GI JCU4

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Anonymous
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176904
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GI JCU4
Updated:
2012-10-10 22:01:13
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JCU4
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GI
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  1. What are the 3 patterns of alcoholic liver disease? (sm)
    • 1. Fatty change - reverisble
    • 2. Alcoholic hepatitis - irreversible but progression may be arrested
    • 3. Cirrhosis - irrversible
  2. List the steps of ethanol metabolism (with enzymes). sm
    Ethanol ---(ADH)---> Acetaldehyde ---(ALDH)---> Acetate ---> Carbon dioxide + water
  3. List 5 stigmata of chronic liver disease that you will see on physical examination
    • Abnormal skin pigmentation
    • Erythema
    • Hepatic flap
    • Spider naevi
    • Gynaecomastia
    • Clubbing
    • Jaundice
  4. You suspect alcoholic liver disease in a patient. What Ix? (sm)
    • FBC - macrocytosis in absence of anaemia
    • LFTs (GGT)
    • PT 
    • Bilirubin
    • Albumin
    • USS/CT
    • Viral hepatitis serologies
    • Liver biopsy - to determine extent of liver damage
  5. What are some less common causes of viral hepatitis? (sm)
    • Less common - EBV, CMV
    • Rare - Herpes simplex, yellow fever
  6. Morphological features of acute hepatitis? (sm)
    • Diffuse swelling
    • Cholestasis
    • Macrophage aggregates
    • Bridging necrosis
    • Inflammatory cells
    • Kupffer cells
  7. Morphological features of chronic hepatitis? (sm)
    • Lymphoid aggregates
    • Macrovesicular steatosis
    • Bridging necrosis
    • Fibrous tissue deposition
  8. How to improve rates of HepA transmission? (sm)
    • Improve social conditions - overcrowding, poor sanitation etc
    • Inactivated virus vaccine
  9. What is the enzyme required for Hep B virus replication? (sm)
    DNA polymerase
  10. Describe the pathogenesis of Hepatitis B. (sm)
    Ingestion/inoculation > replication in the liver and viraemia > cellular immune response > apoptosis, necrosis of hepatocytes > inflammation (hepatitis) > bridging hepatocyte necrosis > fibrosis > cirrhosis > liver failure, carcinoma
  11. What is the most common cause of transmission of Hep B worldwide? (sm)
    Tranmission from mother to child - most common cause and carries the highest transmission risk
  12. What percentage (~) of cirrhosis patients go on to develop hepatocellular carcinoma? (sm)
    ~5-15%
  13. The persistence of which serological marker is associated with chronic HepB infection?
    HBsAg
  14. Which HepB serological marker is not found in the blood? (sm)
    • core antigen
    • HBcAg
  15. Which HepB serological marker reflects viral replication? (sm)
    • E antigen
    • HBeAg
  16. Interpret these blood test results:
    HBsAg - negative
    anti-HBcAg - negative
    anti-HBsAg - positive
    The patient is immune because of vaccination against HBV
  17. Interpret these blood test results:
    HBsAg - positive
    anti-HBcAg - positive
    anti-HBcAg IgM - negative
    anti-HBsAg - negative
    The patient has a chronic HBV iunfection. The IgM anti-HBc has waned
  18. Interpret these blood test results: (sm)
    HBsAg - positive
    anti-HBcAg - positive
    anti-HBcAg IgM - positive
    anti-HBsAg - negative
    The patient has an acute HBV infection. 
  19. What are some treatment options for Hep B? (sm)
    • Interferon alpha
    • Lamivudine
    • Adefovir (any of the -virs)
    • Liver transplantation
  20. Which type of hepatitis requires HBV for replication and why? (sm)
    • Hep D
    • RNA-virus that cannot exist independently
  21. List 4 risk factors for Hep C. (sm)
    • IVDU
    • Unscreened blood products
    • Vertical transmission
    • Needle stick injury
  22. List 4 drugs that can cause drug-induced hepatitis. (sm)
    • Chlorpromazine
    • Oetrogens
    • NSAIDs
    • Statins
    • Rifampicin
    • Isoniazid
    • Amiodarone
    • Azathioprine
    • Methotrexate
  23. Pathogenesis of ascites in liver disease. (sm)
    decreased albumin production > decreased osmotic pressure/increased hydrostatic pressure > formation of abdominal fluid > decreased intravacular volume > increased aldosterone (kidney) and increaesd Na+ reabsorption > increased intravascular volume > more abdominal fluid > ascites
  24. Aetiology (s) of haemochromotosis. (sm)
    • Hereditary
    • Excess blood transfusions
    • Iron loading anaemias (thalassemia, sideroblastic anaemia)
    • Liver disease
    • Alcoholic liver disease
  25. Pathogenesis of haemochromotosis. (sm)
    Recessive mutation > upregulation of iron-specific transporters > excessive iron absorption
  26. List 5 clinical manifestations (signs or symptoms) of haemohchromotosis. (sm)
    • Fatigue
    • Arthropathy
    • Skin pigmentation
    • Impotence
    • Loss of libido, testicular atrophy
    • Cardiac failure/dysrhythmia (due to iron deposition in the heart)
  27. List the organs in which haemosiderin is deposited in haemochromotosis (and the order of most common > least common). (sm)
    Liver > pancreas > myocardium > pituitary gland > adrenal gland > thyroid and parathyroid > joints > skin
  28. Primary biliary cirrhosis most commonly affects elderly men. True or false?
    False. Most commonly affects middle-aged women

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