HPB

Question 1

Symptoms of cirrhosis
in what two ways are they caused?

Answer 1

Varices, pules, ascites, encephalopathy, renal failure - all caused by portal hypertension

jaundice, coagulopathy, altered drug metabolism, reduced hormone synthesis - all caused by loss of hepatic function

Question 2

What is fulminant hepatitis?

Answer 2

acute hepatitis associated with liver failure. poor prognosis

Question 3

symptoms of acute hepatitis

Answer 3

malaise, jaundice and RUQ pain. Hepatomegaly

Question 4

what types of jaundice do urine/stools change?

Answer 4

dark urine and pale stools in obstructive jaudnice
variable in hepatocellular
never in prehepatic

Question 5

symptoms of delirium tremens

Answer 5

hyperadrenergic state: tremor agitation, nausea, indigestion, delirium , fever, seizures, hallucinations
signs of alcoholic liver disease may also be present

Question 6

management of delirium tremens

Answer 6

admit and observe
IV thiamine (vit B1) prevents Wernicke’s encephalopathy
Long acting benzo (librium) e.g. chlordiazeporide

Question 7

main causes of acute pancreatitis

Answer 7

alcohol
gall stone
then trauma, ERCP and drugs

Question 8

symptoms/managemnet of biliary colic, cholecystitis and cholangitis

Answer 8

colic; RUQ pain esp after fatty meals. cholecystectomy usually elective

cholecystitis; RUQ pain & fever. WCC up.
Nil by mouht, analgesia, anitbiotics, fluids. some need cholecystectomy

cholangitis; RUQ pain, fever and jaundice. can be v unwell
ERCP to manage usually USS guided
A to E management; antibiotics, oxygen, fluids

Question 9

scoring systems for liver cirrhosis

Answer 9

Child Pugh: uses bilirubin, albumin, PTT, ascites, encephalopathy
MELD: uses bilirubin, creatinine, and the international normalized ratio (INR)

Question 10

what is the AST/ALT ratio in alcoholic hepatitis

Answer 10

2:1

Question 11

what cancer is UC associated with?

Answer 11

UC with primary sclerosing cholangitis is associated with cholangiocarcinoma

Question 12

what lab tests characterise autoimmune hepatitis

Answer 12

Antinuclear antibodies, anti-smooth muscle antibodies and raised IgG levels

Question 13

First line treatment for hepatic encephalopathy

Answer 13

Lactulose

Question 14

What is primary biliary cholangitis
Presentation
Diagnosis
Management

Answer 14

Chronic autoimmune liver disorder typically seen in middle aged women
Presents with itching, cholestatic jaundice, hyperpigmentation
Diagnosis: raised serum IgM, anti mitochondrial antibodies. Exclude extra hepatic biliary obstruction
Management: ursodeoxycholic acid. Cholestyramine for pruritus

Question 15

Complications of primary biliary cholangitis

Answer 15

Cirrhosis
Osteomalacia and osteoporosis
Increased risk of hepatocellular carcinoma 20x

Question 16

what is the first line investigation for isolated hyperbilirubinemia?

Answer 16

FBC
need to determine whether haemolysis occurring or if caused by Gilberts disease