12. Liver

Question 1

A 29 year old woman comes to her doctor with RUQ pain and fatigue. Patient history is negative for alcohol, sexual activity, and recent travel. The patient has previously be diagnosed with SLE what would you expect to see in this patients lab?

A. P-Anca 
B. Anti smooth muscle antibodies 
C.  AST>ALT 
D. Anti-HBC 
E. Anti LKM antibodies 

RFA

Answer 1

Ans. B Anti- smooth muscle antibodies- the patients history is negative for other factors of liver damage but has SLE other autoimmune diseases increases you risk of Autoimmune hepatitis. In adult Autoimmune hepatitis you see Anti-nuclear and anti-smooth muscle antibodies

A. P-anca ( will be seen in primary sclerosing cholangitis and ulcerative colitis)

C. AST>ALT - alcoholic hepatitis

D. Anti- HBC- is seen in some who who has been/ is infected with Hep B.

E. Anti LKM antibodies- Liver kidney microsomal type antibodies are found in Autoimmune hepatitis but in children and teens

Question 2

A 45 year old man comes to the doctor for a routine check up. As part of the check up he has liver enzymes taken has has a mild elevation of serum transferases. The doctor suspects the patient might secretly be a heavy drinker. After the confronting the patient after the lab results and still denying of drinking what are the potential risk factors that can cause the patients presentation.

A. Unprotected sex 
B. Travel history 
C. Obesity 
D. Eating Shellfish 
E. Smoking 

RFA

Answer 2

Ans. Obesity- the patient has NAFLD( Nonalcoholic fatty liver diseases ) risk factor are obesity, insulin resistance and diabetes and hyperlipidemia

Question 3

A 45 year old man is a known alcoholic and pressents with features of chronic liver disease such as dupuytren contracture. What does this mean? (MG)

A. His spleen is enlarged
B. He has breast growth
C. His palms are red
D. His fingers are permanently bent
E. He has white nails

Answer 3

D. His fingers are permanently bent

All other choices are also signs of chronic liver disease:
A. splenomegaly
B. Gynecomastia
C. Palmar erythema
E. Leukonychia

Question 4

4 patients sit in 4 rooms. One has acute viral hepatitis. One has a liver reaction from taking too much acetaminophen. One has autimmune hepatitis. One has Wilson disease. All of them share one thing in common- the histologic pattern of their liver. Describe it (MG)

A. Fulminant hepatitis
B. Massive necrosis with little inflammation
C. Microvesicular steatosis
D. Infiltrative

Answer 4

A. Fulminant hepatitis

All others are histologic patterns of acute liver failure.