Liver Disease

Question 1

Diagnostic Tests

ANA or SMA, elevated IgG levels, and compatible histology

Answer 1

Autoimmune hepatitis

Question 2

Diagnostic Tests

Mitochondrial antibody, elevated IgM levels, and compatible histology

Answer 2

Primary biliary cirrhosis

Question 3

Diagnostic Tests

P-ANCA, cholangiography

Answer 3

Primary sclerosing cholangitis

Question 4

Diagnostic Tests

Reduced 1 antitrypsin levels, phenotypes PiZZ or PiSZ

Answer 4

1 Antitrypsin disease

Question 5

Diagnostic Tests

Decreased serum ceruloplasmin and increased urinary copper; increased hepatic copper level

Answer 5

Wilson’s disease

Question 6

Diagnostic Tests
a-fetoprotein level >500
US or CT image of mass

Answer 6

HCC

Question 7

Biopsy size adequate

Answer 7

1.5-2 cm

Question 8

most common causes of chronic liver disease in general order of frequency

Answer 8

chronic hepatitis C, alcoholic liver disease, nonalcoholic steatohepatitis, chronic hepatitis B, autoimmune hepatitis, sclerosing cholangitis, primary biliary cirrhosis, hemochromatosis, and Wilson’s disease

Question 9

CPC score

Answer 9

A 5-6
B 7-9
C 10-15

Question 10

Purpose of CPC

Answer 10

> predictor of survival
predicts the likelihood of major complications of cirrhosis such as bleeding from varices and spontaneous bacterial peritonitis

Question 11

Child pugh

Answer 11

Bilirubin
Albumin
Prothrombin time
Hepatic encephalopathy
Ascites

Question 12

cirrhotics screen/surveillance HCC

Answer 12

6-12 mo ultrasound liver

Question 13

Markers autoimmune hepatitis

Answer 13

ANA

anti LKM

Question 14

MArker sclerosing cholangitis

Answer 14

p-ANCA

Question 15

PBC marker

Answer 15

AMA

Question 16

Dupuytren contracture

parotid enlargement-

Answer 16

o chronic alcoholism

o alcoholic liver disease

Question 17

Kayser-Fleischer rings

Answer 17

Wilson’s disease; olden-brown copper pigment deposited in Descemet’s membrane at the periphery of the cornea

Question 18

Mucocutaneous vasculitis with palpable purpura

Answer 18

o cryoglobulinemia of chronic hepatitis C

Question 19

slate gray pigmentation of skin

Answer 19

hemochromatosis

Question 20

o xanthelasma and tendon xanthomata

Answer 20

o retention and high serum levels of lipids and cholesterol

Question 21

o Hyperpigmentation of skin

Answer 21

primary biliary cirrhosis and sclerosing cholangitis

Question 22

Triad of hepatopulmonary syndrome

Answer 22

• liver disease
• hypoxemia
• pulmonary AV shunting

Question 23

where seen:
platypnea and orthodeoxia- shortness of breath and oxygen desaturation that occur paradoxically upon assuming an upright position

Answer 23

• hepatopulmonary syndrome

Question 24

acute liver failure + hepatic encephalopathy

Answer 24

fulminant hepatitis

Question 25

most reliable physical finding in examining the liver

Answer 25

• Hepatic tenderness

Question 26

Significant history of alcohol intake

Answer 26

o Women more than 2 drinks (22-30 g)

o Men more than 3 drinks in men (33-45g)

Question 27

hallmark symptom of liver disease and perhaps the most reliable marker of severity

Answer 27

jaundice

Question 28

jaundice Rarely detectable if bilirubin level

Question 29

most common and most characteristic symptom of liver disease

Answer 29

Fatigue

Question 30

Total serum bilirubin

Answer 30

1-1.5 mg/dL

Question 31

rate-limiting step in bilirubin metabolism

Answer 31

transport of conjugated bilirubin into the bile canaliculi

Question 32

Aminotransferases >1000

Answer 32

(1) viral hepatitis
(2) ischemic liver injury (prolonged hypotension or acute heart failure)
(3) toxin- or drug-induced liver injury