Hepatology Conditions B

Question 1

Viral Hepatitis - Description

Answer 1

inflammation of the liver due to viral infection

Question 2

Viral Hepatitis - Causes (6)

Answer 2

1) hepatitis A
2) hepatitis B
3) hepatitis C
4) hepatitis D
5) hepatitis E
6) herpes (CMV, EBV)

Question 3

Viral Hepatitis - Types (Acute) (4)

Answer 3

< 6 months

1) hepatitis A
2) hepatitis B
3) hepatitis E
4) herpes (CMV, EBV)

Question 4

Viral Hepatitis - Types (Chronic) (2)

Answer 4

> 6 months

1) hepatitis B (±D)
2) hepatitis C

Question 5

Viral Hepatitis - Transmission (HAV) (1)

Answer 5

faecal oral

1) contaminated food and water

Question 6

Viral Hepatitis - Transmission (HBV) (3)

Answer 6

blood borne

1) contaminated needles
2) sexual intercourse
3) vertical transmission

Question 7

Viral Hepatitis - Transmission (HCV) (1)

Answer 7

blood borne

1) contaminated needles —> IV drug abusers*

Question 8

Viral Hepatitis - Transmission (HDV) (3)

Answer 8

blood borne

1) contaminated needles
2) sexual transmission
3) contaminated blood products

Question 9

Viral Hepatitis - Transmission (HEV) (1)

Answer 9

faecal oral

1) contaminated food and water

Question 10

Viral Hepatitis - Symptoms (Acute) (8)

Answer 10

1) asymptomatic (HBV>70%, HEV>95%)
2) non-specific flu-like symptoms (clinically silent)
3) right upper quadrant pain
4) nausea
5) fever
6) malaise
7) arthralgia (HAV, HBV)
8) urticaria - hives (HBV)

Question 11

Viral Hepatitis - Symptoms (Chronic) (2)

Answer 11

1) asymptomatic

2) non-specific symptoms

Question 12

Viral Hepatitis - Signs (HAV)

Answer 12

1) hepatomegaly

2) jaundice

Question 13

Viral Hepatitis - Signs (HEV) (2)

Answer 13

1) hepatomegaly

2) jaundice

Question 14

Viral Hepatitis - Complications (4)

Answer 14

acute
1) fulminant hepatitis
chronic 
2) cirrhosis
3) liver failure
4) hepatocellular carcinoma

Question 15

Viral Hepatitis - Diagnosis (HAV) (6)

Answer 15

1) high AST (day 22-40)
2) high ALT (day 22-40)
3) high bilirubin (icteric stage)
4) high ESR
5) low WCC
6) anti HAV IgM

Question 16

Viral Hepatitis - Diagnosis (HBV) (3)

Answer 16

1) HBsAg (month 1-6, infected)
2) HBsAg (month 6->, carrier)
3) anti HBV IgM

Question 17

Viral Hepatitis - Diagnosis (HCV) (2)

Answer 17

1) HCV RNA

2) anti HCV IgM

Question 18

Viral Hepatitis - Diagnosis (HDV) (1)

Answer 18

1) anti HDV IgM (request only if HBsAg +ve)

Question 19

Viral Hepatitis - Diagnosis (HEV) (6)

Answer 19

1) high AST (day 22-40)
2) high ALT (day 22-40)
3) high bilirubin (icteric stage
4) high ESR
5) low WCC
6) anti HEV IgM

Question 20

Viral Hepatitis - Management (HAV) (4)

Answer 20

1) supportive (self-limiting)
2) monitor liver function (spot fulminant liver failure)
3) vaccine (travelling to endemic areas)
4) alcohol cessation

Question 21

Viral Hepatitis - Management (Acute HBV ± HDV) (6)

Answer 21

1) supportive
2) monitor liver function (spot fulminant liver failure)
3) vaccine (primary prevention)
4) vaccine (close contacts)
5) anti HBV IgG (close contacts)
6) alcohol cessation

Question 22

Viral Hepatitis - Management (Chronic HBV ± HDV) (3)

Answer 22

1) SC pegylated INFα2A
2) tenofovir/entecavir (nucleotide analogues)
3) alcohol cessation

Question 23

Viral Hepatitis - Management (HCV) (3)

Answer 23

1) SC pegylated INFα2A/2B
2) ribavirin (anti-viral)
3) alcohol cessation

Question 24

Viral Hepatitis - Management (HEV) (4)

Answer 24

1) supportive (self-limiting)
2) monitor liver function (spot fulminant liver failure)
3) vaccine (travelling to endemic areas)
4) alcohol cessation

Question 25

Hereditary Haemochromatosis - Description

Answer 25

increased intestinal iron absorption

Question 26

Hereditary Haemochromatosis - Causes (2)

Answer 26

1) HFE gene mutation (autosomal recessive) | 2) other gene mutations (autosomal dominant)

Question 27

Hereditary Haemochromatosis - Risk Factors (4)

Answer 27

1) family history 2) alcoholic 3) high dietary iron 4) high dietary chelating agents (e.g. vitamin C)

Question 28

Hereditary Haemochromatosis - Pathophysiology (6)

Answer 28

1) homogenous chromosome 6 HFE gene mutation 2) deficiency of hepicidin 3) decreased inhibition of ferroportin 4) increased intestinal iron absorption via ferroportin 5) increased plasma iron 6) iron accumulation in organs

Question 29

Hereditary Haemochromatosis - Symptoms (4)

Answer 29

early 1) asymptomatic 2) fatigue 3) arthralgia (esp. 2nd MCP, 3rd MCP, knee) 4) low libido

Question 30

Hereditary Haemochromatosis - Signs (4)

Answer 30

``` later 1) slate grey skin pigmentation signs of chronic liver disease 2) ascites 3) bruising 4) oedema ```

Question 31

Hereditary Haemochromatosis - Complications (7)

Answer 31

1) diabetes mellitus* 2) dilated cardiomyopathy —> heart failure 3) hepatitis 4) cirrhosis 5) hepatocelluar carcinoma 6) hypogonadism 7) osteoporosis

Question 32

Hereditary Haemochromatosis - Investigations (2/3)

Answer 32

initial 1) iron studies (high iron, high ferritin) 2) LFT (high) consider 1) genetic testing (confirmation if abnormal iron studies) 2) liver MRI 3) liver biopsy (Perls’ stain —> blue)

Question 33

Hereditary Haemochromatosis - Management (3/1/1)

Answer 33

``` conservative 1) monitor iron studies 2) low dietary iron (e.g. avoid tea, coffee, fruit, red meat) 3) screen all first-degree relatives medical 1) deferoxamine (chelating agent) surgery 1) venesection* (3-4 times yearly) ```

Question 34

Wilson’s Disease - Description

Answer 34

decreased biliary copper excretion

Question 35

Wilson’s Disease - Causes (1)

Answer 35

1) ATP7B mutation (autosomal recessive)

Question 36

Wilson’s Disease - Pathophysiology (4)

Answer 36

1) homogenous chromosome 13 ATP7B gene mutation 2) mutated copper ATPases 3) decreased biliary copper excretion 4) copper accumulation in hepatocytes and basal ganglia

Question 37

Wilson’s Disease - Symptoms (9)

Answer 37

neuropsychiatric symptoms 1) tremor 2) dysarthria 3) dysphagia 4) dyskinesia 5) involuntary movements 6) dementia 7) depression 8) labile emotions 9) decreased cognition

Question 38

Wilson’s Disease - Signs (2)

Answer 38

1) Kayser-Fleischer rings (dark rings around iris) | 2) dysdiadochokinesis (slowness alternating hands from prone to supine)

Question 39

Wilson’s Disease - Complications (6)

Answer 39

1) hepatitis (fulminant —> chornic) 2) cirrhosis 3) dementia 4) depression 5) anaemia 6) haemolysis

Question 40

Wilson’s Disease - Investigations (1/5)

Answer 40

``` initial 1) LFT (high) consider 1) high urine copper (>100ug/24h) 2) low serum copper (<11uM) 3) low serum caeruloplasmin 4) brain MRI (basal ganglia degeneration) 5) liver biopsy (copper deposition, hepatitis, cirrhosis) ```

Question 41

Wilson’s Disease - Management (2/2/1)

Answer 41

``` conservative 1) low dietary copper (avoid liver, chocolate, nuts, mushrooms, legumes) 2) screen siblings medical 1) penicillamine (chelating agent) 2) zinc supplements surgery 1) liver transplant (severe) ```

Question 42

Alpha-1-Anti-Trypsin Deficiency - Description

Answer 42

deficiency of alpha-1-anti trypsin

Question 43

Alpha-1-Anti-Trypsin Deficiency - Causes (1)

Answer 43

1) homozygous PiZZ (symptomatic)

Question 44

Alpha-1-Anti-Trypsin Deficiency - Pathophysiology (3)

Answer 44

1) deficiency of alpha-1-anti-trypsin 2) decreased inhibitor of proteolytic enzyme neutrophil elastase 3) liver and lung tissue damage

Question 45

Alpha-1-Anti-Trypsin Deficiency - Symptoms (1)

Answer 45

1) dyspnoea | 2) productive cough

Question 46

Alpha-1-Anti-Trypsin Deficiency - Complications (5)

Answer 46

1) emphysema (COPD) 2) hepatitis 3) cirrhosis 4) hepatocellular carcinoma 5) cholestatic jaundice

Question 47

Alpha-1-Anti-Trypsin Deficiency - Diagnosis (3)

Answer 47

``` initial 1) low serum alpha-antitrypsin 2) spirometry (FEV1<0.8, FEV1/FVC<0.7) 3) chest x-ray 4) LFT consider 1) genotyping 2) liver biopsy ```

Question 48

Alpha-1-Anti-Trypsin Deficiency - Management (4/2/2)

Answer 48

``` conservative 1) no treatment 2) smoking cessation 3) alcohol control 4) hepatitis AB vaccine medical 1) IV A1AT (expensive) 2) treat complications surgery 1) lung transplant 2) liver transplant ```

Question 49

Hepatocellualar Carcinoma - Description

Answer 49

malignant proliferation of hepatocyte epithelium

Question 50

Hepatocellualar Carcinoma - Causes (6)

Answer 50

1) hepatitis B* 2) hepatitis C 3) aflatoxin (Aspergillus) 4) alcoholic liver disease 5) non-alcoholic fatty liver disease 6) haemochromatosis

Question 51

Hepatocellualar Carcinoma - Symptoms (4)

Answer 51

1) right upper quadrant pain 2) fatigue 3) anorexia 4) weight loss

Question 52

Hepatocellualar Carcinoma - Signs (2)

Answer 52

1) jaundice | 2) ascites

Question 53

Hepatocellualar Carcinoma - Complications (4)

Answer 53

1) metastases (lymph nodes, bones, lungs) 2) liver failure 3) biliary obstruction 4) haemobilia

Question 54

Hepatocellualar Carcinoma - Investigations (2/2)

Answer 54

initial 1) serum alpha-fetoprotein (high) 2) abdomen ultrasound consider 3) abdomen enhanced CT (confirmation if tumour>1cm) 4) liver biopsy (rare —> potential tumour seeding)

Question 55

Hepatocellualar Carcinoma - Management (1/1/3)

Answer 55

``` conservative 1) hepatitis B vaccine medical 1) chemotherapy (sorafenib) surgery 1) percutaneous ablation 2) surgical resection 3) liver transplant (cure) ```

Question 56

Cholangiocarcinoma - Description

Answer 56

malignant proliferation of bile duct epithelium

Question 57

Cholangiocarcinoma - Causes (4)

Answer 57

1) parasitic worms 2) biliary cysts 3) inflammatory bowel disease (esp. ulcerative colitis) 4) primary sclerosing cholangitis

Question 58

Cholangiocarcinoma - Symptoms (3)

Answer 58

1) abdominal pain 2) fever 3) malaise

Question 59

Cholangiocarcinoma - Signs (1)

Answer 59

1) jaundice (painless)

Question 60

Cholangiocarcinoma - Complications (2)

Answer 60

1) biliary obstruction | 2) cholangitis

Question 61

Cholangiocarcinoma - Investigations (2/1)

Answer 61

``` initial 1) LFT (high ALP, high bilirubin) 2) abdomen ultrasound consider 1) endoscopic retrograde cholangiopancreatography ```

Question 62

Cholangiocarcinoma - Management (2/2)

Answer 62

``` medical 1) chemotherapy 2) radiotherapy surgery 1) tumour resection (only possible in 30% of which 76% recur) 2) liver transplant (unresectable) ```

Question 63

Pancreatic Adenocarcinoma - Description

Answer 63

malignant proliferation of pancreatic exocrine duct epithelium

Question 64

Pancreatic Adenocarcinoma - Risk Factors (7)

Answer 64

1) KRAS2 gene (95%) 2) chronic pancreatitis 3) diabetes mellitus 4) alcohol 5) smoking 6) caffeine 7) aspirin

Question 65

Pancreatic Adenocarcinoma - Symptoms (3)

Answer 65

1) epigastric pain (body and tail) 2) anorexia 3) weight loss

Question 66

Pancreatic Adenocarcinoma - Symptoms (Pain) (3)

Answer 66

body and tail 1) epigastric 2) radiated to back 3) relived by sitting forward

Question 67

Pancreatic Adenocarcinoma - Signs (3)

Answer 67

1) painless jaundice (head) 2) dark urine (head) 3) pale stool (head)

Question 68

Pancreatic Adenocarcinoma - Complications (3)

Answer 68

1) diabetes mellitus 2) acute pancreatitis 3) obstructive jaundice (head)

Question 70

Pancreatic Adenocarcinoma - Management (0/3/1)

Answer 70

``` medical 1) pancreatic enzymes 2) palliative care (e.g. opiates) 3) chemotherapy (post-op, delays progression) surgery 1) tumour resection ```

Question 71

Autoimmune Hepatitis - Description

Answer 71

autoimmune inflammation of liver

Question 72

Autoimmune Hepatitis - Risk Factors (4)

Answer 72

1) female 2) genetics 3) autoimmune conditions 4) viral trigger (e.g. measles, CMV, EBV)

Question 73

Autoimmune Hepatitis - Symptoms (8)

Answer 73

1) non-specific flu-like symptoms 2) fever 3) malaise 4) right upper quadrant pain 5) anorexia 6) nausea 7) arthralgia 8) pruritus

Question 74

Autoimmune Hepatitis - Signs (3)

Answer 74

1) hepatomegaly 2) jaundice 3) spider angiomata

Question 75

Autoimmune Hepatitis - Investigations (2/0)

Answer 75

initial 1) serum globulin (hypergammaglobulinaemia) 2) LFT (high)

Question 76

Autoimmune Hepatitis - Management (0/2/1)

Answer 76

``` medical 1) prednisolone 2) azarthioprine (>6 months) surgery 1) liver transplant ```

Question 77

Ascites - Description

Answer 77

fluid accumulation in peritoneal cavity

Question 78

Ascites - Causes (Portal Hypertension) (6)

Answer 78

1) thrombosis (splenic or portal vein) 2) cirrhosis (70-80% of all ascites) 3) schistosomiasis 4) sarcoidosis 5) Budd-Chiari syndrome 6) congestive heart failure

Question 79

Ascites - Causes (Hypoalbuminaemia) (2)

Answer 79

1) nephrotic syndrome | 2) malnutrition

Question 80

Ascites - Causes (Inflammation) (3)

Answer 80

1) peritonitis 2) abdominal malignancy 3) surgery

Question 81

Ascites - Symptoms (2)

Answer 81

1) abdominal discomfort | 2) abdominal distension (esp. flanks)

Question 82

Ascites - Signs (2)

Answer 82

1) shifting dullness* | 2) abdominal swelling (esp. flanks)

Question 83

Ascites - Investigations (3/1)

Answer 83

``` initial 1) abdomen ultrasound (>1500ml) 2) abdominal paracentesis + analysis (ascites tap) 3) LFT consider 1) liver biopsy ```

Question 84

Ascites - Management (0/2/2)

Answer 84

``` medical 1) treat underlying cause 2) spironolactone surgery 1) abdominal paracentesis (asciti tap) 2) transjugular intrahepatic portosystemic shunt (refractory, high risk) ```

Question 85

Pancreatic Adenocarcinoma - Investigations (3/1)

Answer 85

``` initial 1) LFT 2) abdomen ultrasound 3) abdomen CT consider 1) endoscopic retrograde cholangiopancreatography ```