Hepatobiliary and Pancreatic Disorders Flashcards

A patient with hepatitis C cirrhosis undergoes surveillance ultrasound revealing a 2 cm hepatic lesion with arterial enhancement and washout on MRI. What is the most likely diagnosis?

Answer: Hepatocellular carcinoma (HCC)

Arterial enhancement followed by portal venous washout on contrast imaging is the hallmark radiologic pattern of hepatocellular carcinoma in a cirrhotic liver.

Which medication is first-line therapy for primary sclerosing cholangitis (PSC) to slow bile duct fibrosis?

Answer: No proven disease-modifying therapy currently exists

Unlike PBC, PSC has no proven disease-modifying medical therapy; management focuses on symptom control, surveillance, and liver transplant evaluation for end-stage disease.

A cirrhotic patient develops sudden onset fever, abdominal pain, and ascitic fluid with PMN count >250 cells/mm³. What is the diagnosis?

Answer: Spontaneous bacterial peritonitis (SBP)

Spontaneous bacterial peritonitis is defined by an ascitic fluid PMN count ≥250 cells/mm³ without an evident surgically treatable source, and is a life-threatening complication of cirrhosis.

Which scoring system is used to assess short-term mortality risk in acute variceal bleeding in cirrhotic patients?

Answer: MELD-Na Score

The MELD-Na (Model for End-Stage Liver Disease-Sodium) score is the primary tool used to predict 90-day mortality in cirrhotic patients and prioritizes liver transplant allocation.

A patient with chronic pancreatitis presents with foul-smelling, oily stools and significant weight loss. What is the underlying mechanism?

Answer: Exocrine pancreatic insufficiency causing fat malabsorption

Chronic pancreatitis destroys acinar cells, reducing pancreatic lipase secretion and causing fat malabsorption, which manifests as steatorrhea.

Which type of biliary stricture is most likely to develop after laparoscopic cholecystectomy?

Answer: Bismuth type I — low common bile duct stricture

Post-cholecystectomy bile duct injury most commonly occurs at the distal common bile duct, classified as Bismuth type I, due to clip misplacement or thermal injury during surgery.

A 45-year-old with acute liver failure has an INR of 3.8 and grade III encephalopathy. Which criterion must be met to qualify under King's College Criteria for emergency liver transplant listing?

Answer: PT > 100 seconds (INR > 6.5) OR any 3 of: age, etiology, bilirubin, time to encephalopathy

King's College Criteria for non-acetaminophen acute liver failure require PT > 100 seconds (INR > 6.5) or any combination of three adverse factors including unfavorable etiology, age extremes, jaundice-to-encephalopathy interval, and bilirubin > 17.5.