Liver and friends

Question 1

Which liver enzymes is raised the most in alcoholic liver disease?

Answer 1

AST

Question 2

What are the metabolic causes of liver disease?

Answer 2

Hereditary haemochromatosis
Wilsons disease
Alpha 1 antitrypsin deficiency

Question 3

What are the symptoms of hereditary haemochromatosis?

Answer 3

(Jack lost his point and shoot)
Joints - arthralgia
Liver - CLD
Heart - dilated cardiomyopathy
Pancreas - DM
& - loss of libido 
Skin - slate grey skin

Question 4

What Ix are done for hereditary haemochromatosis?

Answer 4

Ferritin (low values would exclude)
Transferrin sat > 45%
HFE gene testing

Question 5

What is the mainstay of treatment for hereditary haemochromatosis?

Answer 5

Venesection

Question 6

What additional monitoring will a hereditary haemochromatosis pt need if liver is cirrhotic?

Answer 6

Yearly screen for hepatocellular carcinoma with USS +- AFP

Question 7

Why is iron high in hereditary haemochromatosis?

Answer 7

Increased intestinal iron absorption

Question 8

What are the presenting features of wilsons disease/

Answer 8

hepatic - ALF, cirrhosis, chronic hepatitis
Depression/personality change
Tremor, ataxia, clumbsiness
Kayser Fleischer rings

Question 9

What Ix for wilsons disease?

Answer 9

Low serum caeruloplasmin
High free copper
High urine copper excretion

Question 10

How is wilsons disease mx?

Answer 10

Diet control

Penicillamine

Question 11

Ix should you do in young person with features of COPD and liver disease

Answer 11

serum alpha1- antitrypsin

Question 12

Define hyperacute liver failure

Answer 12

Onset less than 7 days

Question 13

Define acute liver failure

Answer 13

Onset 8-21 days

Question 14

Which drug can be used to help tx encephalopathy due to liver failure?

Answer 14

Lactulose

Question 15

How do you tx cerebral oedema?

Answer 15

Mannitol IV and hyperventilate on ITU

Question 16

Aet of ascites

Answer 16

CIRRHOSIS
MALIGNANCY
heart failure
nephrotic syndrome

Question 17

What should you suspect in a patient with a triad of cirrhosis, ascites and renal failure?

Answer 17

Hepatorenal failure

Question 18

What are the comps of cirrhosis?

Answer 18

Hepatic failure
Portal htn
Hepatocellular carcinoma (HCC risk)

Question 19

What are the most common causes of cirrhosis?

Answer 19

Chronic alcohol abuse
HBV
HCV
non-alcoholic steatohepatitis

Question 20

What features on liver biopsy indicate cirrhosis?

Answer 20

Loss of hepatic architecture
Bridging fibrosis
Nodular regeneration

Question 21

What scoring system can be used to assess the prognosis of CLD?

Answer 21

Child-pugh classification

Question 22

What are the components of child-pugh classification?

Answer 22

Encephalopathy
Ascites
Bilirubin
Albumin 
INR

Question 23

What are the comps of portal htn?

Answer 23

Oesophageal varices
Caput medusae
Rectal haemorrhoids
Ascites

Question 24

What drug can be used in the primary prevention of varices?

Answer 24

Beta blockers (e.g. propranolol)

Question 25

What drug can be used to help manage an acute varices bleed?

Answer 25

Terlipressin

Question 26

What are the two most common types of primary liver Ca?

Answer 26

HCC | cholangiocarcinoma

Question 27

Causes of HCC?

Answer 27

Cirrhosis Hep C Hep B Autoimmune hepatitis

Question 28

How do you screen for HCC?

Answer 28

12 monthly USS and AFP

Question 29

Which condition increases the risk of cholangiocarcinoma?

Answer 29

PSC

Question 30

Name a immunohistochemical sign of ALD?

Answer 30

Mallory bodies

Question 31

Which Abs are raised in autoimmune hepatitis?

Answer 31

Antismooth muscle Abs

Question 32

How is autoimmune hepatitis mx?

Answer 32

Steroids and azathioprine

Question 33

What amylase value is suggestive of acute pancreatitis?

Answer 33

3 fold of upper limit

Question 34

What Ix for acute pancreatitis?

Answer 34

``` Amylase Lipase AXR CXR CT ABG ```

Question 35

What score is used to calculate the probability of severe pancreatitis developing?

Answer 35

Modified Glasgow score

Question 36

What happens to glucose in acute pancreatitis?

Answer 36

Goes up

Question 37

What's the leading cause of chronic pancreatitis?

Answer 37

Alcohol

Question 38

How does chronic pancreatitis present?

Answer 38

Abdo pain N & V Diarrhoea, steatorrhoea DM

Question 39

What amylase level indicates chronic pancratitis?

Answer 39

Will be normal

Question 40

What should you suspect in a patient with painless obstructive jaundice?

Answer 40

Pancreatic Ca

Question 41

What is courvoisiers sign?

Answer 41

In a pt with painless jaundice and an enlarged gallbladder unlikely to be gallstones Likely pancreatic or biliary neoplasm

Question 42

Which tumour marker can aid in diagnosis of pancreatic Ca?

Answer 42

CA19-9

Question 43

Which tests are used to visualise the pancreas and bile ducts?

Answer 43

ERCP/MRCP

Question 44

What are gallstones made of?

Answer 44

Cholesterol (80%) Pigment (10%) Mixed (10%)

Question 45

Whats the most sensitive Ix for biliary stones?

Answer 45

USS

Question 46

How does cholecystitis px?

Answer 46

``` RUQ pain (continuous) + Fever/raised WCC ```

Question 47

Whats the definitive tx for cholecystitis?

Answer 47

Laparoscopic cholecystectomy

Question 48

What's charcots triad?

Answer 48

RUQ pain Fever/ raised WCC JAUNDICE

Question 49

What does charcots triad suggest?

Answer 49

Ascending cholangiitis

Question 50

What is Reynolds pentad?

Answer 50

Charcots (RUQ pain, fever and jaundice) + ALTERED MENTAL STATE and CONFUSION

Question 51

What can cause ascending cholangitis?

Answer 51

Stones Tumours ERCP

Question 52

What three conditions help dx ascending cholangitis?

Answer 52

1) systemic inflammation 2) evidence of cholestasis 3) Imaging (CT best)

Question 53

How do you manage ascending cholangitis?

Answer 53

same as sepsis

Question 54

Define primary sclerosing cholangitis

Answer 54

Progressive cholestasis with bile duct inflammation and strictures Effects intra and extrahepatic ducts

Question 55

How does PSC px?

Answer 55

Pruritus Fatigue Can eventually get cirrhosis/liver failure

Question 56

What conditions is PSC associated with?

Answer 56

IBD (esp UC) | Cancer (bileduct, gallbladder, liver, colon)

Question 57

What monitoring do PSC pts need?

Answer 57

Yearly USS and colonoscopy due to Ca risk

Question 58

Which autoantibody is most commonly positive in PSC?

Answer 58

ANA

Question 59

Define primary biliary cirrhosis

Answer 59

INTERLOBULAR bile ducts damaged by chronic autoimmune granulomatous inflammation

Question 60

Which auto Ab is positive in primary biliary cirrhosis?

Answer 60

Antimitichondrial Ab

Question 61

Give three tests you would want to do in PBC?

Answer 61

LFTs USS (rule out obstruction) MRCP (rule out PSC)

Question 62

What drug can be used to tx pruritus due to biliary obstruction?

Answer 62

Colestyramine