Pacreas n Liver

Question 1

The most likely mechanism for NAFLD is?

Answer 1

Insulin resistance

Question 1

A middle aged woman presenting with asymptomatic elevation of AST, ALT with normal or slightly elevated ALP, and a large gamma gap (total protein - albumin>|=4) most likely has?

Answer 1

Autoimmune hepatitis - can b asymptomatic in 25% of the cases
- autoantibodies, commonly anti-smooth muscle antibodies or hypergammaglobulinemia confirm the dx

Question 3

Rx of PSC

Answer 3

cholestiramine or ursodeoxycholic acid

Question 4

Most accurate test in PSC?

Answer 4

MRCP; biopsy isn’t essential

Question 5

Rx of PBC

Answer 5

Ursodeoxycholic acid, obeticholic acid( decreases fibrosis).
Severe liver damage- liver transplant

Question 6

Most common causes of acute pancreatitis

Answer 6

Gallstones, alcohol, ^TGA, ERCP

Question 7

The most accurate blood test in PBC

Answer 7

Antimitochondrial abs

Question 8

Rx of acute pancreatitis?

Answer 8

Primarily supportive: fluid, NGT suction, analgesia, NPO.

Abx might b indicated in severe cases

Question 9

The most accurate test in PBC?

Answer 9

Liver biopsy

Question 10

Indicator of worst prognosis in acute pancreatitis

Answer 10

Low calcium levels

Question 11

Best initial test in acute pancreatitis ?

- most specific test?

Answer 11

Amylase n lipase- initial

CT scan- most specific

Question 12

Best diagnostic test for pancreatic pseudocyst

Answer 12

Ultrasound

Question 13

The initial imaging performed on a pt with jaundice?

If non revealing?

Answer 13

Abdominal u/s

Next CT, then ERCP/MRCP

Question 14

Rx response follow up in pancreatic ca is with ?

Answer 14

CA19-9

Question 15

A patient presented with septic shock and developed marked elivations in AST, ALT. This is typical of?

Answer 15

Ischemic hepatopathy (shock liver). One of the causes of ALF

Question 16

The single most important prognostic factor in ALF is?

Answer 16

PT

Question 17

Do cirrhotic pts get screened for cancer? By what? How frequent?

Answer 17

Abdominal U/S

Every 6months

Question 18

Is endoscopy routinely indicated in cirrhotic pts?

Answer 18

Yes, to exclude varices, indicate hemorrhage and primary prevention

Question 19

Stepwise approach to the Rx of ascites

Answer 19

1. Na n water restriction
2. Spironolactone
3. Loop diuretic
4. Frequent paracentesis

Question 20

Peritoneal fluid analysis of cirrhotic pt,, the total protein n SAAG r expected to be?

Answer 20

Protein<2.5= cirrhosis, nephrotic syndrome.

SAAG(serum - ascitic) > 1.1 indicates portal htn

Question 21

SBP prophylaxis ( primary n secondary) for whom?

Answer 21

Primary- pts with variceal bleeding

2ndary- anyone with SBP needs lifelong prophylaxis

Question 22

Effect of hypokalemia on Hepatic encephalopathy

Answer 22

Low potassium (metabolic alkalosis) favors conversion of ammonium to ammonia—> cross BBB—> ^HE

Question 23

Role of lactulose and rifaximin

Answer 23

Lactulose- converts ammonia to ammonium (ammonia trap)

Rifaximin- a non absorbable abx clears ammonia producing gut bacteria

Question 23

Alcoholic hepatitis: AST, ALT elevations,, how r they different from other causes of acute hepatitis?

Answer 23

Generally characterized by modest elivation (<300-500)

AST>2xALT

Question 23

Hepatorenal syndrome- what happens to Cr n urine Na?

Answer 23

Elevated Cr, very low urinary typically <10meq/L (like pre renal RF)

Question 24

Cause of hepatorenal syndrome is said to be

Answer 24

Renal vasoconstriction in response to decreased total RBF and vasodilatory substance synthesis

Question 26

Female in 40s, xanthalasma, osteoporosis, having associated autoimmune conditions, ^ALP
Most likely Dx?

Answer 26

Primary biliary cirrhosis

Question 28

Primary sclerosing cholangitis occurs in association with?

Answer 28

IBD especially UC

Question 29

A pt with premature onset of COPD and CLD
Most likely Dx?
Dx is established by?

Answer 29

Alpha 1 anti trypsin deficiency

- measure A1AT

Question 30

The best screening tests for hepB acute infection

Answer 30

HBsAg n anti HBc(core Ag)

Not to miss the window period

Question 31

Hep c pts being evaluated for Rx initiation should undergo?

Answer 31

Liver biopsy. Best predictor of disease progression, assess likelihood of Rx response

Question 32

Hepatolenticular degeneration

Best initial test, other lab findings

Answer 32

Slit lamp examination- Kayseri- fleisher rings.

• low serum ceruloplasmin
• high urinary copper excretion

Question 33

All CLD pts should b immunized against

Answer 33

HepA n hepB

as they are at high risk for cirrhosis or acute liver failure upon infection with viral hep

Question 34

NAFLD Vs NASH

Answer 34

NAFLD - is benign n not considered premalignant, not associated with fibrosis.
NASH on the other hand is…

Question 37

Symptomatic gall stones, poor candidates for surgery, mx is?

Answer 37

Ursodeoxycholic acid

Question 38

Enphysematous gall bladder diagnostic tests?

Answer 38

Abdominal X-ray sowing air fluid level in the gb;
U/S;
CT when others r not clear