-
Question 1
Correct
-
A 63-year-old man presents with painless jaundice and weight loss over the last few months. He is a heavy smoker and has a past medical history of COPD. On examination his abdomen is soft and non tender and he is clearly icteric.
His bloods reveal deranged LFTs with an alkaline phosphates of 240 and a bilirubin of 92, ALT and AST are both around 200. An ultrasound of his abdomen is performed and shows both intra and extrahepatic bowel duct dilatation within the liver.
What's the first line investigation of his case?Your Answer: MRCP
Explanation:When you hear painless jaundice and weight loss in the same sentence, the first thing you should think is cancer. Likely cholangiocarcinoma here or some other biliary tract obstructing cancer. The first line imaging for this would be MRCP because you’re looking for obstruction– the dilatation of the intra and extrahepatic ducts suggests this. This is less invasive than an ERCP or a liver biopsy. CT C/A/P will likely be needed for staging later but it is asking for the initial test.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 2
Correct
-
With respect to liver cirrhosis, which of the following statements is correct?
Your Answer: The final common pathway of hepatic fibrosis is mediated by the hepatic stellate cell
Explanation:The development of hepatic fibrosis reflects an alteration in the normally balanced processes of extracellular matrix production and degradation. [6] The extracellular matrix, the normal scaffolding for hepatocytes, is composed of collagens (especially types I, III, and V), glycoproteins, and proteoglycans. Increased collagen in the space of Disse (space b/w sinusoids and hepatocytes) leads to capillarization of sinusoids, and stellate cells also have contractile properties when activated. This is fibrosis processes. This can lead to the development of portal hypertension.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 3
Incorrect
-
A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure is recorded. This pressure is reflective of which part of the hepatic vascular system?
Your Answer: Portal vein
Correct Answer: Sinusoids
Explanation:The wedged hepatic venous pressure is a reflection of the portal venous pressure in the hepatic sinusoids. This is a fact to remember. Here is a great but concise explanation as to why: https://www.ncbi.nlm.nih.gov/pubmed/18695309
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 4
Correct
-
A 54-year-old plumber presents with general deterioration. He drinks approximately 25 units of alcohol each week and is a smoker of five cigarettes daily. Examination reveals that he is jaundiced, has numerous spider naevi on his chest and he has a temperature of 37.2°C. Abdominal examination reveals hepatosplenomegaly.
Investigations reveal:
Bilirubin 100 micromol/L (1-22)
Alkaline phosphatase 310 iu/l (45 - 105)
ALT 198 iu/l (5 - 35)
AST 158 iu/l (1 - 31)
Albumin 25 g/L (37 - 49)
Hepatitis B virus surface antigen positive
Hepatitis B virus e antigen negative
Hepatitis B virus DNA awaited
What is the most likely diagnosis?Your Answer: Chronic hepatitis B infection
Explanation:The clinical scenario describes a man in liver failure. Given the serological results, he is most likely to have a chronic hepatitis B infection. In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have +HBsAg, +anti-HBc, +IgM anti-HBc, and negative anti-HBs. in immunity due to natural infection, you have negative HBsAg, +anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. While he could have a superimposed hepatitis D infection on top of hepatitis B, there is no mention of hepatitis D serology, make this an incorrect answer. The other choices do not involve hepatitis serologies.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 5
Incorrect
-
A 55-year-old man develops central abdominal pain a few hours after having an Endoscopic Retrograde Cholangiopancreatography (ERCP) performed. Investigations reveal the following:
Amylase 545 u/dl
Erect chest x-ray Normal heart and lungs. No free air noted
What is the most appropriate management?Your Answer: Intravenous ciprofloxacin + analgesia
Correct Answer: Intravenous fluids + analgesia
Explanation:A very common complication after ERCP is post-ERCP pancreatitis, which based on the clinical scenario , this man has. The treatment for this is pain control, lots of intravenous fluids, and traditionally bowel rest, although more recent evidence suggests early feeding is better.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 6
Incorrect
-
A 40-year-old male is awaiting a liver biopsy. Which of the following is the most important investigation that has to be performed prior to the procedure?
Your Answer: Abdominal US
Correct Answer: Coagulation profile
Explanation:As the liver is highly vascular, there is a high risk of bleeding during and after the procedure. Patients may have existing liver diseases, which affect the production of clotting factors. So a coagulation profile is necessary to detect any abnormality and correct them prior to the liver biopsy.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 7
Correct
-
A 54-year-old female presents with fatigue and xerostomia. Bloods tests reveal the following:
Hb 13.9 g/dl
WBC 6.1 *109/l
Platelets 246 *109/l
Bilirubin 33 µmol/l
ALP 292 u/l
ALT 47 u/l
What is the most likely diagnosis?Your Answer: Primary biliary cirrhosis
Explanation:With a bilirubin of 33, automatically the diagnosis from the choices listed is primary biliary cirrhosis or autoimmune hepatitis, not SLE, mono, or Primary Sjogren’s Syndrome. With autoimmune hepatitis, however, you would not expect such a high bilirubin and would expect very high AST/ALT, which here is just mildly elevated. This makes primary biliary cirrhosis the most likely answer. The classic presentation is itching in a middle-aged woman. The dry mouth is likely due to Sicca Syndrome, which occurs in 70% of cases of PBC, but with these liver function tests, PBC is most the likely answer.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 8
Correct
-
A 42-year-old man with alcoholic liver disease is admitted with pyrexia. He has been unwell for the past three days and has multiple previous admissions before with variceal bleeding. Examination shows multiple stigmata of chronic liver disease, ascites and jaundice.
Paracentesis is performed with the following results: Neutrophils 487 cells/ul
What is the most appropriate treatment?Your Answer: Intravenous cefotaxime
Explanation:This describes a clinical scenario of spontaneous bacterial peritonitis. The diagnosis is made when fluid removed (ascites) is found to have > 250/mm cubed of PMNs (polymorphonuclear leukocytes). Cefotaxime or another third generation cephalosporin is the treatment of choice.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 9
Correct
-
A 21-year-old student presents with yellowish discolouration of her sclera. She says she has had severe headaches over the last few weeks for which she has been taking paracetamol. What is the most likely cause of her jaundice?
Your Answer: Gilbert's syndrome
Explanation:Gilbert’s syndrome is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish colour of the skin or whites of the eyes may occur. Other possible symptoms include feeling tired, weakness, and abdominal pain.
The enzymes that are defective in Gilberts – UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) – are also responsible for some of the liver’s ability to detoxify certain drugs. While paracetamol (acetaminophen) is not metabolized by UGT1A1,[10] it is metabolized by one of the other enzymes also deficient in some people with Gilberts. Therefore a subset of people with Gilberts may have an increased risk of paracetamol toxicity. -
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 10
Incorrect
-
An 82-year-old woman is brought in by her carer with fluctuating consciousness. On examination she is deeply jaundiced, hypotensive with a tachycardia and has a hepatic flap. Initial blood tests reveal an ALT of 1000 U/l, INR 3.4, ALP 600 U/l and a bilirubin of 250 mmol/l.
Repeat blood tests 6 hours later show an ALT of 550 U/l, INR 4.6, ALP 702 U/l and bilirubin of 245 m mol/l. The toxicology screen for paracetamol and aspirin is negative; she is positive for hepatitis B surface antibody and negative for hepatitis B surface antigen.
Which of the following would best explain her clinical condition?Your Answer: Acute liver failure secondary to alcohol
Correct Answer: Acute liver failure secondary to paracetamol
Explanation:Liver flap is pathognomonic for liver failure. Paracetamol (also known as acetaminophen) overdose usually presents with symptoms including liver failure, resulting in confusion, jaundice, and coagulopathy a few days after overdose. The first 24 hours, people usually have minimal symptoms. Diagnosis is based on blood levels of acetaminophen at specific times after it was taken (see reference). If she took it a few days ago, levels may indeed be undetectable. The hepatitis B serology suggests prior vaccination. Wilson’s disease is not the most likely diagnosis given her presentation. The AST:ALT ratio would be expected to be reversed in alcohol induced liver failure.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 11
Incorrect
-
A 40-year-old female presented with fever, jaundice, and pain in the middle and upper abdomen. Her stools are clay-coloured. Which of the following should be done now?
Your Answer:
Correct Answer: Endoscopic retrograde cholangio pancreatography (ERCP)
Explanation:ERCP is necessary to look for any obstruction or compression of the extra-hepatic bile duct. The clay-coloured stools are a result of impaired bilirubin movement into the duodenum.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 12
Incorrect
-
A 45-year-old man who had a liver transplant just over 3 months ago, now has primary sclerosing cholangitis. He complains of fever, abdominal pain and diarrhoea, which has come on over the last week. He has a platelet count of 60 x 109/L and alanine transaminase (ALT) of 300 U/L with a normal bilirubin.
He is taking tacrolimus and prednisolone for immunosuppression, and tells you that he recently stopped taking valganciclovir.
What is the most likely diagnosis?Your Answer:
Correct Answer: Donor-acquired cytomegalovirus
Explanation:The fact that he has recently stopped taking his valganciclovir, anti-viral, is key to the answer to this question. This makes the answer quite plainly donor-acquired CMV infection over all of the other answer choices. He needs to stay on prophylaxis against this, particularly in the first 3 months after transplant. Symptoms and presentations of CMV infection can include fever, abdominal pain, diarrhoea, pneumonitis, hepatitis, hematologic abnormalities, retinitis, and esophagitis.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 13
Incorrect
-
A 56-year-old woman has a family history of haemochromatosis and is homozygous for the C282Y mutation. Her ferritin is 927 mg/L (normal range 15-150), haemoglobin 12.5 g/dL (normal range 11.5-16) and aspartate aminotransferase 87 U/L (normal range <40).
Which is the best course of action?Your Answer:
Correct Answer: Weekly venesection to drop her ferritin into the low-normal range
Explanation:Venesection should be done (essentially blood-letting) to decrease the too-high ferratin level. IV Desterrioxamine would have the opposite effect. ASA does not have to do with ferritin. You do not just watch this and recheck. And you do not want to make the patient anaemic.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 14
Incorrect
-
A 36-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine.
Given her presentation, what is the best investigation to diagnose the most likely underlying condition?Your Answer:
Correct Answer: ERCP (endoscopic retrograde cholangiopancreatography)
Explanation:With biliary obstructive symptoms in a patient with ulcerative colitis, one should immediately think of primary sclerosing cholangitis (PSC). PSC is characterized by inflammation and fibrosis of the intrahepatic and extrahepatic ducts. The best diagnostic test for PSC is ERCP. ANCA antibiotics may be positive, but not the best test to DIAGNOSE THE CONDITION. The same can be said of serum transaminase levels– they will be abnormal but nonspecific. While a liver ultrasound may be helpful, it is not the best test. Liver biopsy would be used to stage the PSC later.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 15
Incorrect
-
Which one of the following is not associated with non-alcoholic steatohepatitis?
Your Answer:
Correct Answer: Type 1 diabetes mellitus
Explanation:There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
Non-alcoholic steatohepatitis (NASH)
NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world. -
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 16
Incorrect
-
A 30-year-old female presents with an infected skin ulcer. She is prescribed flucloxacillin and later develops jaundice, pale stools, and dark-coloured urine. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Cholestatic jaundice
Explanation:Due to its cholestatic properties, Flucloxacillin can block bile flow through the liver, leading to the accumulation of bilirubin in the blood, giving rise to jaundice. Dark urine is the result of excessive bilirubin in the blood being filtered by the kidney. Pale stools is an effect of the blocked bile flow through the liver.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 17
Incorrect
-
A woman presents with pallor and jaundice. History reveals she has been taking medication to treat her acne. Which of the following medication has she been taking?
Your Answer:
Correct Answer: Erythromycin
Explanation:Oral erythromycin is used to treat acne, and has been known to cause various degrees of hepatotoxicity in many patients. It is believed to cause liver lesions leading to hampered bile formation and cholestasis. This presents as jaundice due to the increased movement of bile into the blood instead of into the duodenum. All the other drugs mentioned here are not known to cause such hepatotoxicity.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 18
Incorrect
-
A 57-year-old school teacher is found to have abnormal liver function tests at a health screening. Other than tiredness and occasional gritty eyes that she attributes to age, she is well. She is postmenopausal and takes hormone replacement therapy (HRT) but no other medication. She smokes 12 cigarettes per day but takes no alcohol. There is nothing to find on examination.
Some of her blood results are shown below:
Albumin 40 g/l (37-49)
Alanine aminotransferase(ALT) 14 U/l (5-35)
Alkaline Phosphatase 300 U/l (45-105)
AMA positive >1:40
Anti-dsDNA weakly positive
Bilirubin 12 μmol/l (1-22)
High-density lipoprotein (HDL) cholesterol 4.0 mmol/l (>1.55)
Liver-kidney microsomal antibody (anti-LKM) negative
Liver transaminase (AST) 10 U/l (1-31)
Low-density lipoprotein (LDL) cholesterol 4.0 mmol/l (<3.36)
Plasma thromboplastin (PT) 12 s (11.5-15.5)
Smooth muscle antibody (SMA) negative
Which of the following would be an appropriate next step?Your Answer:
Correct Answer: Ursodeoxycholic acid
Explanation:The patient is AMA+ and weakly + for anti-dsDNA, suggesting an autoimmune process. She also has gritty eyes, which makes you think Sjogren’s syndrome. She has an elevated ALP and normal AST/ ALT. All of these factors, in addition to her middle age and the fact that she is a woman, make the diagnosis of primary biliary cirrhosis (PBC) most likely. It is associated with conditions (autoimmune) such as Sjogren’s syndrome. The treatment for this disease initially is ursodeoxycholic acid. Liver transplantation is the definitive treatment for end-stage disease.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 19
Incorrect
-
Which one of the following statements regarding hepatocellular carcinoma is correct?
Your Answer:
Correct Answer: Diabetes mellitus is a risk factor
Explanation:Diabetes is a risk factor for hepatocellular carcinoma. Screening has been shown to be effective. Bevacizumab is not used for advanced cases. The incidence is higher in men. Alcohol is not the most common underlying cause worldwide; this is from cirrhosis from diseases like hepatitis B and C.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 20
Incorrect
-
A 54-year-old woman, with a long history of inflammatory bowel disease presents to his GP with abnormal liver function tests. She has a raised alkaline phosphatase level but no symptoms of liver disease.
Which of the following options is the best set of investigations to confirm the diagnosis?Your Answer:
Correct Answer: MRCP and liver biopsy
Explanation:In a patient with abnormal LFTs and UC, think primary sclerosing cholangitis (PSC). MRCP and liver biopsy is the best answer. MRCP will show classically beads on a string – intra and extrahepatic stricturing and dilation. Remember this finding!! Liver biopsy is required for official diagnosis (need tissue!).
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 21
Incorrect
-
A 34-year-old HIV positive man is referred to gastroenterology due to jaundiced sclera. Liver function tests are as follows:
Albumin 34 g/l
ALP 540 iu/l
Bilirubin 67 µmol/l
ALT 45 iu/l
What is the most likely diagnosis?Your Answer:
Correct Answer: Sclerosing cholangitis
Explanation:HIV can cause strictures in the biliary tract (see source for details of the disease). This makes the diagnosis of primary sclerosing cholangitis most likely given the clinical presentation and lab values. Due to its association with HIV this is more likely than all of the other answer choices. Know this association.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 22
Incorrect
-
A 6 week old female patient was brought by her mother to the emergency department with icterus. Although she's had a good appetite, and breast-feeding well, she hasn't gained any weight. Her mother noticed that her stools are pale while her urine is noticeably dark. What is the most probable diagnosis?
Your Answer:
Correct Answer: Biliary atresia
Explanation:Biliary atresia is a rare condition that usually becomes symptomatic 2 to 8 weeks after birth. It can be congenital or acquired. Typical symptoms include jaundice, weight loss, dark urine and pale stools.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 23
Incorrect
-
A 53-year-old man is brought into the emergency department by the paramedics. He collapsed at home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain.
Given this man's presentation, what is the most likely cause of his impaired liver function tests?Your Answer:
Correct Answer: Ischaemic hepatitis
Explanation:When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 24
Incorrect
-
A 45-year-old man was referred for abnormal liver biochemistry. Investigations showed he had an ALT of 98 U/l and was Hep B surface antigen positive.
Which of the following is true of chronic active hepatitis due to the hepatitis B virus?Your Answer:
Correct Answer: It carries an increased risk of subsequent hepatocellular carcinoma
Explanation:Chronic hepatitis B patients have an increased risk of hepatocellular carcinoma. In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have+HBsAg, + anti-HBc, + IgM anti-HBc, and negative anti-HBs. In immunity due to natural infection, you have negative HBsAg, +anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. It is important to remember these serologies, it will get you a lot of points on the test.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 25
Incorrect
-
A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is 214 mmol/L, alanine transaminase (ALT) 62 U/L, alkaline phosphatase (ALP) 605 U/L, albumin 34 g/L and prothrombin time 17 seconds. Ultrasound of the abdomen shows a grossly dilated biliary tree and a dilated pancreatic duct, but no mass is seen.
What is the next most appropriate step in her management?Your Answer:
Correct Answer: Abdominal CT scan
Explanation:This scenario is suggestive of a pancreatic head mass with obstructive jaundice and US showing a ‘double duct’ sign. A CT Scan would be recommended to evaluate for a pancreatic head mass. If a mass was found, the next step would then be to do an ERCP with EUS to obtain a biopsy of the mass for tissue diagnosis. Laparoscopy would not be recommended. CA19-9 would not be diagnostic.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 26
Incorrect
-
A 44-year-old obese woman presented with severe abdominal pain in her right hypochondrium. An US abdomen was done which showed the presence of gallstones. The next step in management would be?
Your Answer:
Correct Answer: Laparoscopic Cholecystectomy
Explanation:With patients who are obese and have gallstones, the best procedure to be done is a laparoscopic cholecystectomy. Reassurance and low fat diets would not have much affect because these symptoms would recur if a cholecystectomy is not done.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 27
Incorrect
-
A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer:
Correct Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 28
Incorrect
-
A 55-year-old obese woman presents to casualty. She has rigors and reports a fever. On examination there is jaundice and tenderness over the right upper quadrant of her abdomen.
She has an elevated white blood cell count and a markedly raised alkaline phosphatase level; transaminases and bilirubin are also abnormal.
Which of these diagnoses best fits the clinical picture?Your Answer:
Correct Answer: Ascending cholangitis
Explanation:This question describes Charcot’s triad– fever, RUQ pain, and jaundice, which is seen in ascending cholangitis. Reynold’s pentad is a worsened version of this, where you have RUQ pain, fever, jaundice, hypotension, and altered mental status. Risk factors for gallstones are the 4F’s- female, fat, forty, and fertile. You would not have the elevated bilirubin, ALP, transaminases with a kidney stone or in peptic ulcer disease. Hepatitis would not cause elevation of bilirubin.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 29
Incorrect
-
A 32-year-old man, originally from Pakistan, was admitted with ascites and weight loss. The protein level on ascitic tap was 9 g/l.
Which of the following is the most likely cause of this presentation?Your Answer:
Correct Answer: Hepatic cirrhosis
Explanation:This is a low protein level, indicating the fluid is transudative. The only answer choice that is a transudative fluid is in hepatic cirrhosis. Exudative fluid would be seen in tuberculous peritonitis, peritoneal lymphoma, with liver mets, and with intra-abdominal malignancy.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 30
Incorrect
-
A 57-year-old, alcoholic male was admitted to the medical ward for an ascitic tap. The ascitic fluid was found to be yellow in colour. Which of the following had most likely lead to this observation?
Your Answer:
Correct Answer: Decompensated cirrhosis
Explanation:Uncomplicated cirrhotic ascites is usually translucent. If the patient is deeply jaundiced, the fluid might appear yellow/brown.
Turbidity or cloudiness of the ascites fluid suggests that infection is present and further diagnostic testing should be performed.
Pink or bloody fluid is most often caused by mild trauma, with subcutaneous blood contaminating the sample.
Bloody ascites is also associated with hepatocellular carcinoma or any malignancy-associated ascites.
Milky-appearing fluid usually has an elevated triglyceride concentration. Such fluid, commonly referred to as chylous ascites, can be related to thoracic duct injury or obstruction or lymphoma, but it is often related primarily to cirrhosis. -
This question is part of the following fields:
- Hepatobiliary System
-
SESSION STATS - PERFORMANCE PER SPECIALTY
