Liver

Question 1

What is the first line investigation for suspected hepatitis A?

Answer 1

Serum transaminases e.g. ALT, AST etc.

Question 2

How do LFT’s present in a patient with hepatitis A?

Answer 2

Very high ALT and high AST

Question 3

What are the risk factors for hepatitis B?

Answer 3

IVDU, unprotected sex, living in endemic areas such as Asia and Africa

Question 4

What are the symptoms of hepatitis B?

Answer 4

Most patients are asymptomatic, but some will present with complications such as liver cirrhosis or liver failure.

Question 5

What is the name of the antiviral medication given to patients with hepatitis B?

Answer 5

Entecavir.

Question 6

What are the 3 stages of ALD?

Answer 6

Fatty liver, alcoholic hepatitis and alcholic liver cirrhosis.

Question 7

What are the complications of ALD?

Answer 7

Variceal bleeding, ascites, hepatic encephalopathy and liver cancer.

Question 8

What are the signs/symptoms of ALD?

Answer 8

Malnutrition, hepatomegaly, abdo pain, haematemesis and melaena.

Question 9

What might you find on a blood test of a patient with ALD?

Answer 9

Elevated GGT, bilirubin, AST and ALT. The AST/ALT ratio >2. Low albumin.

Question 10

What are the signs of liver failure?

Answer 10

Asterixis, bruising clubbing, dupuytren’s contracture, encephalopathy, Fetor hepaticus, gynaecomastia, hepatomegaly, increase in parotids, jaundice.

Question 11

What is the first line treatment for NAFLD?

Answer 11

Lifestyle changes; diet, exercise, weight loss, cholesterol reduction.

Question 12

What is a thrombocytopenia? And what are the causes?

Answer 12

A low platelet count, which can be caused by leukaemia, lymphoma, malignancy, bone marrow fibrosis, excessive alcohol consumption.

Question 13

What is MST?

Answer 13

Slow release morphine

Question 14

What is thiamine?

Answer 14

Vitamin B1

Question 15

What is first and second line treatment of hepatic encephalopathy?

Answer 15

1st line - lactulose

2nd line - lactulose and rifaximin

Question 16

What is HRS? What is the difference between type 1 and type 2?

Answer 16

Hepatorenal syndrome - renal failure that develops as a result of severe liver disease. Type 1 involves a rapidly declining renal function, while type 2 is gradual which allows the build up of ascites.

Question 17

What type of drug is terlipressin and what it is used to treat?

Answer 17

An analogue of vasopressin (ADH), which causes vasoconstriction, reducing blood flow to certain areas of the body. It also causes an increase in water reabsorption. It is used to treat HRS.

Question 18

What is pabrinex used for?

Answer 18

It is a drug administered via an IM injection to replace vitamin B and C, sometimes causes by excessive alcohol consumption.

Question 19

What is the cognitive ACE used for?

Answer 19

It’s a neurophyscological test used to identify cognitive impairment in conditions such as dementia.

Question 20

What is the drug haloperidol used for?

Answer 20

It is an antipsychotic medication used to treat schizophrenia etc.

Question 21

What are the different types of jaundice?

Answer 21

Depending on the cause of the elevated bilirubin, jaundice can divided into pre hepatic (such as an increase in haemolysis), hepatic (such as liver cirrhosis) or post hepatic (caused by a blockage in bile excretion.

Question 22

What is CIWA?

Answer 22

The clinical institution withdrawal assessment for alcohol is a 10 item scale used in the assessment and management of alcohol withdrawal and can be used to decide whether to give benzodiazepines.

Question 23

What causes Wernicke’s encephalopathy?

Answer 23

A neurological emergency resulting from a thiamine deficiency.

Question 24

What can CAGE questions be used for?

Answer 24

To screen for harmful alcohol use.

Cut down, annoyed, guilty, eye opener.

Question 25

What is Wilson’s disease?

Answer 25

A rare inherited disease that causes the build up of copper in the liver, brain and other organs.