GI Liver, Biliary, and Pancreatic Disorders 2 — Questions and Answers
Question 1: Portal hypertension leads to esophageal varices primarily through which mechanism?
- Increased lymphatic pressure causing vessel dilation
- Development of portosystemic collateral vessels to decompress elevated portal pressure (Correct answer)
- Direct erosion of the esophageal mucosa by bile acids
- Splenomegaly compressing the esophagus
Correct answer: Development of portosystemic collateral vessels to decompress elevated portal pressure
When portal pressure rises, blood is shunted through portosystemic collaterals, including submucosal esophageal veins, forming varices.
Question 2: What is the recommended first-line treatment for acute esophageal variceal bleeding?
- Emergency surgical portosystemic shunt
- Endoscopic band ligation combined with IV octreotide (Correct answer)
- Balloon tamponade with a Sengstaken-Blakemore tube alone
- TIPS procedure as primary intervention
Correct answer: Endoscopic band ligation combined with IV octreotide
Endoscopic band ligation with concurrent IV octreotide (to reduce splanchnic blood flow) is the standard first-line treatment for acute variceal hemorrhage.
Question 3: Courvoisier's sign — painless jaundice with a palpable, non-tender gallbladder — is classically associated with which condition?
- Choledocholithiasis
- Carcinoma of the head of the pancreas (Correct answer)
- Primary sclerosing cholangitis
- Acute cholecystitis
Correct answer: Carcinoma of the head of the pancreas
Pancreatic head carcinoma obstructs the common bile duct gradually, allowing the gallbladder to distend painlessly; stones cause chronic fibrosis and a non-distensible gallbladder.
Question 4: Which scoring system is used at 48 hours to predict severity and mortality in acute pancreatitis?
- APACHE II score only
- Ranson's criteria (Correct answer)
- Glasgow-Blatchford score
- BISAP score only
Correct answer: Ranson's criteria
Ranson's criteria evaluate 11 parameters (5 at admission, 6 at 48 hours); a score ≥3 indicates severe disease with significantly increased morbidity and mortality.
Question 5: Which hepatitis virus is transmitted via the fecal-oral route and never causes chronic infection?
- Hepatitis B
- Hepatitis C
- Hepatitis A (Correct answer)
- Hepatitis D
Correct answer: Hepatitis A
Hepatitis A is transmitted fecal-orally, causes self-limited acute illness, and does not establish chronic infection or a carrier state.
Question 6: What is currently the most common cause of chronic liver disease in the United States?
- Hepatitis B
- Alcoholic liver disease
- Non-alcoholic fatty liver disease (NAFLD) (Correct answer)
- Hepatitis C
Correct answer: Non-alcoholic fatty liver disease (NAFLD)
NAFLD, strongly linked to obesity, insulin resistance, and metabolic syndrome, has surpassed other etiologies to become the most prevalent chronic liver disease in the US.
Question 7: Wilson's disease results from the toxic accumulation of which trace metal due to an ATP7B gene mutation?
- Iron
- Copper (Correct answer)
- Manganese
- Zinc
Correct answer: Copper
ATP7B encodes a copper-transporting ATPase; its dysfunction prevents biliary copper excretion, leading to copper deposition in the liver, brain, and cornea (Kayser-Fleischer rings).
GI Liver, Biliary, and Pancreatic Disorders 2
Portal hypertension leads to esophageal varices primarily through which mechanism?