Chem Path: Liver diseases CPC

Question 1

What are the causes of high bilirubin

Answer 1

Pre hepatic - Haemolysis - You will have unconjungated bilirubin
hepatic
Post hepatic - Obstruction

Question 2

What is Van den Bergh reaction?

Answer 2

Test for unconjugated vs conjugated bilirubin

Direct - Conjugated
Indirect - Unconjugated

Question 3

What is Gilberts

Answer 3

Benign raised bilirubin due to UDP glucoronyl transferase activity downregulation

Question 4

How is Gilbert inherited

Answer 4

Autosomal recessive

Question 5

What makes Gilbert’s worse and how is Gilberts treated

Answer 5

Worse on fasting and treated by phenobarbital

Question 6

What does it mean if there is no urobilinogen in urine?

Answer 6

Bilirubin is broken down by gut bacteria into sterco and uro bilinogen. Some of this is reabsorbed and peed out. If it is not present in urine, that means the biliary tree is blocked

Question 7

When would ALT leak out?

Answer 7

Liver damage

Question 8

How would the LFTs be in paracetamol overdose

Answer 8

Very high ALT and AST

Question 9

What is the antidote for paracetamol overdose

Answer 9

N acetyl cysteine

Question 10

How is Prothrombin time a good indicator of how serious paracetamol overdose is

Answer 10

If PT > no of hours since overdose, liver transplant is needed

Question 11

Which LFT rises a lot in obstruction

Answer 11

ALP

Question 12

How do you contract Hep A?

Answer 12

Contaminated water and faecal matter

Question 13

What is the serology of Hep A like?

Answer 13

Jaundice

Rise in IgM, which will eventually taper off

Later rise in IgG which will stay forever

Question 14

What is the serology of Hep B like for someone who has been infected?

Answer 14

HbS and HbE antigens will present first. When they fall there will be a rise in Antobodies against HbS and HbE and HbC

Question 15

What will the serology of a Hep B vaccinated person look iike?

Answer 15

Only antibody against HbS will be there

Question 16

What would you see in fatty changes in liver

Answer 16

Swollen/Ballooing cell - Mallory-Hyaline

Question 17

What would you see in histology of alcoholic hepatitis

Answer 17

Neutrophil polymorphs and megamitochondria

Question 18

What does it mean if you see blue staining on liver histology?

Answer 18

Collagen - End stage liver disease

Question 19

What does thiamine/B1 deficiency cause?

Answer 19

Beri beri

Question 20

What does vit C deficiency cause

Answer 20

Scurvy

Question 21

What does B12 deficiency cause

Answer 21

Pernicious anaemia

Question 22

What does b3 deficiency cuase

Answer 22

Pellagra - caused by mothers who do not take folic acid

Question 23

How does stable chronic liver disease present

Answer 23

Spider naevi
Duputryens contracture
Gynacomastia
Palmar erythema

Question 24

What would you see in portal hypertension

Answer 24

Caput Medusa and splenomegaly and ascites (You will NOT have hepatomegaly)

Question 25

What is the portal vein made up of

Answer 25

Splenic vein and superior mesenteric vein

Question 26

What does shifting dullness indicate?

Answer 26

Ascites

Question 27

What kind of nodules will you have in alcoholic cirrhosis

Answer 27

Micronodular

Question 28

What happens in porto systemic anastomoses

Answer 28

If portal pressure increases, it can lead to varices and blood can back down the azygos vein. It it bursts, you can die

Question 29

List some sites where varices can form

Answer 29

Oesophageal
Rectal
Spleno-rectal
Umblicial vein recanalising

Question 30

What happens in liver failure

Answer 30

Decrease in clotting factors
Reduced clearance of bilirubin
Reduced clearance of ammonia leading to hepatic encephalopathy

Question 31

What do scratch marks in the background of jaundice mean?

Answer 31

Obstructive jaundice is the only reason you will have scratch marks due to bile salts

Question 32

What is courvasiers law

Answer 32

A palpable gall bladder with jaundice mostly mean its pancreatic cancer

Question 33

What type of cancer is pancreatic tumour

Answer 33

Adenocarcinoma

Question 34

How does pancreatic cancer spread

Answer 34

Lymph

Question 35

How does pancreatic cancer spread to the liver

Answer 35

Via the portal vein that goes back to the liver