HPB IM

Question 1

Clinical presentation of Wilson’s Disease?

Answer 1

Liver disease e.g. hepatosplenomegaly, jaundice, cirrhosis etc etc.
Affects eyes = Kayser-Fleischer rings, sunflower cataracts
Affects CNS.
Characteristic combination is hepatitis/cirrhosis + dementia + parkinsonism

Question 1

In which type of hepatitis is LDH raised?

Answer 1

In ischemic hepatitis

Question 2

Liver toxicity from which drug can cause AST and ALT to rise into the thousands?

Answer 2

Paracetamol overdose

Question 2

Which hepatitis viruses cause acute liver damage?

Answer 2

Hep A
Hep B
Hep E

Question 3

Which hepatitis viruses cause chronic hepatitis?

Answer 3

Hep B 70%
Hep C 20%
NASH 10%

Question 4

NCEP ATP 3 definition for Metabolic Syndrome?

Answer 4

Diagnosed if 3 or more criteria met.
1. Waist circumference >40M or >35W (inches)
2. BP 130/85
3. Fasting Triglyceride >1.7mmol/L
4. Fasting HDL <1.03M or <1.29W
5. Fasting glucose >6.1mmol/L

Question 5

Why is Octreotide (Somatostatin) used for variceal bleeding?

Answer 5

It reduces bloodflow to portal system without major ADRs.

Question 6

How does UBGIT affect urea levels?

Answer 6

Urea levels rise significantly out of proportion to creatinine in UBGIT

Question 7

Difference between Primary Biliary Cholangitis vs PSC?

Answer 7

PBC is progressive destruction of intralobular BD.
PSC is progressive chronic inflammation of both intra and extrahepatic BD.

Question 8

Normal liver size?

Answer 8

13cm for men
10cm for women

Question 9

If ever had Hep B, which antibody will be positive?
What about for vaxxed pt?

Answer 9

Past infection = Anti-HbC +ve
Vaxxed = anti-HbsAg
In infection, Anti-HBc IgM is first Ab produced

Question 10

Criteria for Metabolic-associated fatty liver disease?

Answer 10

Detection of steatosis via liver histo/biomarkers/imaging
AND 1/3 of obesity, T2DM, evidence of metabolic dysfunction e.g. increased wasit circumference, abnormal lipid/glycaemic profile

Question 11

Prevalence of Hep B in SG?

Answer 11

3-5%

Question 12

If Hep B positive, how often to screen for Hep B?

Answer 12

every 6 months - 1 year.
AFP/LFT + cross-sectional imaging (US)

Question 13

Risk of perforation and bleeding in OGD and colonoscopy?

Answer 13

Perforation =0.01% for OGD
0.3% for colonoscopy
Risk of bleeding 2% in colono

Question 14

Alternatives for colonoscopy?

Answer 14

1. CT Colonography
2. Barium enema (phased out)

Question 15

When to stop iron tablets, blood thinners and hypoglycaemics before colonoscopy?

Answer 15

Iron tablets 5 days before
Blood thinners 3-7d before depending on drug. E.g. stop epixaban 3d before
Diabetic meds stop on the morning of scope

hypoglycaemics dangerous cuz risk of hypoglycemia while under sedation

Question 16

Causes of splenomegaly?

Answer 16

Increased degradation of defective RBCs - hemolytic anemia (thalassemia, spherocytosis, early sickle cell disease), polycythemia vera
Infection (immune response)
Portal HTN (liver cirrhosis or venous obstruction)
Hodgkin lymphoma/leukemia/mets
RA/SLE/Vasculitis/Connective tissue disease

Question 17

Causes of transaminitis?

Answer 17

EBV, CMV
Genetic: Haemochromatosis, Wilson’s, a-1-antitrypsin deficiency
Hemolysis, bone, muscle
Congestive hepatopathy
Viral hepatitis
NASH
ALD
FLD
ERCP

Question 18

Ascites + Cirrhosis + Variceal bleeding etc. raises risk of?

Answer 18

Spontaneous bacterial peritonitis.
Test with SAAG.

Question 19

where is ALT found?

Answer 19

Liver
Bone
Placenta

Question 20

Where is AST found?

Answer 20

Liver
Blood
Lungs
Brain
Kidneys
Muscles

Question 21

What is Budd Chiari syndrome?

Answer 21

Rare thromboembolic disorder of hepatic veins/IVC causing obstruction of hepatic vein outflow, hence post-sinusoidal portal HTN

Question 22

What happens to VLDL, LDL, IDL and CRL in nephrotic syndrome?

Answer 22

They rise due to impaired clearance

Question 23

Commonest pathogen for liver abscess?

Answer 23

Klebsiella commonest in SG