Things professors have said will be on the test

Question 1

What drug should be administered to a patient with cirrhosis and an active bleed upon admission, and why?

Answer 1

Octreotide. Is a vasoconstrictor, so can lessen the wall pressure and reduce the chances of a bleed/rupture.

Question 2

What information does the Serum Ascites Albumin Gradient give you?

How is it calculated?

Answer 2

SAAG can give an indication of the cause of the ascites. It correlates well with the hepatic venous pressure gradient.

Greater than 1.1 is a pressure about 11. Remember that greater than 12 will show varices, etc.

SAAG = Serum albumin - the ascites albumin.

Question 3

What is the pattern of albumin and SAAG that might indicate ascites due to cirrhosis? Why?

Answer 3

SAAG above 1.1

Low total albumin in the ascites fluid.

The sinusoids are cirrhotic so the protein can’t leak out.

Question 4

What is the ascites albumin and SAAG that might indicate cardiogenic ascites?

Answer 4

SAAG below 1.1

High albumin in the ascites fluid.

Sinusoids are normal so protein leaks out.

Question 5

DDX for ascites (in descending order)

Answer 5

1) CIRRHOSIS
2) Peritoneal malignancy
3) Heart failure
4) Other (Bacterial infection, Budd Chiari, Pancreatic, Nephrogenic)
5) Peritoneal tuberculosis

Question 6

What is the generic combination called Bactrim?

What is a severe consequence (rare) of this drug?

Answer 6

Trimethoprim-sulfamethoxazole.

Liver damage.

Question 7

Ursodeoxycholic acid is used to treat what condition? How does it work?

Answer 7

Primary Biliary Cirrhosis. Derived from bear bile. Helps slow the progression of PBC and normalizes the liver enzymes.

Question 8

What medication should be given to reverse hepatic encephalopathy?

What other indication does this medication have?

Answer 8

Lactulose. NH3–> NH4+ for removal.

Also acts as an osmotic laxative.

Question 9

Hepatitis A diagnosis is by detection of serum Ig___ against HAV.

Answer 9

IgM

Question 10

IgA is fecal oral with passage by contaminated strawberries. T/F

Answer 10

True. There is a vaccine.

Question 11

Hepatocellular carcinoma is most commonly caused by which hepatitis? Is there a vaccine?

Answer 11

B. Yes vaccine.

Question 12

The majority of hep C progress to chronic disease transmitted by blood and body fluids. T/f

Answer 12

True on both counts. (80-85% of the time)

Question 13

Hep C is an RNA or DNA virus? Is there a vaccine?

Answer 13

RNA. No vaccine.

Question 14

Hep E

Answer 14

Transmitted fecal oral, does not cause chronic disease, RNA virus.

Hep E is assx with HIGHER mortality in pregnant women.

Question 15

Alpha 1 antitrypsin

Answer 15

PAS positive diastase resistant globules in hepatocytes (misfolded proteins gumming up the works, pink globules on histology)
Emphysema
No gender bias

Question 16

Primary Biliary Cirrhosis

Answer 16

Elevated IgM
Anti-mitochondrial antibody (also IgM)
Middle-aged women
Female predominance
Granulomatous lymphocytic cholangitis/florid duct lesion
Presents with itching early, later jaundice
–Despite the name, does not necessarily mean there is cirrhosis present

Question 17

Autoimmune hepatitis

Answer 17

Elevated IgG
Anti-smooth muscle antibodies
PLASMA CELL rich interface and centrilobular hepatitis
Female predominance

Question 18

Primary Sclerosing Cholangitis

Answer 18

Cholangiography with large bile duct strictures
Assx with UC (80% of PSC have UC)
Male predominance

Question 19

Cholangiocarcinoma

Answer 19

Malignant neoplasm of bile ducts
Gland forming tumor with marked desmoplasia
ASSX with PSC

Question 20

Hepatocellular carcinoma (aka hepatoma)

Answer 20

Proliferation of hepatocytes
Malignant
Almost all occur in patients with cirrhosis
Most common primary malignant hepatic tumor (metastatic disease is the most common)
Unpaired arteries with thickened hepatic plate

Question 21

Hepatocellular adenoma

Answer 21

Proliferation of hepatocytes
Benign
FEMALE predominance (reproductive age, oral contraceptive use, steroid use)
Paired arteries with normal thickness hepatic plate

Question 22

Hemangioma

Answer 22

Tumor of blood vessels
Most common tumor found in livers (1-2 %)
Benign

Question 23

Focal nodular hyperplasia

Answer 23

Proliferation of hepatocytes
Benign
Central scar and malformed blood vessels

Question 24

Plasma cell hepatitis word association:

Answer 24

Autoimmune hepatitis

Question 25

sequesters iron to limit bacterial growth

Answer 25

Lactoferrin

Question 26

Pore forming salivary secretion enzyme

Answer 26

Lysozyme

Question 27

This drug is useful in both constipation and diarrhea.

Answer 27

Polycarbophil

“Polycarbophil is a bulk-forming laxative that increases the amount of water in your stools to help make them softer and easier to pass. Polycarbophil is used to treat constipation and to help maintain regular bowel movements.”

Basically, it absorbs water (thus preventing diarrhea) but also prevents dessication of the feces, thus preventing constipation.

Question 28

AST:ALT of 2:1 or greater is indicative of___.

Answer 28

Alcoholic liver disease.

Question 29

Ddx for AST/ALT elevations greater than 5x normal (7).

Answer 29

• Acute viral hepatitis (A-E, herpes) • Medications/toxins
• Ischemic hepatitis
• Autoimmune hepatitis
• Wilson’s disease
• Acute Budd-Chiari syndrome
• Hepatic artery ligation or thrombosis