Hepatic

Question 1

Elevated AST vs ALT?

Answer 1

AST > ALT in a > 2:1 ratio = EtOH

Question 2

Prognosis for end-stage-liver-disease

Answer 2

Can use the MELD score (originally intended for TIPS - but can give idea of prognosis), or the Child-Pugh score for 1 year survival

Question 3

Sx of end-stage-liver-disease

Answer 3

Acities, pruritis, MSK cramps, hand flapping, anorexia, encephalopathy

Question 4

Tx for Hepatic encephalopathy

Answer 4

Avoid dehydration, diet modification (involve nutritional support) and can give lactulose and rifampin

Question 5

Antibiotics for Cholangitis?

Answer 5

Ciprofloxacin and Metronidazole

Question 6

Confusion in a cirrhotic patient differential?

Answer 6

Hepatic encephalopathy, infection, hyponatremia

Question 7

Hyponatremia key concept?

Answer 7

It is a WATER problem not a SALT problem.

Question 8

Screen for what CA in cirrhosis?

Answer 8

Hepatocellular Carcinoma

Question 9

Spontaneous Bacterial Peritonitis Tx?

Answer 9

Cextriaxone

Question 10

Acities gradient can help with DDX

Answer 10

Low gradient - loss of albumin

High gradient - portal HTN, liver problems

Question 11

Elevated liver enzymes + ceruloplasmin

Answer 11

Wilson’s disease (problem with copper build up in the body - look for a copper ring around the eye.

Question 12

Charcot’s triad?

Answer 12

RUQ pain, fever, jaundice - sign of choleangitis

Question 13

NASH

Answer 13

Nonalcoholic steatohepatitis

Fatty liver (not yet progressed to cirrhosis)

If suspecting autoimmune order anti-smooth muscle antibody.