Liver Diseases
Cirrhosis
Pregnancy-Related Liver Diseases
IBS & IBD
Mesenteric Ischemia
100
A 55-year-old man is hospitalized for acute alcoholic hepatitis. He is confused and lethargic; the temperature is 100.0 F, the BP is 90/60 mm Hg, HR is 120/min. The Maddrey discriminant function score is greater than 32. Which of the following should be done next?
A. Administer prednisolone
B. Begin cefuroxime
C. Begin nadolol
D. Evaluate for liver transplantation
A. Administer prednisolone
100
A 55-year-old woman has newly discovered hepatitis C infection. There are spider angiomata on the upper body, a nodular liver edge, and splenomegaly. Which of the following should be done next?
A. Evaluation for liver transplantation
B. Interferon and ribavirin
C. Lamivudine
D. Observation
E. Upper Endoscopy
E. Upper Endoscopy
100
A 28-year-old woman is 30 weeks pregnant and has a 2 week history of pruritus. Vital signs are normal. Examination reveals scleral icterus, spider angiomas, palmar erythema, and ankle edema. CBC, INR, AST/ALT, and hepatitis viral studies are normal. Total and direct bilirubin are 4.2 and 2.3 mg/dL. Which of the following is the most likely diagnosis?
A. Acute fatty liver of pregnancy
B. HELLP syndrome
C. Hyperemsis gravidarum
D. Intrahepatic cholestasis of pregnancy
D. Intrahepatic cholestasis of pregnancy
100
A patient presents with IBS and diarrhea. What other diagnosis needs to be ruled out?
Celiac disease
100
Name 2 of the 3 common causes of acute mesenteric ischemia.
- Emboli (atrial fibrillation) most common
- Thrombosis
- Nonocclusive ischemia caused by low-flow states
- Medications
200
A 70-year-old man has a 6 year history of asymptomatic elevated liver enzymes. He has type 2 diabetes mellitus, hyperlipidemia, and obesity treated with metformin, HCTZ, and simvastatin; he does not drink alcohol. His BMI is 30 and physical examination is normal. AST is 80 U/L, ALT is 150 U/L. Iron studies are normal and hepatitis serologies are negative. Ultrasound shows fatty infiltration. Which of the following is the most appropriate next step in management for this patient?
A. Abdomen MRI
B. Liver Scintography
C. Observation
D. Weight loss
D. Weight loss
200
Name a disease that has a SAAG ≥ 1.1 and ascitic fluid protein > 2.5.
Right sided heart failure, Budd- Chiari syndrome
200
A 25 year old pregnant female presents with prolonged vomiting in the first trimester with elevated AST/ALT. What is her diagnosis?
Hyperemesis Gravidarum
200
Name a lab test that can be performed to differentiate IBS from IBD.
Fecal calprotectin is positive in IBD but negative in IBS.
200
A 67 year old woman has a 9 month history of postprandial abdominal pain. She avoids eating and has lost 20 pounds. The patient had an MI 2 years ago. She still smokes. Medications are simvastatin, lisinopril, and aspirin. Vital signs are normal. Other than an epigastric bruit the abdominal exam is normal. Labs are normal as are abdominal ultrasonography and upper endoscopy. Colonscopy was normal 7 years ago. Which of the following should be done next?
A. Capsule endoscopy
B. Colonoscopy
C. Magnetic Resonance Angiography
D. Small Bowel Radiographic Series
C. Magnetic Resonance Angiography
300
Name two scoring tools that can be used to assess the severity of alcoholic hepatitis and indicate the cutoff for when you would treat a patient with prednisolone for each.
Maddrey Discriminant Function ≥ 32
MELD score ≥ 18
300
Name 4 causes of acute liver failure.
Acetominophen hepatotoxicity
Idiosyncratic drug reactions
Acute HBV and HAV infections
HELLP syndrome
Acute Fatty Liver of Pregnancy
Ischemic Hepatitis
Wilson Disease
300
Name two treatment options for intrahepatic cholestasis of pregnancy.
Ursodeoxycholic acid
- improves pruritus and fetal outcomes
- normalizes aminotransferase levels
Early delivery
- good maternal and fetal prognosis
300
Name 4 extraintestinal manifestations of IBD.
- Oral aphthous ulcers
- Arthritis including spondylitis and sacroilitis
- Episcleritis or uveitis
- Erythema nodosum
- Pyoderma gangrenosum
- Primary sclerosing cholangitis
300
What is sitophobia? A symptom of chronic mesenteric ischemia.
Fear of eating
400
Name this disease and how you would treat it.
Wilson Disease. Treatment with chelation with D-penicillamine or trientine
400
Name the type of syndrome that is associated with cirrhosis and is characterized by pulmonary hypertension with portal hypertension and how it is diagnosed.
Portopulmonary. Diagnosed by echocardiography.
400
A 22 year old 36 week pregnant female presents with abdominal pain, nausea, and vomiting. She also notes pruritus and jaundice. CBC is significant for a hemoglobin of 7 and platelets of 100. CMP is remarkable for AST 300 and ALT 250. What is her diagnosis and how should she be treated?
HELLP Syndrome. Treatment with delivery.
400
What medications are used to treat simple vs complex fistulas in Crohn Disease?
Simple perianal fistulas
- Metronidazole and Ciprofloxacin ± Infliximab
Complex fistulas
- Infliximab
400
Name 2 medications which can cause acute mesenteric ischemia.
- Vasopressors
- Triptans
- Cocaine
- Digitalis
500
This disease causes acute liver failure that is associated with food outbreaks from raspberries and scallions.
Hepatitis A
500
Describe the difference between Type 1 and Type 2 Hepatorenal Syndrome.
Type 1
- increase Cr ≥ 0.3 mg/dL or increase Cr by 50% from baseline
- no response to 2 days of diuretic withdrawal or volume expansion with albumin 1 g/kg body weight
Type 2
- more gradual increase in Cr
- diuretic refractory ascites
500
A 27 year old 37 week pregnant female presents with altered mental status, nausea, vomiting, abdominal pain, and pruritus. Labs are remarkable for Hgb of 7, Plts of 125, Glucose of 65, AST of 400, ALT of 450, and INR of 1.5. What is her diagnosis?
Acute Fatty Liver of Pregnancy
500
What medication is FDA approved for women with IBS-C?
Lubiprostone
500
What are the 2 indications for a surgery consult in patients with acute mesenteric ischemia?
- Pancolitis
- Isolated right-sided ischemia