Liver

Question 1

Causes of hepatic failure

Answer 1

Vascular: ischaemia
Infection: hepatitis, EBV, CMV
Trauma>Toxins: alcohol, paracetamol poisoning
Autoimmune liver disease
Metabolic: Wilsons, A1AT, haematochromatosis
Neoplastic: hepatocellular carcinoma
Drugs: isonaizid, amiodarone, MTX
Acute fatty liver of pregnancy

Question 2

treatment for NALD

Answer 2

lifestyle, orlistat, vitamin E

Question 3

causes of cirrhosis

Answer 3

Vascular: Budd Chiari
Infective: viral hepatitis
T-
Autoimmune hepatitis
Metabolic: alcoholic, NAFLD, Wilson's, CF, PBC, PSC

Question 4

how does budd chiari usually present?

Answer 4

abdo pain, hepatomegaly, ascites

Question 5

what should be monitored in patients with cirrhosis

Answer 5

renal function

Question 6

findings in patients with cirrhosis

Answer 6

low glucose-no gluconeogenesis
raised alk phos
raised bilirubin

Question 7

how should all patients with cirrhosis be treated regardless of the type?

Answer 7

less alcohol and NSAIDs

USS for HCC

Question 8

what differentiates fatty liver from alcoholic hepatitis?

Answer 8

fatty-just infiltration

hepatitis PMN infiltration

Question 9

what is the pathology behind hepatic encephalopathy?

Answer 9

NH3 build up

Question 10

what increase the risk of hepatocellular carcinoma

Answer 10

cirrhosis (PBC), HBV

Question 11

how does alcoholic hepatitis present?

Answer 11

most symptomatic of the 3 types of liver disease that can be caused by alcohol: 
rapid onset jaundice
nausea
encephalopathy
fever
ascites

Question 12

what are Mallory bodes?

Answer 12

eosinophilic material that fills up ballooning hepatocytes in alcoholic hepatitis and alcoholic cirrhosis

Question 13

how does haemochromatosis present?

Answer 13

late in 40-60s, fatigue, weakness, heart disease.

Later: DM, bronzing of skin, hepatomegaly

Question 14

how does Wilson’s disease present?

Answer 14

20-30s

acute hepatic failure, behavioural problems, disease, greyness of skin

Question 15

what might you suspect in a neonate with jaundice and hepatitis?

Answer 15

A1AT deficiency, in older people presents with cirrhosis, more likely to cause a respiratory problem however

Question 16

give an example of triple therapy?

Answer 16

clarithromycin, metronidazole, omeprazole

Question 17

how can you test for H pylori?

Answer 17

C13 urea breath test or stool antigen

Question 18

what is the cause of gastropathy?

Answer 18

destruction of the gastric mucosa without inflammation-no infection so NSAIDs

Question 19

what disease do many PSC patients have?

Answer 19

UC

Question 20

what is cirrhosis?

Answer 20

scarring and disorganisation of hepatocytes

Question 21

what kind of cancer is most pancreatic

Answer 21

ductal adenocarcinoma

Question 22

RFs for pancreatic cancer

Answer 22

smoking, alcohol, large waist circumference, chronic pancreatitis

Question 23

what treatment reduces incidence of colorectal ca?

Answer 23

aspirin

Question 24

what are the causes of hepatomegaly?

Answer 24

Vascular congestion: Budd chiari, RHF
Infective: hepatitis, malaria, sickle cell, schisto, amoebiasis
T
A
M
Inflammatory
Neoplastic: HCC/mets

haematological: cas, sickle cell, haemolytic anaemias

Question 25

what are the causes of oesophageal varicies?

Answer 25

pre hepatic: portal vein thrombosis, spleinic vein thrombosis
hepatic: cirrhosis, schisto, sarcoidosis, myeloproliferative disease, congential hepatic fibroids
post hepatic: budd chiari, RHF, constrictive pericarditis, veno occlusive disease