JAUNDICE

Question 1

In alcoholic hepatitis which enzyme is predominantly raised?

Answer 1

AST

Question 2

What criteria are used to determine eligibility for liver transplant?

Answer 2

Kings College Criteria

Question 3

What is the pathophysiology of paracetamol overdose?

Answer 3

• Liver damage occurs due to depletion of glutathione, leading to a build up of NAPQI

Question 4

Following a single paracetamol overdose how long must you wait until serum paracetamol leves are accurate?

Answer 4

4 hours

Question 5

What is the timeframe from beginning of single paracetamol overdose to commencement of NAC for maximum effectiveness?

Answer 5

8 hours

Question 6

What is the prescribed management of paracetamol overdose?

Answer 6

• bag 1-> 150mg/kg NAC in 200ml 5% glucose soln in 1 hour
• bag 2-> 50mg/kg NAC in 500ml 5% glucose soln in 4 hour
• bag 3-> 100mg/kg NAC in 1000ml 5% glucose soln in 16 hour

Question 7

Grade II or above varices should be managed with what primary prophylaxis?

What is the secondary prophylaxis of varices?

Answer 7

• propranolol 40mg
• 2 weekly variceal bading or TIPSS

Question 8

PBC vs PSC

Which is more common in men and which is more common in women?

Which is associated with IBD?

Which damages interlobular bile ducts and which damages intra- and extra-hepatic bile ducts?

Answer 8

• PBC women, PSC men
• PSC think IBD
• PBC interlobular bile ducts, PSC intra- and extra-hepatic bile ducts

Question 9

In addition to modafinil for lethargy and cholestyramine for pruritis, what is the mainstay of management for PBC?

Answer 9

Ursodeoxycholic acid 15mg/kg/day

Question 10

What is the gold standard investigation for diagnosis of PSC?

Answer 10

ERCP

Question 11

What si the only truly effective therapy in PSC (not including symptomatic therapy)?

Answer 11

Liver transplant

Question 12

What is the major complication of PSC and how is it monitored for?

Answer 12

Cholangiocarcinoma, annual USS screening

Question 13

What scale is used in the assessment of alcohol withdrawal?

Answer 13

The Clinical Institute Withdrawal Assessment for Alcohol, commonly abbreviated as CIWA or CIWA-Ar (revised version), is a 10-item scale used in the assessment and management of alcohol withdrawal.

Question 14

What disease should spring to mind in cases of concurrent chronic liver disease and COPD like symptoms?

Answer 14

alpha-1 antitrypsin deficiency