Gastro

Question 1

how does liver cirrhosis affect the portal system

Answer 1

portal hypertension

Question 2

causes of liver cirrhosis

Answer 2

NAFLD
alcoholic liver disease
hep B
hep C

Question 3

size of liver in cirrhosis

Answer 3

can be small or large

Question 4

nail change in cirrhosis and why

Answer 4

leukonychia due to hypoalbuminaemia

Question 5

what test is used for assessing extent of fibrosis in NAFLD

Answer 5

enhanced liver fibrosis blood test

Question 6

examination signs of liver disease

Answer 6

jaundice
bruising
palmar erythema
spider naevi
gynacomastia
ascites
splenomegaly
asterixis
caput medusae
leukonychia

Question 7

what happens to platelets in cirrhosis

Answer 7

thrombocytopenia

Question 8

what is transient elastography

Answer 8

test for assessing degree of liver fibrosis

Question 9

components of child pugh score pneumonic and scoring

Answer 9

ABCDE

albumin
bilirubin
clotting (INR)
dilated (ascites)
encephalopathy

each scored 1-3 so max score 15

Question 10

what score is used in cirrhosis patients to assess mortality

how often is it done

Answer 10

MELD score

done every 6 months

Question 11

how often should cirrhosis patients have an endoscopy

Answer 11

every 3 yrs

Question 12

dietary advice in cirrhosis

Answer 12

high protein and high calorie diet (pts have appetite loss and protein metabolism is affected)
reduced sodium intake
avoid alcohol

Question 13

what organ is enlarged as a result of portal hypertension

Answer 13

spleen

Question 14

what type of ascites do you get in cirrhosis

Answer 14

transudate

Question 15

what prophylactic abx are given for ascites and when

Answer 15

cipro or norfloxacin

when protein in fluid <15g

Question 16

hepatic encephalopathy mx

Answer 16

lactulose
abx (rifaximin)
nutritional support (NG feeds)

Question 17

stages of alcoholic liver diease

Answer 17

alcoholic fatty liver
alcoholic hepatitis
cirrhosis

Question 18

recommended alcohol intake and over what time

Answer 18

no more than 14 units/ week
spread out over 3 or more days
not more than 5 units a day

Question 19

dietary advice for alcoholic liver disease

Answer 19

thiamine supplementation
high protein diet

Question 20

CAGE questions

Answer 20

cut down- do you feel the need to down

annoyed- do you get annoyed at people for commenting about your drinking

guilty- do you feel guilty about how much you drink

eye opener- do you ever drink first thing in the morning

Question 21

AUDIT questionnaire is used for

Answer 21

screening for harmful alcohol use

Question 22

AUDIT questionnaire score above what is concerning

Answer 22

8

Question 23

in alcohol withdrawal when do people get hallucinations

Answer 23

12-24 hrs after last drink

Question 24

in alcohol withdrawal when do people get seizures

Answer 24

24-48 hrs after last drink

Question 25

in alcohol withdrawal when do people get delirium tremens

Answer 25

24-72 hrs after last drink

Question 26

what receptors does alcohol stimulate

Answer 26

GABA

Question 27

what receptors does alcohol inhibit

Answer 27

glutamate

Question 28

what tool is used to score patients on alcohol related symptoms

Answer 28

CIWA-Ar

Question 29

what drug is used to prevent alcohol withdrawal

Answer 29

chlordiazepoxide

Question 30

wernickes encephalopathy triad

Answer 30

confusion opthalmoplegia ataxia

Question 31

korsakoff syndrome features

Answer 31

memory impairment behavioural changes

Question 32

wernicke/korsakoff arises due to deficiency in

Answer 32

thiamine

Question 33

stages of non alcoholic fatty liver disease

Answer 33

normal fatty liver steatohepatitis fibrosis cirrhosis

Question 34

rf for NAFLD

Answer 34

same as cardiovasc disease: diabetes age smoking obesity sedentary lifestyle poor diet hypertension hypercholesterolaemia

Question 35

what LFT is raised in NAFLD

Answer 35

ALT

Question 36

enhanced liver fibrosis test what level indicates advanced fibrosis

Answer 36

>10.51

Question 37

gold standard ix for NAFLD

Answer 37

liver biopsy

Question 38

what types of virus are hep A-E

Answer 38

all RNA apart from hep B is DNA

Question 39

vaccines for what hepatitis virus exist

Answer 39

A and B

Question 40

how is hep A treated

Answer 40

supportive care

Question 41

how is hep B treated

Answer 41

supportive care

Question 42

how is hep C treated

Answer 42

antiviral

Question 43

how is hep D treated

Answer 43

pegylated interferon alpha

Question 44

how is hep E treated

Answer 44

supportive care

Question 45

which hepatitis viruses are notifiable

Answer 45

all of them

Question 46

what does HBeAg indicate

Answer 46

if the person has active infection and wether they are infectious currently it will be high when the virus is replicating

Question 47

what antibody is raised in autoimmune hepatitis

Answer 47

IgG

Question 48

autoantibodies for type 2 autoimmune hep

Answer 48

anti LKM-1 anti LC1

Question 49

how do type 1 and 2 autoimmune hepatitis differ

Answer 49

1 is usually in older post menopausal women and is less aggressive 2 is usually in younger girls and is more acute

Question 50

haemochromatosis inheritance

Answer 50

autosomal recessive

Question 51

haemochromatosis gene and chromosome

Answer 51

HFE gene on chromosome 6

Question 52

what stain is used to look at iron deposition in the liver

Answer 52

perls stain

Question 53

how does haemochromatosis affect the thyroid

Answer 53

hypothyroidism

Question 54

complications of haemochromatosis

Answer 54

diabetes erectile dysfunction reduced fertility hepatocellular carcinoma hypothyroidism cirrhosis cardiomyopathy arthritis

Question 55

wilsons disease inheritance

Answer 55

autosomal recessive

Question 56

wilsons disease gene and chromosome

Answer 56

ATP7B gene chromosome 13

Question 57

what neuro sx are seen in wilsons disease

Answer 57

dysarthria tremor dystonia parkinsonism (rigidity, tremor, bradykinesia) depression cognitive impairment psychosis

Question 58

what anaemia can you get in wilsons disease

Answer 58

haemolytic

Question 59

initial screening test in wilsons disease and result

Answer 59

serum caeruloplasmin it will be low

Question 60

double panda sign on MRI brain

Answer 60

wilsons disease

Question 61

wilsons disease mx

Answer 61

penicillamine or trientine zinc salts

Question 62

what 2 main organs does alpha 1 antitripsin deficiency affect and how

Answer 62

lungs- causes COPD and bronchiectasis liver- fibrosis, cirrhosis

Question 63

what does alpha 1 antitripsin do

Answer 63

inhibits proteases

Question 64

stain used for alpha 1 antitripsin deficiency in liver biopsy

Answer 64

periodic acid schiff

Question 65

what is attacked in PBC

Answer 65

small bile ducts in liver

Question 66

how does PBC affect cholsterol

Answer 66

its high

Question 67

PBC sx

Answer 67

white middle aged woman fatigue pruritus abod pain jaundice pale greasy stools dark urine