Liver and biliary tree

Question 1

What is the cause of oesophageal varices?

Answer 1

Portal HTN

Question 2

Which seroform of viral hepatitis is most likely to be transmitted where there is a poor water supply?

Answer 2

Hepatitis E

Question 3

For which type of hepatitis are IVDUs particularly at risk?

Answer 3

Hep C

Question 4

How can viral load be determined in viral hepatitis?

Answer 4

Nucleic Acid Amplification Test

Question 5

Which antibodies will be present in someone who has been vaccinated against Hep B?

Answer 5

Anti-HbS (surface antigen)

Question 6

Which antibodies will be present in someone who has chronic Hep B?

Answer 6

Anti-HbS

Question 7

Which antibodies will be present in someone who has acute Hep B?

Answer 7

Anti-HBc IgM

Question 8

Which antibodies will be present in someone who has resolved acute Hep B?

Answer 8

Anti-HbC IgG

Question 9

How is acute viral hepatitis managed?

Answer 9

Supportive care

Question 10

How is chronic viral hepatitis B managed?

Answer 10

Antivirals and peginterferon

Question 11

How is chronic viral hepatitis C managed?

Answer 11

Antivirals

Question 12

Describe the LFTs of someone with NASH as opposed to alcoholic liver disease

Answer 12

AST:ALT ratio <1 in NASH whereas in ALD AST:ALT > 2:1

Question 13

How is NASH progression to cirrhosis measured?

Answer 13

Hepatic US

Question 14

Recall the pathophysiology of alcoholic liver disease

Answer 14

Alcohol metabolism –> Excess NADH –> inhibition of gluconeogenesis and FA oxidation

Question 15

What % of heavy drinkers will develop alcoholic hepatitis?

Answer 15

10-15%

Question 16

What electrolyte imbalance results from ascites?

Answer 16

Hyponatraemia

Question 17

What 3 tests would you do first-line in suspected Wilson’s disease?

Answer 17

LFTs
Urinary copper
Serum caeruloplasmin

Question 18

Recall 3 symptoms of haemachromatosis

Answer 18

Tanned skin
T1DM
Liver symptoms

Question 19

What is Boas’ sign?

Answer 19

Radiation of cholecystitis pain to scapula

Question 20

Differentiate the expected LFTs in cholelithiasis vs choledocholithiasis

Answer 20

Cholelithiasis: normal
Choledocholithiasis: raised ALP

Question 21

Differentiate cholelithiasis and choledocholithiasis

Answer 21

Cholelithiasis = in gallbladder
Choledocholothiasis = in CBD

Question 22

Describe the ERCP procedure

Answer 22

Endoscope down into small bowel to the opening of the bile duct

Question 23

Differentiate ascending cholangitis and acute cholecystitis

Answer 23

Ascending cholangitis is caused by stasis in the CBD, whereas acute cholecystitis is to do with inflammation in the gallbladder or cystic duct

Question 24

Charcot’s triad and Reynold’s pentad are associated with which condition?

Answer 24

Ascending cholangitis

Question 25

If RUQ pain is constant, what sort of infection is it most likely to be?

Answer 25

Acute cholecystitis

Question 26

Rebound tenderness is indicative of which pathology in the RUQ?

Answer 26

Acute cholecystitis

Question 27

Is jaundice more likely to develop in acute cholecystitis or ascending cholangitis?

Answer 27

Ascending cholangitis

Question 28

What is a common comorbidity of PBC?

Answer 28

Sjorgen's syndrome

Question 29

Which antibodies are diagnostic of PBC?

Answer 29

AMA

Question 30

What is the diagnostic test for PSC?

Answer 30

MRCP

Question 31

What is seen upon MRCP in PSC?

Answer 31

Beading

Question 32

Which test is diagnostic of gallstones?

Answer 32

USS biliary tree