Liver

Question 1

Acute liver failure, haemolytic anaemia, high retics and unconjugated bilirubin

Answer 1

Wilson’s disease. Low serum caeruloplasmin and high urinary copper. Penacillamine - copper chelating agents. Low ALP because excessive copper acts to diminish zinc (a cofactor)

Question 2

Target of AMA in PBC?

Answer 2

Pyruvate dehydrogenase (PD), required for the generation of acetyl-CoA from pyruvate for entry into the tricarboxylic acid (TCA) cycle, is found in the mitochondria.

Question 3

King’s college criteria for liver transplantation

Answer 3

pH <7.30 or
INR >6.5 (PT >100 seconds) and serum creatinine >300 µmol/L (>3.4 mg/dL) in patients with grade 3 or 4 hepatic encephalopathy.
Serum bilirubin is only considered in cases of acute liver failure not secondary to paracetamol overdose.

Question 4

SBP Usually caused by aerobic bacterial

Answer 4

E Coli, Klebsiella

Question 5

Dublin Johnson

Answer 5

Conjugated hyperbilirubinaemia - trouble excreting

Question 6

Gilberts and Crigger Najjar

Answer 6

Unconjugated hyperbilirubinaemia due to trouble with UDP glucoronyl transferase

Question 7

Lactulose

Answer 7

Not absorbed, causes hypomagnesaemia, inhibits proliferation of ammonia forming organisms in the gut

Question 8

Most common electrolyte abnormality precipitating encephalopathy

Answer 8

Hypokalaemia (more NH3)