Liver disease

Question 1

The liver is the only organ to have two blood supplies. True or false?

Answer 1

True

Question 2

The gall bladder is positioned just outside the liver. True or false?

Answer 2

False - within the liver

Question 3

Where does the bile produced by the gall bladder drain into?

Answer 3

The GIT

Question 4

Why may a large rise in enzymes represent minimal damage to the liver?

Answer 4

Because there is a large number of hepatic enzymes present in hepatocytes so when there is damage, the enzymes spill out, leading to an increase in the blood

Question 5

What is bilirubin a breakdown product of?

Answer 5

RBC

Question 6

Bilirubin is conjugated in the liver and excreted where?

Answer 6

In the bile

Question 7

Following recent alcohol consumption, you may expect a rise in which LFT?

Answer 7

GGT (gamma-glutamyl-transferase)

Question 8

Alkaline phosphates are specific to the liver. True or false?

Answer 8

False

Question 9

What does ALT stand for?

Answer 9

alanine aminotransferase

Question 10

What does AST stand for?

Answer 10

Aspartate aminotransferase

Question 11

If there is hepatocellular damage (damage inside the liver), you may expect a rise in which LFTs?

Answer 11

ALT
AST
GGT
Total bilirubin (i.e. conjugated and unconjugated)

Question 12

Acute liver disease is usually self-limiting. True or false?

Answer 12

True

Question 13

If there is cholestatic damage (blockage of the bile duct etc.) which LFTs would you expect an increase in?

Answer 13

Alk phos
total cholesterol
conjugated bilirubin
pruritus is common

Question 14

What is hepatitis?

Answer 14

Inflammation of hepatocytes

Question 15

What is the latent period for a type A reaction?

Answer 15

Hours to weeks

Question 16

What is the latent period for a type B reaction?

Answer 16

Weeks to months

Question 17

Type A reactions are more frequent than type B. True or false?

Answer 17

True

Question 18

Type A reactions are dose dependent and type B are dose independent. True or false?

Answer 18

True

Question 19

Liver disease lasting more than 3 months is classed as chronic. True or false?

Answer 19

False - 6/12 months

Question 20

What are the common causes of chronic liver disease?

Answer 20

Alcohol

Chronic viral hepatitis (Hepatitis C)

Question 21

What is meant by steatosis?

Answer 21

Fatty deposits around the liver

Question 22

What is the difference between cirrhosis and fibrosis?

Answer 22

Cirrhosis is the scarring of liver and fibrosis is death of liver cells

Question 23

Why is pruritus more common in cholestasis?

Answer 23

Because of presence of bile salts in skin

Question 24

What is the treatment for pruritis, if caused by bile stones?

Answer 24

Surgical removal of bile stones

Question 25

What are the two main treatments for pruritis?

Answer 25

Anion exchange resins | Antihistamines

Question 26

How do anion exchange resins work?

Answer 26

Bind bile acids in the gut and stop them from being absorbed into the blood

Question 27

What is ascites?

Answer 27

Collection of fluid in the abdominal cavity

Question 28

Name 3 drugs that treat ascites?

Answer 28

Spironolactone Furosemide Metolazone

Question 29

Which two analgesics are used in liver disease for ascitic pain?

Answer 29

Paracetamol - with caution 2g daily max | Tramadol

Question 30

Which analgesics should be avoided in liver disease?

Answer 30

NSAIDs/Antiplatelets - risk of bleeding | Opioids - decrease clearance

Question 31

Name 4 drugs for the treatment of hepatic encephalopathy

Answer 31

Lactulose Neomycin Metronidazole Rifaxamin

Question 32

Why is oesphageal varices a medical emergency?

Answer 32

Due to large blood loss

Question 33

How does liver disease lead to bleeding varices?

Answer 33

Cirrhosis -> portal hypertension -> varices

Question 34

What happens in oesophageal varices?

Answer 34

Small blood vessels form along gastric vein and up towards the oesophagus to release pressure in portal system. However, these are very weak and any increase in pressure causes them to rupture and bleed. Blood spills into oesphagus and patient vomits blood

Question 35

What is the aim of treatment for oesphageal varices?

Answer 35

Constrict blood flow - stop bleeding and replace lost blood

Question 36

What is chlordiazepoxide used to treat?

Answer 36

Alcohol withdrawal

Question 37

What is menandiol used to treat?

Answer 37

Vitamin K deficiency

Question 38

How is hep A transmitted?

Answer 38

Faecal-oral route

Question 39

How is hep B transmitted?

Answer 39

Blood-borne

Question 40

Vaccination for hep A is recommended for healthcare workers. True or false?

Answer 40

False - for travellers

Question 41

Vaccination for hep B is recommended to who?

Answer 41

Healthcare workers

Question 42

What is hep B treated with?

Answer 42

Entercavir or tenofovir (antiviral) | Interferon alpha a (boosts immune function)

Question 43

What is the treatment for hep A?

Answer 43

Supportive treatment, no therapy to eradicate

Question 44

How is hep C transmitted?

Answer 44

Blood borne

Question 45

Ribavirin is used to treat which hepatitis?

Answer 45

C - combined with interferon alpha 2b

Question 46

Hepatitis A causes hep D. True or false?

Answer 46

False - hep B is needed to cause hep D

Question 47

Hep E causes chronic liver disease. True or false?

Answer 47

False - self limiting infection, doesn't cause chronic liver disease