Q65: A 36-year-old engineer presents with pain in the upper right abdomen and epigastrium.
A 36-year-old engineer presents with pain in the upper right abdomen and epigastrium. The pain has been present for more than 6 months. Using a number rating scale (NRS 0-10) for abdominal pain the score is 6-8 with no association to food intake. Serum liver tests are normal apart from slightly elevated alkaline phosphatase. Physical examination discloses marked hepatomegaly. Ultrasound and subsequently a CT-scan demonstrate multiple benign cysts (from 2 to 6 cm in diameter) in the left liver lobe (segments 2 and 3) with only a single 1,5 cm cyst in the right liver lobe. Elastography of the right liver lobe is normal.
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Q65: A 36-year-old engineer presents with pain in the upper right abdomen and epigastrium.
A 36-year-old engineer presents with pain in the upper right abdomen and epigastrium. The pain has been present for more than 6 months. Using a number rating scale (NRS 0-10) for abdominal pain the score is 6-8 with no association to food intake. Serum liver tests are normal apart from slightly elevated alkaline phosphatase. Physical examination discloses marked hepatomegaly. Ultrasound and subsequently a CT-scan demonstrate multiple benign cysts (from 2 to 6 cm in diameter) in the left liver lobe (segments 2 and 3) with only a single 1,5 cm cyst in the right liver lobe. Elastography of the right liver lobe is normal.
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Q51: During a screening for unexplained symptoms of portal hypertension symptoms
During a screening for unexplained symptoms of portal hypertension symptoms in a 30-year-old man without known previous liver diseases, a Budd-Chiari syndrome (BCS) is diagnosed on a contrast-enhanced liver CT-scan.
Q51: During a screening for unexplained symptoms of portal hypertension symptoms
During a screening for unexplained symptoms of portal hypertension symptoms in a 30-year-old man without known previous liver diseases, a Budd-Chiari syndrome (BCS) is diagnosed on a contrast-enhanced liver CT-scan.
Q55: A 46-year-old man presents at the outpatient clinic with elevated serum liver tests observed since two years.
A 46-year-old man presents at the outpatient clinic with elevated serum liver tests observed since two years. Serum ALT, AST, and gamma-glutamyl transferase are mildly elevated whereas bilirubin and alkaline phosphatase are within the normal range. Hemoglobin and reticulocytes, leucocytes and platelets are within the normal range. Abdominal ultrasound reveals no relevant abnormalities. Transient elastography (6.3 kPA, IQR 1.3, success rate 100%) is within the normal range. Serum ferritin is 820 μg/L and transferrin saturation is 87%. HFE genotyping reveals homozygosity for pC282Y. Additional risk factors for liver cancer such as alcohol consumption, type 2 diabetes mellitus, and viral hepatitis have been excluded.
Q55: A 46-year-old man presents at the outpatient clinic with elevated serum liver tests observed since two years.
A 46-year-old man presents at the outpatient clinic with elevated serum liver tests observed since two years. Serum ALT, AST, and gamma-glutamyl transferase are mildly elevated whereas bilirubin and alkaline phosphatase are within the normal range. Hemoglobin and reticulocytes, leucocytes and platelets are within the normal range. Abdominal ultrasound reveals no relevant abnormalities. Transient elastography (6.3 kPA, IQR 1.3, success rate 100%) is within the normal range. Serum ferritin is 820 μg/L and transferrin saturation is 87%. HFE genotyping reveals homozygosity for pC282Y. Additional risk factors for liver cancer such as alcohol consumption, type 2 diabetes mellitus, and viral hepatitis have been excluded.
Q48: A 43-year-old man with an estimated regular alcohol intake of at least 50g per week
A 43-year-old man with an estimated regular alcohol intake of at least 50g per week has ALT 55 U/L (normal < 35 U/L), AST 47 U/L (< 35 U/L), Gamma-GT 124 U/L (< 55 U/L) and 186x109 platelets/L yielding a Fib-4-Score of 1.47 and has been referred for transient elastography. Here, his liver stiffness is 11.9 kPa suggesting advanced fibrosis.
Q48: A 43-year-old man with an estimated regular alcohol intake of at least 50g per week
A 43-year-old man with an estimated regular alcohol intake of at least 50g per week has ALT 55 U/L (normal < 35 U/L), AST 47 U/L (< 35 U/L), Gamma-GT 124 U/L (< 55 U/L) and 186x109 platelets/L yielding a Fib-4-Score of 1.47 and has been referred for transient elastography. Here, his liver stiffness is 11.9 kPa suggesting advanced fibrosis.
Q136: A 47-year-old woman with no history of liver disease
A 47-year-old woman with no history of liver disease presents with progressive abdominal pain, new-onset ascites, and elevated D-dimer. Doppler ultrasound reveals absent flow in all three hepatic veins, and CT confirms complete occlusion of the hepatic veins without IVC involvement. Laboratory studies: bilirubin 1.3 mg/dL, INR 1.1, platelets 390×10⁹/L. No encephalopathy. JAK2V617F mutation is positive. No focal liver lesions are seen. She is hemodynamically stable and has no contraindications to anticoagulation.
Q136: A 47-year-old woman with no history of liver disease
A 47-year-old woman with no history of liver disease presents with progressive abdominal pain, new-onset ascites, and elevated D-dimer. Doppler ultrasound reveals absent flow in all three hepatic veins, and CT confirms complete occlusion of the hepatic veins without IVC involvement. Laboratory studies: bilirubin 1.3 mg/dL, INR 1.1, platelets 390×10⁹/L. No encephalopathy. JAK2V617F mutation is positive. No focal liver lesions are seen. She is hemodynamically stable and has no contraindications to anticoagulation.
Q52: A 54-year-old man with primary sclerosing cholangitis stage 4 (biliary cirrhosis)
A 54-year-old man with primary sclerosing cholangitis stage 4 (biliary cirrhosis) is admitted to the hospital with a third episode of acute bacterial cholangitis within 1 year. He had previously undergone a MRCP that showed a high-grade stricture in the common bile duct.
Q52: A 54-year-old man with primary sclerosing cholangitis stage 4 (biliary cirrhosis)
A 54-year-old man with primary sclerosing cholangitis stage 4 (biliary cirrhosis) is admitted to the hospital with a third episode of acute bacterial cholangitis within 1 year. He had previously undergone a MRCP that showed a high-grade stricture in the common bile duct.
Q89: A 45-years-old female diagnosed with primary sclerosing cholangitis (PSC) and no history of liver cirrhosis or inflammatory bowel disease (IBD)
A 45-years-old female diagnosed with primary sclerosing cholangitis (PSC) and no history of liver cirrhosis or inflammatory bowel disease (IBD) presents at the hepatological outpatient clinic for her annual surveillance. At abdominal ultrasound a solid mass, approximately 2 cm in size, is located in the right liver lobe. The mass has mixed hypo- and hyper echogenicity, with dilated bile ducts peripheral to the mass. The CA 19-9 was 60 U/ml (Ref 0-37 U/ml). Given the suspicion for intrahepatic cholangiocarcinoma (iCCA), further investigations are necessary.
Q89: A 45-years-old female diagnosed with primary sclerosing cholangitis (PSC) and no history of liver cirrhosis or inflammatory bowel disease (IBD)
A 45-years-old female diagnosed with primary sclerosing cholangitis (PSC) and no history of liver cirrhosis or inflammatory bowel disease (IBD) presents at the hepatological outpatient clinic for her annual surveillance. At abdominal ultrasound a solid mass, approximately 2 cm in size, is located in the right liver lobe. The mass has mixed hypo- and hyper echogenicity, with dilated bile ducts peripheral to the mass. The CA 19-9 was 60 U/ml (Ref 0-37 U/ml). Given the suspicion for intrahepatic cholangiocarcinoma (iCCA), further investigations are necessary.
Q111: A 67-year-old woman with a history of MASLD-related cirrhosis presents to the emergency department
A 67-year-old woman with a history of MASLD-related cirrhosis presents to the emergency department with worsening confusion, abdominal distension, and fatigue. Her symptoms developed over the last five days. On examination, she is jaundiced and drowsy, and is diagnosed with hepatic encephalopathy grade III (West Haven Criteria). Laboratory findings are as follows: bilirubin 14 mg/dL (239 µmol/L), creatinine 2.5 mg/dL (221 µmol/L), INR 2.3, arterial lactate 5.2 mmol/L, sodium 126 mmol/L, polymorphonuclear leukocyte count in ascites: 700/mm³ (consistent with SBP). She was treated with intravenous antibiotics, lactulose, rifaximin and albumin infusion. Her CLIF-C ACLF score is 66, which corresponds to ACLF grade: 3 (liver, kidney, brain failure, coagulation impairment).
Q111: A 67-year-old woman with a history of MASLD-related cirrhosis presents to the emergency department
A 67-year-old woman with a history of MASLD-related cirrhosis presents to the emergency department with worsening confusion, abdominal distension, and fatigue. Her symptoms developed over the last five days. On examination, she is jaundiced and drowsy, and is diagnosed with hepatic encephalopathy grade III (West Haven Criteria). Laboratory findings are as follows: bilirubin 14 mg/dL (239 µmol/L), creatinine 2.5 mg/dL (221 µmol/L), INR 2.3, arterial lactate 5.2 mmol/L, sodium 126 mmol/L, polymorphonuclear leukocyte count in ascites: 700/mm³ (consistent with SBP). She was treated with intravenous antibiotics, lactulose, rifaximin and albumin infusion. Her CLIF-C ACLF score is 66, which corresponds to ACLF grade: 3 (liver, kidney, brain failure, coagulation impairment).
Q106: A 64-year-old male with a history of cirrhosis due to viral hepatitis C was successfully treated with DAAs
A 64-year-old male with a history of cirrhosis due to viral hepatitis C was successfully treated with DAAs. During surveillance a hypervascular tumour (largest diameter 3.5 cm) with wash-out in the portal phase was detected in the left lobe. At the liver tumour board meeting the multidisciplinary team evaluated the patient based on a multi-parametric composite assessment of liver function, portal hypertension, extent of hepatectomy, expected volume of the future liver remnant, performance status and patients’ co-morbidities. The tumour board suggested a liver resection of the involved segment. When informing the patient, he asks about the risk of morbidity and mortality.
Q106: A 64-year-old male with a history of cirrhosis due to viral hepatitis C was successfully treated with DAAs
A 64-year-old male with a history of cirrhosis due to viral hepatitis C was successfully treated with DAAs. During surveillance a hypervascular tumour (largest diameter 3.5 cm) with wash-out in the portal phase was detected in the left lobe. At the liver tumour board meeting the multidisciplinary team evaluated the patient based on a multi-parametric composite assessment of liver function, portal hypertension, extent of hepatectomy, expected volume of the future liver remnant, performance status and patients’ co-morbidities. The tumour board suggested a liver resection of the involved segment. When informing the patient, he asks about the risk of morbidity and mortality.
Q7: A 34-year-old woman presents to the emergency department with a 1 week history of fatigue, malaise, lethargy and jaundice.
A 34-year-old woman presents to the emergency department with a 1 week history of fatigue, malaise, lethargy and jaundice. Her initial examination shows she is disoriented and has asterixis in keeping with suspected hepatic encephalopathy. The lab tests show an AST of 15,070 IU/L, ALT 22,000 IU/L, INR 5.4, Bilirubin of 23 mg/dL (393 micromol/L).
Q7: A 34-year-old woman presents to the emergency department with a 1 week history of fatigue, malaise, lethargy and jaundice.
A 34-year-old woman presents to the emergency department with a 1 week history of fatigue, malaise, lethargy and jaundice. Her initial examination shows she is disoriented and has asterixis in keeping with suspected hepatic encephalopathy. The lab tests show an AST of 15,070 IU/L, ALT 22,000 IU/L, INR 5.4, Bilirubin of 23 mg/dL (393 micromol/L).
Q64: In which of the following cases of biopsy confirmed hepatocellular adenoma should a liver resection be considered without a period of further observation
In which of the following cases of biopsy confirmed hepatocellular adenoma should a liver resection be considered without a period of further observation?
Q64: In which of the following cases of biopsy confirmed hepatocellular adenoma should a liver resection be considered without a period of further observation
In which of the following cases of biopsy confirmed hepatocellular adenoma should a liver resection be considered without a period of further observation?
Q75: A portal vein thrombosis (PVT) is diagnosed in a 50 years-old man with polycythaemia vera
A portal vein thrombosis (PVT) is diagnosed in a 50 years-old man with polycythaemia vera. Serum liver tests are normal and a CT scan doesn’t show local factors to explain this thrombotic event. No portal hypertension symptoms are present.
Q75: A portal vein thrombosis (PVT) is diagnosed in a 50 years-old man with polycythaemia vera
A portal vein thrombosis (PVT) is diagnosed in a 50 years-old man with polycythaemia vera. Serum liver tests are normal and a CT scan doesn’t show local factors to explain this thrombotic event. No portal hypertension symptoms are present.