Liver

Question 1

What is ascites?

Answer 1

describes an accumulation of fluid within the peritoneal cavity, seen in patients with cirrhosis and is believed to be caused by portal hypertension

Question 2

What is serum ascites albumin gradient calclulation?

Answer 2

albumin concentration of ascitic fluid - serum albumin concentration

Question 3

a high SAAG can be caused by

Answer 3

cirrhosis
heart failure
budd chiari syndrome
constructive pericarditis
hepatic failure

= raised portal pressure

Question 4

a low SAAG indicates

Answer 4

cancer of the peritoneum
tuberculosis
pancreatitis
nephrotic syndrome

Question 5

How is ascites managed?

Answer 5

address underlying cause, restrict salt in diet and give spironolactone

Question 6

What is the most common association with autoimmune hepatitis?

Answer 6

Grave’s disease

usually a young-middle aged woman

Question 7

Clinical features of autoimmune hepatitis

Answer 7

jaundice
fatigue
loss of appetite
hepatomegaly
splenomegaly
abdominal pain

Question 8

What do LFTs show in autoimmune hepatitis?

Answer 8

raised ALT and bilirubin

normal ALP

Question 9

What is the most common type of autoimmune hepatitis?

Answer 9

type 1 that is caused by anti-smooth muscle antibodies and antinuclear antibodies

Question 10

what is compensated cirrhosis

Answer 10

sufficient liver function remains to keep the patient systemically well

Question 11

decompensated cirrhosis

Answer 11

liver function is not sufficient to keep the patient well

Question 12

What are the symptoms of compensated liver cirrhosis?

Answer 12

fatigue
anorexia and cachexia
nausea
spider naevi

Question 13

What are the symptoms of decompensated cirrhosis?

Answer 13

ascites
jaundice
pruritus
palmar erythema
gynaecomastia
easily bruising

Question 14

Give 5 examples of complications of cirrhosis

Answer 14

1. ascites
2. spontaneous bacterial peritonitis
3. hepatocellular carcinoma
4. oesophageal varices
5. renal failure

Question 15

what is the most common form of hepatitis globally?

Answer 15

hepatitis B

Question 16

General symptoms of hepatitis

Answer 16

malaise and fatigue
nausea
RUQ pain
jaundice
hepatomegaly

Question 17

What is hepatocellular carcinoma?

Answer 17

primary tumour of the liver

Question 18

Which hepatitis types increase risk of hepatocellular carcinoma?

Answer 18

hepatitis C and hepatitis B

Question 19

How is hepatocellular carcinoma treated/managed?

Answer 19

hepatic resection
liver transplant
radiofrequency ablation

Question 20

What is hereditary haemochromatosis?

Answer 20

disorder of iron metabolism in which excess iron accumulates in liver, heart and pancreas

Question 21

Which gene is responsible for haemochromatosis?

Answer 21

homozygosity for HFEC282Y

Question 22

Clinical features of haemochromatosis

Answer 22

bronze skin
type 2 diabetes mellitus
fatigue
joint pain
liver cirrhosis 
adrenal insufficiency

Question 23

Mx of haemochromatosis

Answer 23

phlebotomy/venesection to restore normal levels of iron

prescribe desferrioxamine to chelate iron

Question 24

Which drugs can cause cirrhosis?

Answer 24

methotrexate
amiodarone
isonazid

Question 25

How is cirrhosis tested/investigated?

Answer 25

``` LFTs FBC u+es INR take some ascitic fluid doppler ultrasound liver biopsy ```

Question 26

what is spontaneous bacterial peritonitis?

Answer 26

sudden peritonitis that occurs in patients with ascites. an ascitic tap with neutrophils over 250mm indicates SBP

Question 27

What drug is given to manage pruritus?

Answer 27

colestyramine

Question 28

which tumour marker indicates hepatocellular carcinoma?

Answer 28

alpha fetoprotein

Question 29

hyperacute liver failure onset

Answer 29

7 days or less

Question 30

acute liver failure onset

Answer 30

8-21 days

Question 31

subacute liver failure onset

Answer 31

4-26 weeks

Question 32

causes of liver failure

Answer 32

``` hepatitis infection paracetamol overdose malignancy wilson's disease fatty liver of pregnancy ```

Question 33

clinical features of liver failure

Answer 33

hepatic encephalopathy abnormal bleeding jaundice ascites

Question 34

pathophysiology of hepatic encephalopathy

Answer 34

ammonia accumulates due to lost liver function ammonia passes through blood brain barrier turns into glutamate which disrupts osmotic balance and causes cerebral oedema

Question 35

4 stages of HE

Answer 35

1. altered mood and behaviour 2. drowsiness and confusion 3. incoherency, restlessness and asterixis 4. coma

Question 36

how to treat liver failure

Answer 36

treat underlying cause give lactulose to get rid of ammonia in faeces IV mannitol reduces cerebral oedema abx for peritonitis vitamin k for coagulation factor production