicolic acid (second line)

52
Q

Most reliable marker for declining liver function?

A

Serum bilirubin

53
Q

Pruritus in PBC. RX?

A

Cholestyramine> rifampicin>naltrexone>plasmapheresis.

54
Q

Coeliac disease incidence is increased in

55
Q

Cancer ass with PSC?

A

Cholangiocarcinoma, GB, Colon

56
Q

Biopsy finding of autoimmune hepatitis

A

Portal lymohoplasmocytic hepatitis

57
Q

Which anca positive in autoimmune haptitis

A

P anca (50%)

58
Q

Raised ALP in a patient of Ulcerative colitis. Dx?

59
Q

AMA is always negative in PSC/PBC.?

60
Q

MRCP is diagnostic test for PSC/PBC?

61
Q

PSC Dx done. Next imp investigation?

A

Colonoscopy

62
Q

UDCA in PSC? BENIFIT?

A

Reduce colon carcinoma risk.

63
Q

Leading cause of death in PSC?

A

Cholangiocarcinoma

64
Q

DOC of IgG4 associated cholangitis.

A

Glucocorticoids.

65
Q

Major risk factor of HCC.

A

Chr. Hep B (More in HbeAg positive)

66
Q

Marker of HCC

A

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

67
Q

High risk and low risk in HCC

A

High risk- chr hep B, cirrhosis due to viral hep and hemochromatosis.

Low risk- Cirrhosis due to Wilson disease, autoimmune hepatitis.

68
Q

Which drug helps to prolong survival in HCC

69
Q

Hepatic adenoma risk factor?

A

OCP, Androgen, Anabolic steroid use.

70
Q

Medical Management of hepatic adenoma?

A

Avoidance of OCP and weight loss.

71
Q

MC benign liver tumour.

A

Hemangioma

72
Q

Cyst in liver? Next step?

A

Search also in kidney. Mostly benign

73
Q

Permanent bile duct loss associated with

A

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

74
Q

Chronic overdose of which vit may cause portal HTN?

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