Week 4

Question 1

Symptoms of acute liver disease
• May be _________ and _________
• Symptomatic disease, often ______, producing malaise, ________ and _______
• ________ (seen later), often appearing as the illness progresses

Answer 1

asymptomatic and anicteric

viral; anorexia and fever

Jaundice

Question 2

Symptoms of chronic liver disease
• Non-specific symptoms, particularly weakness, anorexia and fatigue
• ________________ due to liver ———-
• Abdominal ________ due to ________
• _________ due to fluid retention
• __________ and ________ from variceal haemorrhage
•__________ due to cholestasis– often an early symptom of primary biliary cholangitis (PBC)
• Endocrine dysfunction: ________,__________, and __________
• Confusion and drowsiness due to ______________

Answer 2

Right hypochondrial pain; distension

distension; ascites; Ankle swelling

Haematemesis and melaena

Pruritus

gynaecomastia, loss of libido and amenorrhoea

hepatic encephalopathy

Question 3

Features of metabolic syndrome: __________,________,________,___________

Answer 3

obesity, diabetes, gout,
hypercholesterolaemia

Question 4

Clinical skills for liver disease

General:

Eyes

Skin

Legs

Groin

Abdomen

Chest

Cheek

Answer 4

Jaundice, smell of alcohol, encephalopathy, weight loss

Jaundice, xanthelesma

Scratch marks

Pitting edema

Testicular atrophy

Pain, distention,Hepatomegaly,varices

Gyneocmastia, spider naevi

Parotid swelling

Question 5

In the developed world, liver inflammation is most often due to _________,____________,__________,_____________ .

In the developing world, __________________________ is the leading cause of liver mortality.

Answer 5

obesity, the metabolic syndrome (non-alcoholic fatty liver disease, NAFLD),
non-alcoholic steatohepatitis (NASH) and alcohol excess

chronic viral infection with either hepatitis B or
hepatitis C

Question 6

_____________ represents the final common pathway for liver diseases
and is characterized by _____________ of the liver parenchyma, which leads to _______________ and deterioration of liver function.

Answer 6

Cirrhosis

progressive fibrosis

portal hypertension

Question 7

Aspartate aminotransferase
(AST) is primarily a _________
enzyme (80%; 20% in ___________ ) and is also present in _______,________,_______, and ________ .

Answer 7

mitochondrial; cytoplasm

heart,
muscle, kidney and brain

Question 8

High levels of AST are seen in __________,_________,_________, and ————-.

Answer 8

hepatic necrosis, myocardial infarction, muscle injury and congestive cardiac failure

Question 9

Alanine aminotransferase
(ALT) is a _________ enzyme, more
specific to the liver, so that a rise occurs only with liver disease.

Answer 9

cytosol

Question 10

The ALT:AST ratio is a useful clinical indicator:

•In viral hepatitis, ______ is greater than _____ unless _______ is
present, in which case reverse occurs

•In alcoholic liver disease and _________, the _____ is often greater than the _____.

Answer 10

ALT; AST; cirrhosis

steatohepatitis; AST; ALT

Question 11

In patients with viral hepatitis, an AST:ALT ratio of more than 1
indicates __________.

Answer 11

cirrhosis

Question 12

In patients with liver disease without cirrhosis, in whom AST is
greater than ALT, ________ or _________ is the most likely aetiological
agent.

Answer 12

alcohol or obesity