Liver Disease

Question 1

Increased aminotransferases (ALT, AST) suggests ____

Answer 1

Hepatocellular injury

Question 2

Increased alkaline phophatase suggests ____

Answer 2

Cholestasis

Question 3

When there is an increase in alkaline phosphatase w/o increase in bilirubin and aminotransferases, where do you think the source of the injury is?

Answer 3

Bone

Placenta

Question 4

What tests do you perform withincreased alkaline phosphatase to confirm liver origin?

Answer 4

Increased GGT

5’nucleotidase

Question 5

What condition?

Large increase in AST and ALT

Answer 5

Viral hepatitis

Question 6

What condition?
Large increase in AST and ALT
Increase in LDH

Answer 6

Ischemic Hepatitis

Question 7

What condition?
AST >2xALT
Increased bilirubin

Answer 7

Alcoholic liver disease

Question 8

What condition?
Increased alkaline phosphatase
Large increase bilirubin

Answer 8

Cholestasis

Question 9

What condition?
Increase in bilirubin
Increased LDH
Decreased haptoglobin

Answer 9

Hemolysis

Question 10

What condition?
Increased in alkaline phosphatase
Normal ALT/AST

Answer 10

Hemolysis

Question 11

(ALT/AST) is more specific for liver.

Answer 11

ALT

Question 12

Which of the following is NOT on the differential for mild hepatocellular injury (ALT/AST elevation)
A. Chronic viral hepatitis
B. Primary biliary cholangitis
C. Non-alcoholic fatty liver disease
D. Autoimmune hepatitis

Answer 12

B. Primary biliary cholangitis is on differential of cholestatic injury

Question 13

Which of the following is NOT on the differential for extreme hepatocellular injury (ALT/AST elevation >30x ULN = 1,000U/L)?
A. Drug induced liver injury
B. Acute viral hepatitis
C. Hepatic ischemia
D. Congestive hepatopathy

Answer 13

D. Congestive hepatopathy is on the differential for mild hepatocellular injury

Question 14

Hyperbilirubinemia of sepsis shows (direct/indirect) bilirubin.

T/F: Labs show elevated alk. phos, ALT and AST.

Answer 14

Direct

False. Normal ALT, AST. Minimal elevation in alk phos

Question 15

Gilbert’s Syndrome =

Answer 15

Unconjugated (indirect) hyperbilirubinemia

Question 16

3 types of decompensation of chronic liver disease

Answer 16

Acites
Variceal bleeding
Hepatic encephalopathy

Question 17

T/F: A patient with platelet defficiency is contraindicated for paracentesis.

Answer 17

False. Coagulopathy is NOT a contraindication for tapping ALL ascites.

Question 18

Diagnosis of Spontaneous Bacterial Peritonitis

Answer 18

> 250 PMN/mm3 in ascetic fluid

Question 19

SAAG > 1.1 =

Answer 19

portal HTN

Question 20

T/F: Prophylactic abx should be given to cirrhotic patients admitted with nausea/vomitting.

Answer 20

False. Admitted with GI bleeding

Question 21

T/F: You should wait for culture to come back before giving abxwhen suspiscious of Spontaneous Bacterial Peritonitis to ensure that you are giving the right antibiotic.

Answer 21

False. Start abx immediately

Question 22

The most effective management of ascites

Answer 22

Sodium restriction

Question 23

Which of the following is FALSE about management of ascites?
A. Sodium restricted diet
B. Spironolactone, furosemide
C. Fluid restriction
D. Avoid IV diuretics
E. Acetaminophen for pain management

Answer 23

C.NO fluid restriction needed for serum Na>120

E. Acetaminophen is ok b/c it’s not an NSAID. NSAID should be avoided in pts w/ cirrhosis.

Question 24

Most common cause of upper GI bleeding in cirrhotics

Answer 24

Variceal bleeding

Question 25

Clinical diagnosis of hepatic encephalopathy based on presence of:(3)

Answer 25

Advanced liver disease
Asterixis
Hyperreflexia

Question 26

T/F: Elevated blood ammonia levels is required to make diagnosis of Hepatic Encephalopathy.

Answer 26

False. NOT required

Question 27

Which of the following is NOT a treatment of hepatic encephalopathy?
A. Lactulose (laxative)
B. Rifaximin
C. Protein restriction
D. ID and correct precipitating causes

Answer 27

C. NO need for protein restriction

Question 28

MELD score is based on (3)

MELD score used for ____

Answer 28

Creatinine
Bilirubin
INR

Predicting 3 month mortality