GI And liver

Question 1

DNA hepatitis

Answer 1

B

Question 2

Unenveloped hepatitis

Answer 2

A and E

Question 3

IV hepatitis

Answer 3

BCD

Question 4

Hep A diagnosis

Answer 4

Serum IgM ABs

Question 5

Hep B diagnosis

Answer 5

HBsAg
AB to HBcAg
PCR for HBV DNA

Question 6

Hep C diagnosis

Answer 6

3rd gen ELISA for AB detection
PCR for HCV RNA

Question 7

Hep D Diagnosis

Answer 7

IgM and IgG ABs
Serum RNA
HDAg in liver

Question 8

Hep E diagnosis

Answer 8

IgG and IgM ABs serum
PCR for RNA

Question 9

Serology carrier hep B

Answer 9

HBsAg present
HBeAg not present
Anti HBeAB present
Normal transaminases
Low/ undetectable HBV DNA
Liver bx no inflamation or necrosis

Question 10

UC

Answer 10

spreads prox from rectum
broad based shallow ulcers, mucosa only
no strictures
multiple pseudopolyps
toxic megacolon

Question 11

Crohns

Answer 11

skip lesions
cobblestone
transmural
rik calcium oxalate stones
strictures, deep ulcers
non caseating granulomas

Question 12

coeliac

Answer 12

tissue transglutaminase and gliadin blood tests
diffuse enteritis with flattened villi
assoc dermatitis herpetiform

Question 13

Whipple disease

Answer 13

assoc HLA B27
tropherma whippeli infection
lamina propria SI laden macrophages
diarrhoea, statorrhoea, fever weight loss, migratory arthritis, brain involvement

Question 14

Blood tests liver

Answer 14

hepatocyte - ALT AST LDH
bile canaliculi - ALP GGT

Question 15

Scar formation liver

Answer 15

collagen release by stellate (Ida cells)

Question 16

Cirrhosis morphology

Answer 16

proliferating hepatocyte surrounded by on going fibrosis
- fibrous septae
- parenchymal nodules
- disruption architecture

Question 17

Acute liver failue

Answer 17

80% function lost
80% die without transplant

acute illness assoc encephalopathy and coagulopathy
within 26 weeks initial illness
absence pre existing liver disease

Question 18

Ascites

Answer 18

85% due to cirrhosis
low protein fluid
amount of lymph thoracic cavity exceeds thoracic duct capacity

Question 19

Mortality acute on chronic hepatic failure

Answer 19

50%

Question 20

HBV % acute and chronic

Answer 20

65% subclinical
25% acute
10% chronic

Question 21

HCV % chronic

Answer 21

80%, main cause IVDU

Question 22

HIV % with hepatitis

Answer 22

10% HBV
25% HCV

Question 23

Chronic hepatitis morphology

Answer 23

mononuclear portal infiltration
hepB ground glass hepatocytes
hepC lymphoid aggregates and bile duct injury

Question 24

Type 1 autoimmune hepatitis

Answer 24

middle aged/ old
ANA and anti smooth muscle actin ABs

plasma cells as infiltrate

Question 25

Type 2 autoimmune hepatitis

Answer 25

kids/ teenagers anti liver kidney microsome 1 antibodies plasma cells as infiltrate

Question 26

Hepatic cancer associations

Answer 26

hepatocellular adenoma - OCC and anabolic steroids HCC - ETOH angiosarcoma - vinyl chloride

Question 27

Stages alcoholic liver disease

Answer 27

1. steatosis (reversible) fatty change and perivenular fibrosis 2. hepatitis (reversible) hepatocyte swelling, mallory bodies, neutropilic infiltrate 3. fibrosis and cirrhosis (non reversible) extensive fibrsosis with hyperplastic nodules

Question 28

NAFLD

Answer 28

>5% hepatocytes invlved less mallory bodies and more mononuclear cells tan ETOH 80% isolated fatty liver, 20% NASH which is progressive

Question 29

Unconjugated bilirubin

Answer 29

insoluble in water highly albumin bound unbound crosses BBB and icteric sclera increased unbound in haaemolytic disease or when drugs displace

Question 30

Causes unconjugated bilirubinaemia

Answer 30

neonatal jaundice criggler najar gillbert syndrome

Question 31

Biliary atresia

Answer 31

conjugated fetal/ perinatal (more common) obstruction biliary tree viral/ autoimmune hepatic or common bile duct

Question 32

Primary biliary cirrhosis

Answer 32

autoimmune cholangiopathy destruction small medium bile ducts female in 50s assoc sjorgens 95% AMA dx bx

Question 33

Primary sclering cholangitis

Answer 33

autoimmune cholangiopathy intra and extrahepatic bile ducts with dilation and preserved segments male 30s assoc IBD 65% ANCA radiology strictures and beading large bile ducts

Question 34

Gallstone types

Answer 34

cholesterol - most common, radiolucent unless contain calcium carbonate pigment - insoluble calcium salts and unconjugated bilirubin brown infected and radiolucent black sterile and radioopaque

Question 35

Morphology chronic cholecystitis

Answer 35

suserosal fibrosis outpouchings epithelium porxelein gallbladder hydrops gallbladder end stage

Question 36

Cirrhosis collagen

Answer 36

TI and III normally in portal tracts and around veins - deosited in lobules, neovascularisation TIV in space of disse

Question 37

Pathogenesis acute pancreatitis

Answer 37

pancreatic duct obstruction primary acinar cell injury defective intrracellular release proenzymes

Question 38

Main cause acute panreatitis

Answer 38

80% alcohol and gallstones

Question 39

Hereditory pancreatitis

Answer 39

assoc 25% of pacreatitis 40% risk cancer CFTR SPINK1

Question 40

Blood tests pancreatitis (timing)

Answer 40

amylase in 24h lipase in 72-96h decreased Ca2+ 10% glycosuria

Question 41

Cause and mortality chronic pancreatitis

Answer 41

Mainly alcohol TGFbeta and PDGF fibrogenic factors 25y mortality 50%

Question 42

Autoimmune pancreatitis

Answer 42

IgG4 secreting plasma cells in pancreas responsive to steroid therapy similar symptoms to cancer

Question 43

Chronic hepatitis

Answer 43

Symptoms/biochemical/serological evidence for > 6m

Question 44

Hepatitis carrier

Answer 44

Harbours and can transmit No symptoms

Question 45

Virus causing ischaemic gut

Answer 45

CMV