Hepatology

Question 1

Pre-Hepatic Jaundice

Answer 1

Too much bilirubin made
Causes= haemolytic anaemia
Bilirubin unconjugated so bound to albumin
Get yellow eyes and skin

Question 2

Hepatic Jaundice

Answer 2

Too few hepatocytes
Causes= acute injury, late liver disease
Conjugated bilirubin
Yellow eyes and dark urine

Question 3

Post-Hepatic Jaundice

Answer 3

Bile duct obstruction
Causes= stone, stricture, tumour
Conjugated bilirubin
Yellow eyes, dark urine and pale stools

Question 4

Jaundice Pathology

Answer 4

Bile+ copper in liver
Portal tract bigger
Oedema
More ducts

Question 5

Viral Hepatitis

Answer 5

Causes= Hep ABCDE, CMV, HSV

Acute or Chronic

Question 6

Hep A

Answer 6

Faecal-oral transmission
Get jaundice
Only acute

Question 7

Hep B

Answer 7

Parenteral transmission
Get jaundice
Some goes chronic
Treatment= IFN+ lamivudine

Question 8

Hep C

Answer 8

Parenteral transmission
Most goes chronic
Treated with IFN+ ribavarin

Question 9

Paracetamol Toxicity

Answer 9

Get necrosis due to NAPQI

Treated with N-acetyl cysteine or glutathione

Question 10

Acute Hepatitis

Answer 10

Severity depends on amount of damaged hepatocytes and liver regeneration
Causes= viral, drugs, AI, alcohol
Get inflam and necrosis

Question 11

Chronic Hepatitis

Answer 11

Causes= viral, AI, drugs, fatty liver disease, alcohol, alpha 1 antitrypsin, copper overload (Wilson’s), clotting probs
Scar tissues link and form nodules

Question 12

Alcoholic Liver Disease

Answer 12

Get steatosis, inflam, fibrosed portal tracts and big hepatocytes

Question 13

Non- Alcoholic Fatty Liver Disease

Answer 13

Get steatosis, steatohepatitis, cirrhosis

Associated with obesity, DM, drugs, hyperlipidaemia

Question 14

Cirrhosis

Answer 14

Venous blood bypasses sinusoids
Symps= oedema, bruising, muscle wasting, ascites, jaundice
Portal hypertension can cause varices, splenomegaly and piles
Causes= alcohol, steatohepatitis, Hep B/C, AI, metabolic
Can cause cancer

Question 15

Hepatocellular Carcinoma

Answer 15

RF= cirrhosis, obesity, alcohol, viral Hep
Raised alpho-feto protein
Expansile, green, soft nodules
Cancer cells make bile

Question 16

Metastases

Answer 16

Few large nodules= large bowel

Multinodular= lung, pancreas, breast, stomach, melanoma

Question 17

Cholangiocarcinoma

Answer 17

Adenocarcinoma from bile ducts

Intrahepatic or perihilar

Question 18

Gallstones

Answer 18

RFs= female, obese, DM
Types= cholesterol, pigment, mixed, calcium
Comps= cholecystitis, cancer, jaundice, cholangitis, pancreatitis

Question 19

Acute Pancreatitis

Answer 19

Symps= pain, vom
Have raised serum amylase
Causes= gallstones, alcohol, idiopathic, infections, high calcium
Get fat necrosis, swelling, haemorrhage
Comps= shock, coagulopathy, haemorrhage, pseuocysts

Question 20

Chronic Pancreatitis

Answer 20

Tissue replaced by fat fibrosis and calculi
Exocrine tissue goes first
Causes= alcohol, smoking, drugs, infections, genetic, duct obstruction, recurrent acute, AI
Comps= fat malabsorption, DM, pseudocysts, stenosis of ducts

Question 21

Pancreatic Adenocarcinoma

Answer 21

Causes= smoking, alcohol, red meat, obesity, hereditary, chronic pancreatitis, DM
Mets= liver, peritoneum, lung

Question 22

Neuroendocrine Pancreatic Tumour

Answer 22

Benign or malignant

Encapsulated and solid