GI - Liver disease

Question 1

When LDH is raised, this makes you suspicious of what?

Answer 1

Metastatic disease in the liver

obstructive jaundice

Question 2

What would cause a raised ferritin / iron level?

Answer 2

Liver necrosis
Alcoholic liver disease
Acute viral hepatitis
Haemochromatosis

Question 3

At what bilirubin level, does jaundice tend to become visible?

Answer 3

> 40mmol

Question 4

Decreased copper levels is seen in what disease?

Answer 4

Wilson’s

Question 5

Increased copper levels is seen in what disease?

Answer 5

Cholestasis

Question 6

What clotting factors are produced by the liver?

Answer 6

Factors 2 7 9 and 10

Proteins C and S

Question 7

What marker is raised in pancreatic cancer?

Answer 7

Ca-19-9

Question 8

How is the coagulation of the liver monitored?

Answer 8

Prothrombin Time ratio

Question 9

What screening tool is used for liver cirrhosis/

Answer 9

Child Pugh scoring system

Question 10

What 5 things are considered in the child pugh system?

Answer 10

Albumin
Bilirubin
Ascites
INR
Encephalopathy (stages)

Question 11

What is the commonest cause of liver cirrhosis?

Answer 11

Alcohol

Question 12

List some clinical signs of liver disease?

Answer 12

Spider naevi
Jaundice
Ascites
Caput medusa
Palmar erythema
Gynaecomastia
Hepatomegaly
Asterixis
Dupuytren's contracture
Kayser-Fleisher rings
Xanthelasma

Question 13

What medications are given to prevent / management encephalopathy?

Answer 13

Laxatives e.g. lactulose

Question 14

What vitamin are alcohols often deficient in?

Answer 14

Thiamine (B)

Question 15

Steroids are good for long term management of live disease. True or false?

Answer 15

False

Good for acute management, roughly a month, but do not improve long-term outcomes.

Question 16

Why might a patient with liver disease be given vitamin K?

Answer 16

To correct any problems with clotting factors

Question 17

When do NICE recommend a liver biopsy in patients with liver disease?

Answer 17

Patients who are being considered for steroid treatment.

Question 18

What is a serious complication of alcohol withdrawal?

Answer 18

Delirium Tremens

Question 19

What is the mortality rate of delirium tremens.

Answer 19

35%

Question 20

What receptors in the brain does alcohol act on and what action does this have?

Answer 20

GABA receptors

Relaxing effect on the brain

Question 21

What receptors does alcohol inhibit?

Answer 21

Glutamate receptors

Question 22

What medication is used to help combat the effects of alcohol withdrawal?

Answer 22

Lorazepam (benzodiazapines)

Question 23

A deficiency in thiamine can lead to what syndrome?

Answer 23

Wernicke’s Korsakoff

Question 24

What are the features of Wernicke’s encephalopathy?

Answer 24

Confusion
oculomotor disturbances
Ataxia

Question 25

What are the features of Korsakoff's Syndrome?

Answer 25

Memory impairment | Behavioural changes

Question 26

What are the 4 main causes of liver cirrhosis?

Answer 26

Alcohol Non alcoholic fatty liver Hepatitis B hepatitis C

Question 27

What is the tumour marker for hepatocellular carcinoma:

Answer 27

Alpha-fetoprotein

Question 28

How often are patients with cirrhosis screened for HCC, and what screening is done?

Answer 28

Every 6 months | AFP and USS

Question 29

What is a common side effect of PPIs?

Answer 29

Hyponatraemia

Question 30

An elderly patient presenting 1-3 days post a septic shock episode has extremely deranged AST and ALT (>1000). What is the most likely diagnosis?

Answer 30

Ischaemic hepatitis caused by acute hypoperfusion of the liver

Question 31

What is the typical triad for Budd Chiari syndrome?

Answer 31

Abdominal pain (sudden) Ascites Tender Hepatomegaly

Question 32

What syndrome can be seen in patients with underlying hypercoagulation diseases e.g. antiphospholipid syndrome?

Answer 32

Budd chiari syndrome

Question 33

What is Budd Chiari syndrome?

Answer 33

This is when there is an obstruction to the venous outflow, leading to increased hepatic sinusoidal pressure and portal hypertension

Question 34

What liver tests will be raised in Budd Chiari syndrome?

Answer 34

AST ALT ALP Bilirubin

Question 35

What is the appropriate investigation for Budd Chiari syndrome

Answer 35

USS doppler of the hepatic vein | CT or MRI may be required

Question 36

In Budd Chiari syndrome, what liver tests may be decreased?

Answer 36

Albumin

Question 37

How is Budd Chiari syndrome managed?

Answer 37

Anti-coagulation Manage ascites via sodium restriction and diuretics Thrombolysis, angioplasty, TIPS or at end stage liver transplant

Question 38

Is hepatitis B an RNA or a DNA virus?

Answer 38

DNA

Question 39

Is hepatitis A a RNA or DNA virus?

Answer 39

RNA

Question 40

Is Hepatitis C a DNA or an RNA virus?

Answer 40

RNA

Question 41

How is Hepatitis C treated?

Answer 41

Can now be cured with direct acting antivirals