High Yield Concepts in Evaluation of Liver Disease (Gastrointestinal Diseases)

Question 1

Hepatocellular pattern of liver disease

Answer 1

Liver injury, inflammation and necrosis predominate

Question 2

Cholestatic pattern of liver disease

Answer 2

Inhibition of bile flow determinates

Question 3

Grading of liver disease

Answer 3

Histologic assessment of necroinflammatory activity:
Acute or chronic
Active or inactive
Mild, moderate or severe

Question 4

Staging of liver disease

Answer 4

Level of progression of the disease, based on the degree of the hepatic fibrosis:
Early or advanced
Precirrhotic or cirrhotic

Question 5

Criterion standard in evaluation of liver disease and most accurate means of assessing grade and stage

Answer 5

Liver biopsy

Question 6

Prognostication for cirrhosis and provides standard criteria for listing for liver transplantation (Class B & C); utilizes serum bilirubin, serum albumin, PT-INR and severity of ascites and hepatic encephalopathy

Answer 6

Child-Pugh Score

Question 7

More objective means of assessing disease severity; utilizes serum bilirubin, serum creatinine, and PT-INR

Answer 7

Model for End-Stage Liver Disease (MELD) Score

Question 8

Indicates cirrhosis with a Child-Pugh score ≥ 7 (Class B or C)

Answer 8

Liver Decompensation

Question 9

Occurrence of signs or symptoms of hepatic encephalopathy in a person with severe acute or chronic liver disease

Answer 9

Hepatic Failure

Question 10

Hepatic inflammation and necrosis that continue for at least 6 months

Answer 10

Chronic Hepatitis

Question 11

Most common and most characteristic symptom of liver disease

Answer 11

Fatigue

Question 12

Hallmark of liver disease and most reliable marker of severity

Answer 12

Jaundice

Question 13

Most reliable physical finding in examining the liver

Answer 13

Hepatic tenderness

Question 14

Best physical exam maneuver to appreciate ascites

Answer 14

Shifting dullness on percussion

Question 15

Major criterion for diagnosis of Fulminant Hepatitis

Answer 15

Hepatic encephalopathy during acute hepatitis (indicates poor prognosis)

Question 16

Screening test for Hepatopulmonary Syndrome

Answer 16

Oxygen saturation by pulse oximetry

Question 17

Most commonly used Liver Function Tests

Answer 17

Serum bilirubin, serum albumin, prothrombin time (PT)

Question 18

Rate-limiting step in bilirubin metabolism

Answer 18

Transport of conjugated bilirubin into the bile canaliculi (not conjugation itself)

Question 19

Any bilirubin found in urine

Answer 19

Conjugated/direct bilirubin (water-soluble)

Question 20

Exclusive site for synthesis of serum albumin

Answer 20

Hepatocytes

Question 21

Only clotting factor not produced in the liver

Answer 21

Factor VIII

Question 22

Single best acute measure of hepatic synthetic function

Answer 22

Protime (PT)
(PT prolongation >5 secs not corrected by parenteral vitamin K administration is a poor prognostic sign in acute viral hepatitis)

Question 23

Most helpful in recognizing Acute Hepatocellular Diseases

Answer 23

Elevated aminotransferases/transaminases

Question 24

Differentials for striking elevations in aminotransferases (>1000U/L)

Answer 24

Viral hepatitis
Ischemic liver injury
Toxin- or drug-induced liver injury
Acute phase of biliary obstruction caused by passage of gallstone into CBD

Question 25

↑ AST > ↑ ALT

Answer 25

Alcoholic liver disease (AST for San Miguel Beer)

Question 26

↑ ALT > ↑ AST

Answer 26

Viral hepatitis (ALT is a more specific indicator of liver injury)

Question 27

Key events in hepatic fibrogenesis

Answer 27

Stellate cell activation and collagen production

Question 28

First indication of worsening hepatic fibrosis

Answer 28

Mild thrombocytopenia

Question 29

Most commonly employed imaging tests for the liver

Answer 29

Ultrasound, CT, MRI

Question 30

First-line imaging tests for suspected Obstructive Jaundice

Answer 30

Ultrasound and CT (high sensititvitty for biliary duct dilatation)

Question 31

First Test for suspected Budd Chiari Syndrome (Hepatic Vein Thrombosis)

Answer 31

Ultrasound with Doppler imaging

Question 32

Budd-Chiari Syndrome (BCS) vs. Cardiac Cirrhosis

Answer 32

Extravasation of RBCs in BCS (but not in cardiac cirrhosis)