Liver, biliary tract and pancreatic disease

Question 1

LFTs in hepatitis

Answer 1

Raised AST and ALT

Question 2

LFTs in extrahepatic obstruction

Answer 2

Raised ALP with a smaller raise in aminotransferases

Question 3

Bilirubin in haemolytic jaundice

Answer 3

Raised

Question 4

Cholangitis

Answer 4

Inflammation of the gallbladder

Question 5

Principal cause of chronic liver disease, cirrhosis and hepatocellular carcinoma?

Answer 5

Chronic hepatitis

Question 6

Eosinophilic Councilman bodies

Answer 6

Hepatitis

Question 7

In hepatitis, which zone is necrosis maximal in?

Answer 7

Zone 3

Question 8

Drugs which cause hepatitis?

MIKN

Answer 8

MIKN
Methyldopa
Isoniazid
Ketoconazole
Nitrofurantoin

Question 9

Hepatitis types that cause chronic hepatitis?

Answer 9

Hep B, Hep C, Hep D

Question 10

What is fulminant hepatic failure?

Answer 10

Severe hepatic failure in which encephalopathy develops in under 2 weeks in a patient with a previously normal liver

Histologically there is multiacinar necrosis involving a substantial part of the liver

Question 11

Most common cause of FHF in UK?

Answer 11

Paractemol overdose

Question 12

Autoimmune conditions associated with autoimmune hepatitis?

Answer 12

Pernicious anaemia
Thyrotoxicosis
Coeliac disease

Question 13

Treatment for autoimmune hepatitis?

Answer 13

Steroid and aziathioprine therapy

Question 14

Management of NAFLD?

Answer 14

Weight loss, exercise, strict control of hypertension, diabetes and lipid levels

Question 15

Characteristic features of cirrhosis?

Answer 15

Regenerating nodules separated by fibrous septa and loss of the normal lobular architecture within the nodules

Question 16

Micronodular cirrhosis?

Answer 16

Regenerating nodules <3mm

Question 17

Macrondoular cirrhosis?

Answer 17

This type is often seen following chronic viral hepatitis (I reckon nodules are >3mm)

Question 18

Best indicators of liver function?

Answer 18

Serum albumin and prothrombin time

Question 19

Liver biochemistry in cirrhosis?

Answer 19

This can be normal, depending on the severity of the cirrhosis
In most cases, there is at least a slight elevation in the serum ALP and serum aminotransferase
In decompensated cirrhosis, all biochemistry is derranged

Question 20

Increased echogenicity of the liver on US?

Answer 20

Fatty change and fibrosis

Question 21

Percentage of patients with cirrhosis that will develop gasto-oesophageal varices?

Answer 21

90%

But only one third will bleed from them

Question 22

Treatment for variceal bleeding?

Answer 22

Variceal banding or injection scleropathy
(terlipressin, somatostatin)
(Balloon tamponade)

-Re-bleeding occurs in about 15-20% within 5 days after a single session of therapeutic endoscopy

Question 23

Fluid within the peritoneal cavity?

Answer 23

Ascites

Question 24

Neutrophil count in bacterial peritonitis?

Answer 24

Neutrophil count above 250 cells/mm is INDICITAVE OF AN UNDERLYING (usually spontaneous) BACTERIAL PERITONITIS

Question 25

Management of ascites

Answer 25

The aim is to both reduce sodium intake and to increase renal excretion of sodium

• check serum electrolytes, creatinine and eGFR at the start of every other day; weigh patient and measure urine output daily
• give spironolactone
• check the medications they are on as many contain sodium

Question 26

Serious complication of ascites with cirrhosis

Answer 26

Bacterial peritonitis!

Question 27

Antibiotics for bacterial peritonitis?

Answer 27

Third generation cephalosporin e.g. cefotaxime of certazidime
Oral quinolone given e.g. norfloxacin given daily for prevention

Question 28

Hepatopulmonary syndrome

Answer 28

Hypoxemia occuring in patients with advanced liver disease

Question 29

A child of 4 months presents with an abdominal mass. Investigation shows displacement of right kidney
Abdominal distension is present

Answer 29

Nephroblastoma