Hyperbilirubinemia and Functions of Liver MCQs

Ans. is 'a' i.e., Rotor syndrome Conjugated hyperbilirubinemia is seen when ? i) Impaired secretion of conjugated bilirubin into bile -> Dubin Johnson syndrome, Rotor syndrome. ii) Impaired bile flow —> Obstructive jaundice, primary biliary cirrhosis, Neonatal cholestasis, e.g. Extrahepatic biliary atresia/neonate idiopathic hepatitis, Choledocal cyst, Sclerosing cholangitis, Caroli disease, Metabolic (Tyrosinemia, Wolman disease, Nieman pick disease, Galactosemia, Fructosemia).

Answer- D. All of above Impaired bile flow → Obstructive jaundice, primary biliary cirrhosis, Neonatal cholestasis, e.g. Extrahepatic biliary atresia/neonate idiopathic hepatitis, Choledocal cyst, Sclerosing cholangitis, Caroli disease, Metabolic (Tyrosinemia, Wolman disease, Nieman pick disease, Galactosemia, Fructosemia).

Liver biopsy is useful to determine the severity of the disease and for monitory progression when treatment with ribavirin and interferon is instigated. Cirrhosis develops in 20-25 percent of patients with chronic hepatitis C after 10 years. It is also important to rule out liver carcinoma which may be a complication of long standing hepatitis C infection Hepatitis C is an RNA virus and hence option C is incorrect. ERCP is done in cases of obstructive jaundice. CT abdomen is not going to help in this patient Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 341, Pg: 2592

This is a patient with possible HIV who has oesophageal candidiasis (white plaques on endoscopy). Candida is normally found in the throat but can become pathogenic and produce esophagitis in a compromised host. Candida albicans is most common cause. Oral fluconazole for 14-21 days is the preferred treatment. Patients refractory to fluconazole may respond to voriconazole or posaconazole. Reference : Harrison's Principles of Internal Medicine 21 st ed, Ch: 323, Pg: 2432

Periportal necrosis, portal inflammation, bridging necrosis and interface hepatitis are features of active liver inflammation. Inflammatory conditions (e.g Wilson's disease) and drugs such as methyldopa and isoniazid can precipitate chronic active hepatitis. Autoimmune hepatitis is associated with antinuclear antibodies (70%), anti-smooth muscle (30%) and liver specific antibodies (ASGP-R asialoglycoprotein receptor; LKM liver kidney microsomal antibodies). Reference : Harrison's Principles of Internal Medicine, 21 st ed, Ch: 341, Pg: 2592

The given patient has hypoalbuminemia, hyper cholesterolemia, edema and pleural effusion. So the edema is attribute to hypoalbuminemia. Hypoalbuminemia can be due to either decreased albumin production as in CLD or excessive albumin loss through urine or gut. However here the cholesterol levels are high which is an indirect indicator of nephrotic syndrome. So the next investigation will be to confirm the urinary loss, which is 24 hour urine estimation. Followed by a renal biopsy, once proteinuria is confirmed. The classic features of nephrotic syndrome are: Proteinuria >3g/24 hours Hypoalbuminemia( Generalized Oedema Hypercholesterolemia Lipiduria Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 314, Pg: 2341.