Liver Disease

Question 1

Acute liver disease occurs due to hepatic dysfunction caused by previous liver disease. True/False/

Answer 1

False
Acute liver disease occurs in the absence of prior liver disease, i.e. in a previously normal liver

Question 2

List all of the liver function tests (LFTs)

Answer 2

ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time

Question 3

What do ALT/AST levels tell us?

Answer 3

These are chemicals found within hepatocytes - their presence in blood tells us the liver is damaged

Question 4

Where is ALP also found?

Answer 4

Bone

Question 5

What is raised GGT traditionally associated with?

Answer 5

Excess alcohol intake

Question 6

Where is bilirubin made and what is made from?

Answer 6

Made in the liver from broken down RBCs

Question 7

What is PT time?

Answer 7

Time it takes blood to clot

Question 8

Briefly, what happens in Budd Chiari syndrome? What is the classic presentation?

Answer 8

Clotting in hepatic veins
Young women on the pill

Question 9

Name some viral causes of acute liver disease

Answer 9

Hepatitis
CMV
EBV

Question 10

Which drug infamously causes acute liver disease?

Answer 10

Paracetamol

Question 11

Outline treatment for acute liver disease

Answer 11

Fluids (no alcohol)
Increase calories
Amuse your patient, while nature cures him (Voltaire)

Question 12

What are some treatments for itch associated with acute liver disease?

Answer 12

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

Question 13

Hypoglycaemia is a very serious clinical sign of acute liver disease. How does it occur?

Answer 13

Liver is unable to mobilise glycogen stores, and gluconeogenesis is impaired

Question 14

Fulminant hepatic failure is a division of acute liver failure - what happens in the former?

Answer 14

Encephalopathy and jaundice in previous normal liver

Question 15

Is cirrhosis reversible?

Answer 15

No

Question 16

Define cirrhosis

Answer 16

Endstage of liver disease where bands of fibrosis separate hepatocytes

Question 17

Chronic liver disease is defined as liver disease of duration > 6 months. True/False?

Answer 17

True

Question 18

List some common causes of chronic liver disease

Answer 18

Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson’s, haemochromatosis

Question 19

What is NAFLD?

Answer 19

Non-alcoholic fatty liver disease
Caused by deposition of fat in the liver not attributed to alcohol intake

Question 20

What are the 4 stages of NAFLD?

Answer 20

1. Steatosis (harmless fat build up)
2. Non-alcoholic steatohepatitis (NASH)
3. Fibrosis
4. Cirrhosis

Question 21

What is the most common cause of NAFLD?

Answer 21

Obesity

Question 22

How is NASH diagnosed?

Answer 22

Liver biopsy

Question 23

What is primary biliary cirrhosis?

Answer 23

Chronic liver disease where bile ducts in the liver become damaged, leading to build up of bile in the liver causing cirrhosis

Question 24

Women get primary biliary cirrhosis more commonly than men. True/False?

Answer 24

True
Middle-aged women

Question 25

How is primary biliary cirrhosis diagnosed?

Answer 25

2 of +ve AMA cholestatic LFTs liver biopsy

Question 26

What is the main treatment for primary biliary cirrhosis?

Answer 26

Urseodeoxycholic acid

Question 27

Autoimmune hepatitis affects men more commonly than women. True/False?

Answer 27

False Affects women more commonly

Question 28

List some symptoms of autoimmune hepatitis

Answer 28

Hepatomegaly Jaundice Elevated LFTs Non-specific symptoms (fatigue, malaise, nausea)

Question 29

List the corticosteroids used to treat autoimmune hepatitis

Answer 29

Azathioprine Predisolone

Question 30

What is primary sclerosing cholangitis?

Answer 30

Autoimmune destruction of large and medium -sized bile ducts

Question 31

Males are more commonly affected by primary sclerosing cholangitis than women. True/False?

Answer 31

True

Question 32

40% of primary sclerosing cholangitis patients also have Crohn's disease. True/False?

Answer 32

False They have UC, not Crohn's disease

Question 33

How is primary sclerosing cholangitis diagnosed?

Answer 33

MRCP/ERCP

Question 34

What is haemochromatosis?

Answer 34

Autosomal recessive disorder of iron overload

Question 35

What is Wilson's disease?

Answer 35

Autosomal recessive disorder where there is lack of/mutations of ceruloplasmin, leading to excess copper

Question 36

What are the main complications of cirrhosis?

Answer 36

Ascites Oesophageal varices Encephalopathy

Question 37

How is ascites treated?

Answer 37

Treat underlying cause, avoid salt Spironolactone Paracentesis TIPs

Question 38

How does hepatic encephalopathy arise?

Answer 38

Ammonia from diet is taken directly into systemic circulation rather than being metabolised in the liver, causing disruption in brain function

Question 39

Which virus is a somewhat rare cause of hepatitis C?

Answer 39

Herpes simplex virus

Question 40

Hepatocellular adenoma is more common in females than males. True/False?

Answer 40

True

Question 41

Metastatic cancer is more common than primary live cancer in the absence of liver disease. True/False?

Answer 41

True

Question 42

What is the most common liver tumour in non-cirrhotic patients?

Answer 42

Hemangioma

Question 43

Patients with hemangioma are usually asymptomatic. True/False?

Answer 43

True

Question 44

What would be find on ultrasound of a hemangioma?

Answer 44

Well demarcated echogenic spot

Question 45

There is association with the oral contraceptive pill and hepatic adenomas. True/False?

Answer 45

True

Question 46

Which protein is a HCC marker?

Answer 46

Alfa feto protein (AFP)