Hepatobiliary

Question 1

What are the four major functions of the liver?

Answer 1

Metabolism, synthesis, excretion, and immune function.

Question 2

What is the function of Kupffer cells in the liver?

Answer 2

Act as macrophages filtering pathogens in the hepatic sinusoids.

Question 3

What causes hepatitis?

Answer 3

Hepatotropic viruses (A-E), alcohol, toxins, autoimmune disease, fatty liver, and drug injury.

Question 4

What is cirrhosis?

Answer 4

Chronic liver disease characterised by fibrosis and tissue remodelling.

Question 5

What is the most common cause of acute liver failure in Australia?

Answer 5

Paracetamol overdose.

Question 6

What toxic compound causes damage in paracetamol overdose?

Answer 6

NAPQI.

Question 7

What is the antidote for paracetamol poisoning?

Answer 7

N-acetylcysteine (NAC).

Question 8

What are the four clinical phases of paracetamol toxicity?

Answer 8

Phase 1: GI upset; Phase 2: RUQ pain; Phase 3: necrosis, encephalopathy; Phase 4: recovery or death.

Question 9

What is steatosis?

Answer 9

Fat accumulation in liver cells; early stage of fatty liver disease.

Question 10

What is the difference between alcoholic and non-alcoholic fatty liver disease?

Answer 10

Alcoholic is due to ethanol use; non-alcoholic is linked to metabolic syndrome and T2DM.

Question 11

What is portal hypertension?

Answer 11

Increased pressure in the portal venous system due to liver fibrosis.

Question 12

What are complications of portal hypertension?

Answer 12

Varices, ascites, caput medusae, splenic congestion, hepatic renal syndrome.

Question 13

What causes ascites in liver disease?

Answer 13

Portal hypertension and hypoalbuminemia decrease oncotic pressure.

Question 14

What are signs of jaundice?

Answer 14

Yellow skin/sclera, dark urine, pale stools.

Question 15

What is hepatic encephalopathy?

Answer 15

Brain dysfunction from ammonia accumulation in liver failure.

Question 16

What liver condition causes coagulopathy and why?

Answer 16

Liver failure due to decreased clotting factor and vitamin K synthesis.

Question 17

What is a common sign of oesophageal variceal rupture?

Answer 17

Sudden vomiting of bright red blood.

Question 18

What are early symptoms of hepatitis?

Answer 18

Malaise, nausea, RUQ pain, jaundice, dark urine, pale stools.

Question 19

What viral hepatitis types are transmitted faecal-orally?

Answer 19

Hepatitis A and E.

Question 20

Which hepatitis types are transmitted via blood or sexual contact?

Answer 20

Hepatitis B, C, and D.

Question 21

Which hepatitis virus depends on another to replicate?

Answer 21

Hepatitis D depends on Hepatitis B.

Question 22

What is cholestasis?

Answer 22

Impaired bile flow.

Question 23

What are signs of biliary colic?

Answer 23

RUQ pain after eating, nausea, vomiting, +ve Murphy’s sign.

Question 24

What causes gallstones (cholelithiasis)?

Answer 24

Cholesterol or bilirubin precipitation due to genetics, obesity, diet, or pregnancy.

Question 25

What is cholecystitis?

Answer 25

Inflammation of the gallbladder, often due to obstruction by a gallstone.

Question 26

What is choledocholithiasis?

Answer 26

Gallstone lodged in the common bile duct.

Question 27

What is cholangitis?

Answer 27

Infection/inflammation of the bile duct, often causing fever, jaundice, RUQ pain.

Question 28

How is biliary colic managed in the field?

Answer 28

Analgesia, antiemetics, IV fluids, monitor for sepsis.

Question 29

What is pancreatitis?

Answer 29

Inflammation of the pancreas, often due to gallstones or alcohol.

Question 30

What are hallmark signs of acute pancreatitis?

Answer 30

Severe epigastric pain radiating to back, vomiting, fever, fat in stool.

Question 31

What is the most common cause of acute pancreatitis?

Answer 31

Gallstones.

Question 32

What does 'I GET SMASHED' stand for in pancreatitis causes?

Answer 32

Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidaemia/hypercalcaemia, ERCP, Drugs.

Question 33

What is the role of the gallbladder?

Answer 33

Stores and releases bile into the small intestine during digestion.

Question 34

What condition involves bile duct blockage and infection?

Answer 34

Cholangitis.

Question 35

How does alcohol cause fatty liver?

Answer 35

Alters NAD/NADH ratio, promoting lipid accumulation in hepatocytes.

Question 36

What are signs of chronic liver disease?

Answer 36

Jaundice, fatigue, confusion, coagulopathy, ascites, varices.

Question 37

What is caput medusae?

Answer 37

Dilated abdominal veins due to portal hypertension.

Question 38

What does bilirubin do?

Answer 38

Gives stool its brown colour; elevated in jaundice.

Question 39

What are signs of liver cancer?

Answer 39

Weight loss, jaundice, fatigue, ascites, confusion.

Question 40

What increases the risk of liver cancer?

Answer 40

Hepatitis, cirrhosis, alcohol, metabolic syndrome, smoking.

Question 41

What is the significance of altered drug sensitivity in liver disease?

Answer 41

Decreased metabolism and excretion → prolonged/intensified drug effects.

Question 42

What is the paramedic role in managing suspected liver failure?

Answer 42

Symptomatic care, pain management, monitor LOC, IV fluids, alert for GI bleed.

Question 43

Why should paracetamol be used cautiously in liver disease?

Answer 43

It is hepatotoxic in high doses or chronic liver dysfunction.

Question 44

What is the impact of hypoalbuminemia in liver disease?

Answer 44

Reduced oncotic pressure → fluid shift and ascites.