WBR0623

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 42 year old male, comes to the office for routine physical examination. He has mild constipation for the past 2months and feels pain during his act of defecation. His past history is insignificant and his family history is unremarkable. He smokes a pack of cigarettes a day, but denies any illicit drug use. Recently he says his work is very stressful and started consuming alcohol daily. He is really concerned about his alcohol habit as one of his friends died of liver disease and he wants you to check for any initiation of liver damage in him. Which of the following would be the best initial test to assess alcoholic liver damage in this patient?]]
Answer A	AnswerA::Serum albumin
Answer A Explanation	[[AnswerAExp::Incorrect : Serum albumin is also indicator of liver function and only patients with moderate to severe alcoholic hepatitis have typically abnormal albumin levels.]]
Answer B	AnswerB::Serum bilirubin
Answer B Explanation	[[AnswerBExp::Incorrect : Serum bilirubin can be elevated in both hepatic and cholestatic causes and does not help in differentiating alcoholic liver disease. If direct bilirubin is elevated, then the liver is conjugating bilirubin normally, but is not able to excrete it. Bile duct obstruction by gallstones or cancer should be suspected in such cases.]]
Answer C	AnswerC::Serum transaminases
Answer C Explanation	[[AnswerCExp::Correct : The most common pattern of liver biochemical test abnormalities is a disproportionate elevation of serum AST compared with ALT.]]
Answer D	AnswerD::Prothrombin time
Answer D Explanation	[[AnswerDExp::Incorrect : Prothrombin time is an indicator of liver function and only patients with moderate to severe alcoholic hepatitis typically have an elevated INR due to impaired production of coagulation factors by the inflamed liver, that occurs late in the disease.]]
Answer E	AnswerE::Partial prothrombin time
Answer E Explanation	[[AnswerEExp::Incorrect : Partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance indicator measuring the efficacy of both the intrinsic and the common coagulation pathways. Patients with moderate to severe alcoholic hepatitis, i.e later stages of the disease have these abnormal values.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Excessive alcohol consumption is associated with a range of hepatic manifestations, including alcoholic fatty liver disease (with or without steatohepatitis), alcoholic hepatitis, and cirrhosis. Patients with alcoholic hepatitis typically have a history of daily heavy alcohol use (>100 g/day) for more than 20 years and in some cases, patients will have recently increased their alcohol intake in response to stressful life events. The serum AST and ALT are typically less than 300 IU/L and are rarely higher than 500 IU/L. The most common pattern of liver biochemical test abnormalities is a disproportionate elevation of serum AST compared with ALT. This ratio is usually two or greater in alcoholic hepatitis, a value that is rarely seen in other forms of liver disease. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Alcoholic liver disease
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::