Liver

Question 1

causes of hepatic cirrhosis

Answer 1

HEPATIC (causes of hepatic cirrhosis)

Hemochromatosis (primary)
Enzyme deficiency (alpha-1-anti-trypsin)
Post hepatic (infection + drug induced)
Alcoholic
Tyrosinosis
Indian childhood (galactosemia)
Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's)

Question 2

liver failure: decompensating chronic liver failure differential

Answer 2

HEPATICUS (liver failure: decompensating chronic liver failure differential)

Haemorrhage
Electrolyte disturbance
Protein load/ Paracetamol
Alcohol binge
Trauma
Infection
Constipation
Uraemia
Sedatives/ Shunt/ Surgery

Question 3

causes of hepatomegaly

Answer 3

C3 [common] C3 [rarer] (causes of hepatomegaly)

Common are 3 C’s:
Cirrhosis
Carcinoma
Cardiac failure

Rarer are 3 C’s:
Cholestasis
Cysts
Cellular infiltration

Question 4

Child-Pugh score for liver cirrhosis

Answer 4

PH AST (Child-Pugh score for liver cirrhosis)
“pH, so 7-8 is in the middle, just like in arterial blood”

PT/INR
Hepatic encephalopathy

Ascites
Serum albumin
Total bilirubin

Class A [5-6], 100% first year, 85% second
Class B [7-9], 81%, 57%
Class C [10-15], 45%, 35%

Question 5

congenital metabolic defects in intrahepatic conjugation

Answer 5

DRC from GCU “DR Crap from Gold Coast University” (congenital metabolic defects in intrahepatic conjugation)

DR Conjugated
GC Unconjugated

1. Dubin-Johnson syndrome (predominantly conjugated)
2. Rotor syndrome (predominantly conjugated)
3. Gilbert syndrome (predominantly unconjugated)
4. Crigler-Najar syndrome (predominantly unconjugated)

If you import from China, there’s no GST (causes of post-hepatic jaundice)

1. Congenital biliary atresia: often accompanied by a reduction in the number of intrahepatic ducts
2. Gallstones: with biliary colic and a non-distendable chronically inflamed gallbladder
3. Strictures: often following previous biliary surgery
4. Tumours: notably carcinoma of head of pancreas

Question 6

Chronic liver disease signs

Answer 6

Chronic liver disease signs
Mnemonic: ABCDEFGHIJ  
A  	Asterixis (ʻliver flapʼ)/Ascites/Ankle oedema/Atrophy of testicles  B  	Bruising/BP.  
C	Clubbing/Colour change of nails; white (leuconychia)  
D	Dupuytrenʼs contracture  
E	Erythema (palmar)/Encephalopathy  
F	hepatic Foetor  
G	Gynaecomastia 
H	Hepato splenomegaly  
I	Increase in size of parotids  
J	Jaundice

Question 7

causes of post-hepatic jaundice

Answer 7

If you import from China, there’s no GST (causes of post-hepatic jaundice)

1. Congenital biliary atresia: often accompanied by a reduction in the number of intrahepatic ducts
2. Gallstones: with biliary colic and a non-distendable chronically inflamed gallbladder
3. Strictures: often following previous biliary surgery
4. Tumours: notably carcinoma of head of pancreas