VIVA: Pathology - Liver, biliary tract and pancreas

Question 1

What is the most likely diagnosis, and why?

Question 2

How may hepatitis B lead to upper gastrointestinal bleeding?

Answer 2

Cirrhosis and portal hypertension* with development of oesophageal varices*
Coagulopathy* due to loss of synthetic function (unable to produce coagulation proteins)

• 2/3 to pass

Question 3

What are the other complications of hepatitis-B-induced cirrhosis?

Answer 3

3 to pass:
- Jaundice
- Hepatorenal
- Hepatic encephalopathy
- Ascites, pleural effusions
- Splenomegaly
- Hypogonadism (testicular trophy, amenorrhoea etc)
- Hepatocellular carcinoma

Question 4

In general how may a patient acquire hepatitis B?

Answer 4

2 to pass:
- Congenital (i.e. vertical; most common worldwide)
- Contaminated blood products (e.g. IVDU, transfusions, needlestick injury)
- Bodily fluids (e.g. sexual)

Question 5

What are the other possible outcomes of hepatitis B exposure?

Answer 5

2 to pass:
- Asymptomatic
- Acute hepatitis
- Non-progressive chronic hepatitis
- Carrier state