Liver diseases Flashcards
Male patient with liver cirrhosis is admitted to the hospital with massive hematemesis, with the possibility of variceal rupture. The followings should be done, except:
A) ensuring venous access with cannulation of 2 peripheral vein
B) determining blood group, INR, blood count
C) administration of iv. terlipressin
D) oesophagogastroscopy and ligation or sclerotherapy of esophageal varices after hemodynamic stability is reached
E) blood transfusion to increase hemoglobin level above 100 g/l
E) blood transfusion to increase hemoglobin level above 100 g/l
The extrahepatic complication of chronic hepatitis B might be:
A) periarteritis nodosa, immuncomplex vasculitis
B) glomerulonephritis
C) cryoglobulinaemia
D) arthritis
E) all of the above
E) all of the above
Characteristics of drug-induced liver injury, except:
A) it is always dose-dependent
B) indiosyncratic reaction is also possible
C) it can manifest few days or several weeks after drug intake
D) it is forbidden to readminister the drug which caused liver injury
E) cholestasis can be present
A) it is always dose-dependent
A 65-year-old male patient presented with jaundice started 3 weeks before. What is the first step?
A) abdominal ultrasound
B) computer tomography (CT)
C) endoscopic retrograde cholangiopancreatography (ERCP)
D) percutaneous transhepatic cholangiography (PTC)
E) MR cholangio-pancreatography (MRCP)
A) abdominal ultrasound
The most frequent cause of liver cirrhosis nowadays, which was earlier labeled as “cryptogen” cirrhosis:
A) Wilson’s disease
B) Hepatitis E virus (HEV) infection
C) Non alcoholic steatohepatitis (NASH)
D) Hemochromatosis
E) Drugs and other toxic agents
C) Non alcoholic steatohepatitis (NASH)
Select the tumor where serum alpha-fetoprotein (AFP) is mostly pathognomic.
A) prostate cancer
B) osteogenic carcinoma
C) gastric cancer
D) colon cancer
E) hepatocellular cancer (HCC)
E) hepatocellular cancer (HCC)
Characteristics of alcoholic hepatitis, except:
A) excessive alcohol consumption recently
B) corticosteroid administration is always necessary
C) elevated bilirubin, high INR, leukocytosis can be present
D) high mortality in severe cases
E) alcohol abstinence is essential during treatment
B) corticosteroid administration is always necessary
Characteristics of primary biliary cholangitis (PBC), except:
A) antimitochondrial antibody (AMA) is present
B) serum-IgM is frequently elevated
C) female dominance
D) corticosteroid is indicated for treatment
E) it might be associated with scleroderma
D) corticosteroid is indicated for treatment
Which of the following medication can dose-dependently cause liver failure?
A) halothane
B) paracetamol (acetaminophen)
C) chlorpromazine
D) methyldopa
E) erythromycin
B) paracetamol (acetaminophen)
It can trigger hepatic encephalopathy in severe liver cirrhosis, except:
A) gastrointestinal bleeding
B) metabolic acidosis
C) aggressive diuretic therapy
D) enteral infection
E) high amount of oral protein intake
B) metabolic acidosis
Jaundice appears on the 3rd postoperative day after aortic aneurysms surgery in a female patient, who is afebrile, otherwise asymptomatic. Lab results: SeBi: direct 220 μmol/l, indirect 80 μmol/l, ALP 500 IU, AST, ALT, LDH are normal. What is the most likely diagnosis?
A) biliary tract obstruction
B) halothane-induced hepatitis
C) portal vein thrombosis
D) haemolysis
E) benign postoperative cholestasis
E) benign postoperative cholestasis
Predisposing factor(s) for gallstone formation:
A) obesity
B) chronic hemolysis
C) octreotide therapy
D) bowel resection
E) all of the above
E) all of the above
67-year-old patient sees a doctor with dull right hypochondriac pain, fever, weight loss. Lab findings: GGT 600 E, ALP 740 E, LDH: 900 E. What additional lab tests would be helpful to confirm the diagnosis?
A) antinuclear antibody (ANA)
B) serum α-fetoprotein (AFP)
C) antimitochondrial antibody (AMA)
D) anti smooth muscle antibody (SMA)
E) prostate specific antigen (PSA)
B) serum α-fetoprotein (AFP)
True for esophageal variceal bleeding, except:
A) sclerotherapy is needed only when recurrent bleeding occurs after portocaval shunt operation
B) iv. terlipressin is important to stop bleeding
C) deep jaundice and ascites increase the risk of mortality
D) per os propranolol or carvediol are useful in prevention of bleeding
E) portocavalis shunt increases the risk of hepatic encephalopathy
A) sclerotherapy is needed only when recurrent bleeding occurs after portocaval shunt operation
Liver biopsy is indicated, except:
A) suspected liver adenoma
B) unexplained abnormal liver function tests
C) for diagnosis of NASH
D) for diagnosis of autoimmune hepatitis
E) suspected hemangioma
E) suspected hemangioma
The risk of following disorders is increased in female patients who are taking oral contraceptive pills, except:
A) liver adenoma
B) peliosis hepatis
C) focal nodular hyperplasia
D) angiosarcoma
E) thromboembolism
D) angiosarcoma
The effect of acetaldehyde produced in the metabolism of alcohol:
A) induces immunoreaction through neoantigen formation
B) damage of microtubular functions in hepatocytes
C) decrease of the glutathione reserve of liver
D) increase of superoxide formation
E) all of the above
E) all of the above
Characteristic laboratory values in chronic heavy drinkers, except:
A) high MCV, usually above 100 fl
B) elevated GGT
C) elevated triglyceride
D) AST/ALT ratio > 1
E) AST/ALT ratio < 1
E) AST/ALT ratio < 1
Characteristics of HCV infection, except:
A) infection can cause cirrhosis for decades
B) only the IFN-based therapy can lead to total recovery
C) it was transmitted through blood transfusion before 1992
D) infection spreads among intravenous drug users nowadays
E) it increases the risk of hepatocellular carcinoma
B) only the IFN-based therapy can lead to total recovery
True for paracetamol- (acetaminophen) toxicity:
A) toxicity is dose-dependent
B) it is based on immune-allergy
C) it never results in severe toxicity
D) antidote is not known
E) it can safely be administered to alcoholics
A) toxicity is dose-dependent
Septic complications mostly occur in obstructive jaundice caused by Klatskin tumor:
A) after percutaneous transhepatic cholangiography
B) after MRCP
C) after duodenoscopy
D) after ERCP
E) none of the above
D) after ERCP
Characteristics of ursodeoxycholic acid, except:
A) it has hydrophilic property
B) it is used in treatment of primary biliary cholangitis
C) it increases the risk of colorectal cancer in patients with primary sclerosing cholangitis
D) it takes part in the enterohepatic cycle
E) it is non-toxic bile acid
C) it increases the risk of colorectal cancer in patients with primary sclerosing cholangitis
True for hepatocellular carcinoma (HCC), except:
A) metastasis always occurs in the early phase
B) it has bad prognosis
C) it often develops in cirrhotic liver
D) serum-α-fetoprotein (AFP) level increases in half of the cases
E) it develops more frequently in males than in females
A) metastasis always occurs in the early phase
True for the ascites in liver cirrhosis without further cirrhotic complications:
A) it is bloody
B) protein content is always above 30 g/l
C) malignant cells are found in the sediment
D) serum albumin - ascites albumin gradient >11 g/l
E) neutrophil granulocyte count is above 1000/mm3
D) serum albumin - ascites albumin gradient >11 g/l
Characteristics of cholestatic jaundice, except:
A) level of conjugated bilirubin is high in serum
B) it can be accompanied by pruritus
C) it is associated with elevated level of ALP
D) it is always accompanied by increased level of AST
E) it is associated with elevated GGT
D) it is always accompanied by increased level of AST
Characteristics of Wilson’s disease, except:
A) biliary secretion of copper is damaged
B) level of serum ceruloplasmin decreases
C) Kayser–Fleischer-ring is visible with slit lamp examination in half of the cases
D) fulminant hepatitis can occur as acute liver failure
E) it always leads to development of HCC
E) it always leads to development of HCC
Duration of development of hepatocellular carcinoma (HCC) after infection with hepatitis B virus (HBV) or hepatitis C virus (HCV):
A) 1–2 years
B) 5–10 years
C) 10–15 years
D) 20–25 years
E) few months
D) 20–25 years
The earliest sign of primary biliary cholangitis (PBC) can be:
A) spider nevi
B) dilated abdominal wall veins
C) skin hematomas
D) jaundice
E) pruritus
E) pruritus
45-year-old alcoholic male patient is admitted to the hospital with ascites, restlessness, bizarre behavior. In his sudden deterioration provoking factors might be, except:
A) asymptomatic duodenal bleeding
B) aggressive diuretic therapy
C) he discontinued lactulose, consumed large amount of protein
D) his protein intake was insufficient
E) spontaneous bacterial peritonitis developed
D) his protein intake was insufficient
Hepatic encephalopathy can be provoked by:
A) after TIPS procedure
B) gastrointestinal bleeding
C) aggressive diuretic therapy
D) spontaneous bacterial peritonitis
E) all of the above
E) all of the above
Characteristics of autoimmune hepatitis, except:
A) mostly younger females are affected
B) high IgG level
C) it does not require liver biopsy to make diagnosis
D) good response to corticosteroid therapy
E) it leads to liver cirrhosis at a young age without treatment
C) it does not require liver biopsy to make diagnosis
Characteristics of hepatic encephalopathy, except:
A) confusion
B) signs of focal neurological lesions
C) increased blood ammonia level
D) foetor
E) asterixis
B) signs of focal neurological lesions
Cause of fatty liver can be, except:
A) metabolic syndrome
B) coeliac disease
C) Wilson’s disease
D) autoimmune liver disease
E) drugs
D) autoimmune liver disease
Characteristics of hepatitis B virus infection, except:
A) it is prevented by vaccination
B) chronic hepatitis develops mostly when newborns are infected
C) HBV incorporates into the host’s genome
D) it increases the risk of HCC
E) diagnosis is based on detection of HBV RNA
E) diagnosis is based on detection of HBV RNA
Which medication is advised in acetaminophen / paracetamol overdose induced fulminant liver failure?
A) methylene blue
B) desferoxamine
C) atropin
D) silimarin
E) N-acetilcystein
E) N-acetilcystein
Characteristics of primary biliary cholangitis, except:
A) it remains asymptomatic for a long time
B) pruritus might be the first symptom
C) antimitochondrial antibody (AMA) is often positive
D) circulating immuncomplexes, increased IgM level
E) usually younger females are affected
E) usually younger females are affected
In haemochromatosis frequent complication can be, except:
A) diabetes mellitus
B) diabetes insipidus
C) impotence
D) hepatocellular carcinoma
E) pseudogout
B) diabetes insipidus
Side effects of interferon therapy, except:
A) leukopenia
B) autoimmune thyreoiditis
C) fever
D) depression
E) excess of body hair
E) excess of body hair
Enzyme which is responsible for alcohol metabolism:
A) alcohol reductase
B) alcohol oxidase
C) alcohol dehydrogenase
D) alcohol synthetase
C) alcohol dehydrogenase
First investigation(s) when alkaline phosphatase (ALP) is increased:
A) abdominal ultrasound, GGT, serum bilirubin measurement
B) liver-CT
C) bone scintigraphy
D) liver biopsy
E) ERCP
A) abdominal ultrasound, GGT, serum bilirubin measurement
Protein electrophoresis shows increased polyclonal gammopathy in primary biliary cholangitis, which is mostly:
A) IgA
B) IgM
C) IgG
D) IgD
E) IgE
B) IgM
It is important in the pathogenesis of non-alcoholic steatohepatitis (NASH):
A) inflammatory cytokines
B) altered gut microbiome, increased LPS level in the portal circulation
C) genetic factors
D) high level of free fatty acids
E) all of the above
E) all of the above
The extrahepatic manifestation of chronic HCV might be, except:
A) cryoglobulinemia
B) chronic fatigue
C) immunthrombocytopenia
D) acute glomerulonephritis
E) atrial fibrillation
E) atrial fibrillation
Characteristic(s) of haemochromatosis:
1) it is familial disorder
2) hepatocellular carcinoma can be frequent sequelae
3) it is based on inherited disorder of iron metabolism
4) it is more frequent in females
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
Which parameters can indicate the development of hepatocellular cancer in a patient with long-standing cirrhosis?
1) right hypochondriac pain and cachexia
2) fever of unknown origin
3) high LDH in serum
4) increased AFP level
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all 4 answers are correct
E) all 4 answers are correct
It can cause chronic hepatitis in immunocompromised patients:
1) hepatitis B-virus
2) hepatitis E-virus
3) hepatitis C-virus
4) hepatitis A-virus
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
Characteristics of primary biliary cholangitis:
1) it is asymptomatic, never causes pruritus
2) it might be associated with antineutrophil cytoplasmic antibody (ANCA) positivity
3) it significantly increases the risk of cholangiocellular carcinoma
4) middle-age females are mostly affected
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
D) only 4. answer is correct
True for hepatocellular carcinoma:
1) it might be associated with HBV genome integration
2) HCV-infection also might be the etiology
3) it can be caused by aflatoxin
4) it characteristically develops after hepatitis A infection
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
Characteristic(s) of primary sclerosing cholangitis:
1) it is more frequent in males
2) it can be associated with ulcerative colitis
3) it can increase the risk of cholangiocellular carcinoma
4) it can be associated with antineutrophil cytoplasmatic antibody (ANCA) positivity
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
E) all of the answers are correct
It is useful in the therapy of primary sclerosing cholangitis:
1) ursodeoxycholic acid
2) ballondilatation of dominant biliary stricture
3) liver transplantation
4) cyclophosphamide
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
Characteristic(s) of autoimmune hepatitis:
1) low level of serum IgG
2) antinuclear antibody (ANA) positivity
3) young males are affected
4) good response to corticosteroid therapy
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
C) 2. and 4. answers are correct
It can be used for the treatment of chronic hepatitis B:
1) interferon
2) entecavir
3) tenofovir
4) azathioprin
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
Characteristic(s) of hepatitis E viral infection:
1) it can be transmitted with consumption of undercooked pork meet
2) it can become chronic infection in immunocompromised patients
3) it can cause central nervous system symptoms
4) it never causes cirrhosis
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
It plays a role in the transmission of hepatitis C virus infection:
1) iv. narcotic users
2) tattoo
3) blood transfusion before 1992
4) prostitution, male homosexuality
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
E) all of the answers are correct
It can cause obstructive jaundice:
1) neoplasia of papilla of Vater
2) common bile duct stone
3) cancer of pancreatic head
4) cancer of pancreatic tail
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
Antiviral therapy of chronic hepatitis C:
1) it is suggested only in cases of elevated ALT
2) it is suggested only under age of 60 years
3) it is suggested only if Fibroscan shows severe liver fibrosis
4) it can be considered in every HCV infected patients independently of ALT level and degree of fibrosis
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
D) only 4. answer is correct
Characteristics of Gilbert syndrome:
1) increased level of indirect bilirubin
2) increased reticulocyte count
3) normal LDH level
4) low serum haptoglobin level
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
B) 1. and 3. answers are correct
Characteristics of alcoholic hepatitis:
1) granulocyte infiltration in liver tissue
2) leukocytosis, fever
3) increased level of GGT
4) increased level of LDH
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
It can be administered to prevent rebleeding of esophageal varicosity:
1) endoscopic variceal sclerotherapy or ligation
2) portocaval shunt insertion
3) propranolol
4) carvediol
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all 4 answers are correct
E) all 4 answers are correct
Hepatitis B virus infection frequently occurs in:
1) West-Europe
2) the USA
3) Hungary
4) Far-East, Taiwan
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
D) only 4. answer is correct
Biological effects of interferon therapy in chronic B hepatitis:
1) antiproliferative, antineoplastic
2) immunmodulatory
3) antiviral
4) antibacterial
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
It can be the side effects of interferon therapy:
1) flu-like symptoms
2) leukopenia
3) depression
4) relapse of autoimmune diseases
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
E) all of the answers are correct
True for hepatitis C virus infection:
1) it can lead to cirrhosis for decades
2) acute hepatitis is usually asymptomatic
3) it increases the risk of HCC
4) liver transplantation is never recommended
A) 1., 2. and 3. answers are correct
B) 1. and 3. answers are correct
C) 2. and 4. answers are correct
D) only 4. answer is correct
E) all of the answers are correct
A) 1., 2. and 3. answers are correct
The following symptoms indicate liver disease. Choose the most probable diagnosis for each case.
A) primary biliary cholangitis
B) viral hepatitis
C) acute cholecystitis
D) autoimmune hepatitis
E) hepatic encephalopathy
INT - 7.68 - Pruritus, xanthomas, hepatosplenomegaly, high cholesterol level
INT - 7.69 - Jaundice, anorexia, nausea, elevated ALT, normal ALP
INT - 7.70 - Hepatosplenomegaly, hypergammaglobulinaemia, anti-smooth muscle antibody
INT - 7.71 - Fever, right hypochondric pain, leukocytosis
INT - 7.72 - Confusion, flapping tremor, jaundice, high plasma ammonia level
68- A
69- B
70- D
71- C
72- E
Chronic hepatitis C can be cured with new direct antiviral therapies in approximately 90% of the cases, because these medications can be given to patients with cirrhosis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
B) both parts are correct, causative relation does not exist
Gynocomasty is frequent abnormality in cirrhotic males, because the ratio of oestrogen/androgen shifts to the former.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
A) both parts are correct, causative relation exists
Gallstone can be impacted into the cystic duct, therefore biliary pancreatitis develops as a complication of gallstone disease.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
B) both parts are correct, causative relation does not exist
Portal hypertension might develop as a consequence of liver cirrhosis; therefore liver cirrhosis can be accompanied by jaundice.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
B) both parts are correct, causative relation does not exist
Hepatitis B virus infection is acquired in newborns in the Far-East, therefore the hepatocellular carcinoma is more common there.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
A) both parts are correct, causative relation exists
Chronic hepatitis C is susceptible of spontaneous healing; therefore chronic HCV infection should be rarely treated.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
E) both parts are incorrect
Autoimmune disorders might relapse as a side effect of interferon therapy; therefore interferon therapy is contraindicated in autoimmune hepatitis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
A) both parts are correct, causative relation exists
In haemolyticus icterus unconjugated bilirubin is increased in blood; therefore the patient has direct hyperbilirubinaemia in hemolysis.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
C) first part is correct, the second is incorrect
Postransfusion hepatitis was significantly decreased by the screening of blood donors for HBsAg and anti-HCV antibody, therefore post-transfusion hepatitis does not occur nowadays.
A) both parts are correct, causative relation exists
B) both parts are correct, causative relation does not exist
C) first part is correct, the second is incorrect
D) first part is incorrect, second part is correct
E) both parts are incorrect
C) first part is correct, the second is incorrect
What is the diagnosis?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) alcoholic hepatitis
B) hepatocellular carcinoma
C) liver cirrhosis
D) right-sided cardiac failure
C) liver cirrhosis
What type of investigation would be the next step?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) diagnostic ascites tapping
B) oesophagogastroscopy
C) MR cholangiography
D) endoscopic retrograde cholangiography (ERCP)
E) none of the above
A) diagnostic ascites tapping
What other investigations would be recommended?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) percutaneous liver biopsy
B) liver scintigraphy
C) abdominal ultrasound
D) echocardiography
E) none of the above
C) abdominal ultrasound
What can be the complication of disease, based on the laboratory findings and symptomatology?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) acute cholecystitis
B) spontaneous bacterial peritonitis
C) acute pancreatitis
D) hepatic encephalopathy
E) duodenal erosion
B) spontaneous bacterial peritonitis
What would be the recommended drug therapy for this complication?
50-year-old alcoholic male patient visits his physician with following symptoms: fatigue for months, abdominal girth is increased, distended, swelling of the legs, jaundice appeared, lost some weight. He became febrile few days ago and felt abdominal pain. Physical examination reveals jaundice, ascites, enlarged liver with finely irregular surface, mild diffuse abdominal tenderness. Laboratory parameters: serum bilirubin 65 μmol/l, AST 60 E, GGT 560 E, albumin 26 g/l, INR: 1.7, leucocyte count 12 000 G/l, platelet count: 75 000 G/l.
A) penicillin
B) rifaximin
C) lactulose
D) norfloxacin or ceftriaxon
E) all of the above
D) norfloxacin or ceftriaxon
