GI EXAM II

Question 1

DILI- Cholestasis

Answer 1

Anabolic steroids, phenothiazine derivatives, total parenteral nutrition

Question 2

DILI- Fatty change

Answer 2

Steroids

Question 3

DILI- Acute Hepatitis

Answer 3

INH, Augmentin, Phenytoin

Question 4

DILI- Fulminant Hep. Failure

Answer 4

Acetaminophen, Halothane

Question 5

DILI- Chronic Hepatitis

Answer 5

α-methylDOPA, Isoniazid (INH)

Question 6

DILI- Fibrosis/Cirrhosis

Answer 6

Methotrexate

Question 7

DILI- Granulomatous Hepatitis

Answer 7

Allopurinol, Sulfa drugs

Question 8

DILI- Hepatic Cell Adenomas

Answer 8

Oral contraceptive pills e.g. 1st generation

remove pill tumor regresses

Question 9

DILI- Hepatocellular Carcinoma

Answer 9

Anabolic steroids

Question 10

Epidemiological Associations

Hepatic adenoma

Answer 10

oral contraceptives

Question 11

Epidemiological Associations (3)

Cholangiocarcinoma

Answer 11

Primary sclerosing cholangitis (PSC),

Clonorchis,Opisthorchis (Found mainly in Asia

–> irritation of bile ducts–> bile duct cancer)

Question 12

Epidemiological Associations

Angiosarcoma

Answer 12

Arsenic, (poly)vinylchloride(PVC)

Question 13

Epidemiological Associations (7)

Hepatocellular Carcinoma

Answer 13

Hepatitis B virus
•Hepatitis C virus
•Aflatoxin
•Cirrhosis (e.g. Hemochromatosis, Alcoholic liver dis.)
•Non-alcoholic fatty liver disease (NAFLD)
•Anabolic steroids
•Tyrosinemia/A1AT deficiency

Question 14

Hepatitis B and Hepatocellular Carcinoma

Answer 14

Southeast Asia and Southern Africa

Question 15

Stromal Tumors of the Liver

Malignant

Answer 15

Malignant
•Angiosarcoma
•Embryonal sarcoma
•Leiomyosarcoma
•Lymphoma

Question 16

Stromal Tumors of the Liver

Benign

Answer 16

Benign
•Hemangioma
•Mesenchymal hamartoma
•Angiomyolipoma
•Leiomyoma
•Inflammatory pseudotumor
•Peliosis hepatis

Question 17

Epithelial Tumors of Liver

Benign

Answer 17

Benign
•Focal nodular hyperplasia
•Hepatic cell adenoma
•Bile duct hamartoma
•Bile duct adenoma

Question 18

Epithelial Tumors of Liver

Malignant

Answer 18

Malignant
•Hepatocellular carcinoma (HCC)
•Cholangiocarcinoma (CC)

Question 19

Treatment Guidelines: Recommendations for First-
Line Therapy in Patients Without Cirrhosis

Preferred (3)

Answer 19

Preferred - Tenofovir DF, Entecavir, Peg-IFN alfa-2a

Question 20

Treatment Guidelines: Recommendations for First-
Line Therapy in Patients Without Cirrhosis

Alternative

Answer 20

Alternative- Adefovir, Telbivudine*

Question 21

Treatment Guidelines: Recommendations for First-
Line Therapy in Patients Without Cirrhosis

Not Preferred

Answer 21

Not Preferred- Lamivudine

Question 22

autoimmune hepatitis

Type 1

Tx: Treatment
• Corticosteroids
• Immunosuppression
– azathioprine

Answer 22

Type 1: ANA, ASMA, IgG hypergammaglobulinemia

Most common type

Question 23

autoimmune hepatitis

Type 2

Tx: Treatment
• Corticosteroids
• Immunosuppression
– azathioprine

Answer 23

Type 2: Anti‐LKM.

Predominantly in children.
Rare in adults . Patients have more extra hepatic immunologic diseases, lower gamma globulins and higher tendency to develop cirrhosis despite steroid therapy

Question 24

autoimmune hepatitis

Type 3

Tx: Treatment
• Corticosteroids
• Immunosuppression
– azathioprine

Answer 24

Type 3: Anti‐SLA. Rare It may rapidly progress to cirrhosis

Question 25

What to order Chronic liver disease/Cirrhosis- ascites

Answer 25

``` • Routine – Cell count – Albumin – Culture • Optional – Total protein – Glucose – Lactic dehydrogenase – Gram stain • Special – Cytology – TB smear and culture – Triglycerides – Bilirubin – Amylase ```

Question 26

Hepatorenal syndrome progression may be slow (type II) or rapid (type I). • Type I disease frequently is accompanied by rapidly progressive liver failure. Diagnosis

Answer 26

Diagnosis • creatinine clearance less than 40 mL/min • a serum creatinine greater than 1.5 mg/dL, • urine volume less than 500 mL/d, and a • urine sodium less than 10 mEq/L is present. • Urine osmolality is greater than plasma osmolality. Clinically, the diagnosis may be reached if central venous pressure is determined to be normal or if no improvement of renal function occurs following the infusion of at least 1.5 L of a plasma expander

Question 27

HEPATIC ENCEPHALOPATHY What gets through BBB and Grades

Answer 27

facilitate the passage of neurotoxins into the brain [short-chain fatty acids, mercaptans, false neurotransmitters (eg, tyramine, octopamine, and beta-phenylethanolamines), ammonia, and gamma-aminobutyric acid (GABA) ] • Grade 0 - Subclinical; normal mental status, but minimal changes in memory, concentration, intellectual function, coordination • Grade 1 - Mild confusion, euphoria or depression, decreased attention, slowing of ability to perform mental tasks, irritability, disorder of sleep pattern (ie, inverted sleep cycle) • Grade 2 - Drowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality changes, inappropriate behavior, intermittent disorientation (usually for time) • Grade 3 - Somnolent but arousable, unable to perform mental tasks, disorientation to time and place, marked confusion, amnesia, occasional fits of rage, speech is present but incomprehensible • Grade 4 - Coma, with or without response to painful stimuli