Medically Unexplained Symptoms

Question 1

Define medically unexplained symptoms.

Answer 1

Persistent bodily complaints for which adequate examination does not reveal sufficient explanatory structural or other specified pathology

Question 2

What are some risk factors for MUS?

Answer 2

Pre-existing health conditions

Long standing anxiety/depression

Childhood adversity/abuse

Female

Pre-existing mental health conditions, such as personality disorder

Question 3

Give some examples of MUS?

Answer 3

Pain:

• joint/MSK
• headache
• abdo
• chest
• dysuria
• dysmenorrhoea
• dyspareunia

GI:

• n+v
• bloating
• diarhoea

Cardio:

• palpitations
• chest pain

Resp: SOB

Neuro:

• paraesthesia
• weakness
• paralysis
• non-epileptic seizures

Dizziness
Syncope
Fatigue

Question 4

What are the LFTs?

Answer 4

There are 7

ALT
AST
ALP
GGT
Albumin
Bilibrubin
Prothrombin

Question 5

Which of the LFTs asses the liver’s synthetic function?

Answer 5

Albumin
Prothrombin time
Bilirubin

Question 6

What are the synthetic functions of the liver?

Answer 6

Conjugation and elimination

Synthesis of albumin

Synthesis of clotting factors

Gluconeogenesis

Question 7

Which liver enzyme is a good marker for hepatocellular injury? Why?

Answer 7

ALT

Its found in large quantities in hepatocytes

Question 8

ALT can be raised mildly, moderately or markedly.

Give some figures for each?

Answer 8

Mild: <300
Moderate: 300-500
Marked: >1000

Question 9

ALT can be raised mildly, moderately or markedly.

Give causes of each?

Answer 9

Mild: Non-alcohol fatty liver disease, cirrhosis, hepatocellular carcinoma, Wilson’s, haemochromatosis

Moderate: Hepatitis: chronic infection B or C, alcoholic, autoimmune

Marked: acute hepatocellular injury eg. poisoning (paracetamol), acute infection (Hep A, B), liver ischaemia

Question 10

ALT of 150 cause?

ALT of 400, cause?

ALT of 1200, cause?

Answer 10

150: mild increase: NAFLD, cirrhosis, HP carcinoma, Wilson’s, haemachromatosis
400: moderate increase: hepatitis caused by chronic infection (B, C), autoimmune, alcoholic
1200: marked: paracetamol OD, acute infection (A,B)

Question 11

What is the significance pf the ALT: AST ratio?

Answer 11

ALT>AST = chronic liver disease

ALT

Question 12

Where is ALP found?

Answer 12

ALP is found in liver, bile duct and bone tissue

Question 13

What does high GGT suggest?

Answer 13

Alcohol or drug abuse

or Cholestasis

Question 14

What does high ALP suggest?

Answer 14

Bone mets, vit D deficiency, recent fractures

Question 15

What is bilirubin?

Types?

Answer 15

Breakdown product of Hb
Which is conjugated by the liver (ie. made to be water soluble)

Two types: unconjugated and conjugated

Question 16

Causes of raised bilirubin

• unconjugated
• conjugated

Answer 16

Unconjugated (not yet processed by liver): haemolytic anaemia, impaired hepatic uptake, impaired conjugation process (enzyme deficiency)

Conjugated (processed by liver): hepatocellular dysfunction, cholestasis

Question 17

What is Gilbert’s syndrome?

Answer 17

Liver less able to conjugate bilirubin

No symptoms really, except jaundice

Question 18

What does albumin do?

Answer 18

Maintains osmotic pressure in the vessels

Binds to water, cations, fatty acids, bilirubin

Question 19

What happens to albumin levels in liver disease?

Answer 19

Decreases

Question 20

What is prothrombin time? What happens to it in liver disease?

Answer 20

Measures bloods coagulation tendency, specifically the extrinsic pathway

It is prolonged in liver disease as clotting factors are not synthesised as well as usual, so clotting takes longer?

Question 21

What does prothrombin do in the coag cascade?

Answer 21

Its converted into thrombin by factor Xa

Thrombin then converts fibrinogen into fibrin

Question 22

Define Pre-diabetes.

Answer 22

Borderline diabetes
If undiagnosed or untreated can become diabetes

Fasting plasma glucose: 5.5-6.9
HbA1c: 42 to 47