Alcoholic Liver Diseases and Non-Alcoholic Fatty Liver Disease MCQs

In most people (80%), A, B, and H antigens are secreted by the cells and are present in the circulation as well as in various secretions such as saliva ( Se phenotype ). Others, called "nonsecretors" do not secrete A, B, and H antigens ( se phenotype ). ABO and Se/se systems influence the susceptibility to a variety of diseases. Malaria is less severe in O than non O patients. Group O is associated with enhanced susceptibility to Helicobacter pylori (and gastric ulcer) as well as to cholera bacillus or to norovirus . Group O individuals exhibit a lesser procoagulation phenotype when compared to non O individuals. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 113, Pg: 884

The chief vector of epidemic typhus is the human body louse. The hard tick is a vector for a number of rickettsial diseases. Larval trombiculid mites spread scrub typhus. Rat fleas are responsible for the spread of endemic (murine) typhus. The Aedes aegypti mosquito is the vector for dengue fever Reference : Harrison's Principles of Internal Medicine 21 st edition, Ch:187 Pg:1435

Hypercholesterolaemia rather than hypertriglyceridaemia : nephrotic syndrome, cholestasis, hypothyroidism Hyperlipidaemia: secondary causes Causes of predominantly hypertriglyceridemia diabetes mellitus (types 1 and 2) obesity alcohol chronic renal failure drugs: thiazides, non-selective beta-blockers, unopposed estrogen liver disease Reference: Harrison's Principles of Internal Medicine 20 th edition Chapter:400 Page number:2897

The factors that can increase digoxin toxicity include: Electrolyte imbalances like hypokalemia, hypomagnesemia and hypercalcemia Drugs that increase digoxin levels like amiodarone, verapamil or spironolactone Myocardial ischemia and hypoxemia Renal failure Reference : Harrison's Principles of Internal Medicine 21 st edition Page 350

A pH of less than 7.3 is a poor prognostic factor for this patient. The criteria for transfer to a ICU are: Encephalopathy INR >2.0 at 3.5 at Serum creatinine >2.0 mg/dl Blood pH Systolic BP Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 340 Pg: 2588

This patient is likely to have Wernicke's encephalopathy causing confusion. IV thiamine should be given to reduce the progression. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch:333, Pg: 2526

Glucagon acts mainly on the liver and has no action on muscle. It increases glycogenolysis and gluconeogenesis and also stimulates lipolysis in adipose tissue. Adenylate cyclase is a key enzyme involved in the breakdown of glycogen polymers to increase availability of glucose. Activation of this and other enzymes is responsible for restoring blood glucose levels in this case. Insulin induces the synthesis of phosphofructokinase, which increases glycolysis, and stimulates acetyl-CoA carboxylase to increase the synthesis of fatty acids. Glucagon acts via cyclic AMP to stimulate lipolysis, producing free fatty acids that can act as a major source of energy. Reference: Harrison's Principles of Internal Medicine 21 st edition Page:3107

In patients diagnosed with alcoholic hepatitis, short-term mortality can be predicted using the Maddrey discriminant function (MDF; calculated as 4.6 × [the prolongation of the prothrombin time above control {seconds}] + serum bilirubin [mg/dL]). Other scores are MELD score Age-Bilirubin-INR-Creatinine (ABIC) score. Patients with severe alcoholic hepatitis (AH), defined as Maddrey discriminant function (MDF) ≥32 or Model for End-Stage Liver Disease (MELD) score >20, without contraindications for glucocorticoids are candidates for such treatment. Non responders or patients with contraindications for treatment should be considered for early liver transplantation (LT) or supportive or palliative care, as clinically appropriate. Reference : Harrison's Principles of internal medicine 21st ed chap 342 pg. 2619