Liver and friends

Question 1

Jaundice, RUQ pain, sudden onset confusion, been taking paracetamol

Answer 1

Acute liver failure

Question 2

Progressive jaundice over months, brusing, gynaecomastia,

Answer 2

Chronic liver disease
Liver cirrhosis - can lead to portal hypertension
ALD - from alcohol
NAFLD - from being obese and unhealthy lifestyle

Question 3

Pruritus, jaundice, dry eyes/mouth

Answer 3

Primary biliary cholangitis -

associated with autoimmune conditions like Sjorgen’s, RA

Question 4

Pruritus, jaundice, abdominal pain

Answer 4

Primary sclerosing cholangitis

• Associated with IBD

Question 5

Jaundice, difficulty speaking, parkinsonism, memory impairment

Answer 5

Wilson’s disease

Question 6

Painless jaundice, significant family history of some liver disease

Answer 6

Gilbert’s syndrome

Question 7

Jaundice, pale stools, dark urine, pruritus, weight loss

Answer 7

Cholangiocarcinoma

Question 8

RUQ pain, jaundice, hepatomegaly, weight loss, fatigue

Answer 8

Hepatocellular carcinoma

RF - Liver cirrhosis, chronic alcohol use

Question 9

Pale stools, dark urine, weight loss, slight epigastric pain

Answer 9

Pancreatic cancer

(Although could present as painless jaundice as well)

Question 10

Intermittent RUQ pain worse after fatty meals, n+v

Answer 10

Cholelithiasis

Question 11

Intermittent RUQ pain, jaundice, pale stools, dark urine

Answer 11

Choledocholithiasis

Question 12

Constant RUQ pain, fever, n+v

Answer 12

Cholecystitis

Question 13

RUQ pain, fever, jaundice

Answer 13

Ascending cholangitis

Confusion and hypotension - Reynold’s pentad

RF - Previous ERCP, history of gallstones

Question 14

Severe epigastric pain radiating to the back, n+v, fever

Answer 14

Acute pancreatitis

Question 15

loss of libido, erectile dysfunction, depression, arthralgia, bronze pigmentation

Answer 15

Haemochromatosis

(Iron deposits in the liver, heart and anterior pituitary - hypogonadism)

Question 16

Dry cough, wheeze, weight loss, jaundice

Answer 16

A1AT deficiency

ONLY GET JAUNDICE WITH LIVER FAILURE –> it is usually early onset emphysema then chronic liver disease

Question 17

History of liver disease, confusion, personality change

Answer 17

Hepatic encephalopathy

(Ammonia build up due to liver dysfunction)

Question 18

Confusion, ataxia, nystagmus, history of heavy alcohol use

Answer 18

Wernicke’s encephalopathy

(Thiamine deficiency, usually due to heavy alcohol use but can be from severe vomiting/malnutrition)

Question 19

Abdominal swelling, tenderness and discomfort, fever, rebound tenderness

Answer 19

Ascites and SBP