Pathology EMQ.

Name: Sophie Madley

Theme: Liver and Biliary Disease

 

OPTION LIST

 

A

a1-antitrypsin deficiency

I

hepatic adenoma

B

autoimmune hepatitis

J

hepatocellular carcinoma

C

Budd-Chiari syndrome

K

hereditary haemochromatosis

D

cholangiocarcinoma

L

primary biliary cirrhosis

E

haemosiderosis

M

primary sclerosing cholangitis

F

hepatitis B

N

secondary biliary cirrhosis

G

hepatitis C

O

steatohepatitis

H

hepatoblastoma

P

Wilson’s disease

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 45 year old woman complains of fatigue and pruritus. She has also been experiencing some abdominal discomfort. On examination, xanthelasmas are found. Blood tests reveal elevated serum alkaline phosphatase and cholesterol. Antimitochondrial antibodies are present. 

 

 

2. A 32 year old woman presents very concened about a mass she has noticed in her right upper quadrant. She otherwise feels well, and takes no medication other than the oral contraceptive pill, which she has been taking for 8 years. Serum AST, ALT and AFP are within normal ranges. Following further investigation she is advised to discontinue the oral contracepive pill and avoid becoming pregnant.

 

 

3. A 38 year old woman with presents with rapidly developing abdominal pain and confusion. Hepatomegaly, ascites, peripheral oedema and a flapping tremor are found on examination. Blood tests revealed polycythemia, and on Doppler ultrasonography no flow was observed in the hepatic veins.

 

4. A 40 year old ex-IV drug user is feeling tired all the time and having difficulty concentrating. He has noticed his skin appearing slightly yellow in the past. Serum transaminases are elevated. Further investigation reveals infection with a single-stranded RNA virus.

 

 

5. A 67 year old woman with a history of ulcerative colitis and primary sclerosing cholangitis presents with jaundice, dark urine and itching. An ultrasound reveals biliary tree dilatation and no gallstones are found. An ERCP is performed and biliary brush cytology shows cellular discohesion and a high nuclear/cytoplasmic ratio.

 

 

 

ANSWERS

1. L

2. I

3. C

4. G

5. D