Test Your Hepatic Hubris

Which of the following is the most common cause of chronic liver disease in the United States?

A. Hepatitis C

B. Hepatitis B

C. Non-alcoholic fatty liver disease

D. Drug-induced liver disease

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Answer: C. Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) includes a spectrum of liver diseases from fatty liver disease to fibrosis and development of cirrhosis. NAFLD has become the most common liver disease in the United States with an estimated prevalence of 30%, exceeding that of viral hepatitis and drug-induced liver disease.

2.  Which of the following treatments for hepatitis B is most acceptable during pregnancy?

A. Interferon alfa

B. Lamivudine

C. Entecavir

D. Tenofovir

For answer and next question, please click below.Answer: D. Tenofovir

Of the medications above, only tenofovir is pregnancy category B and acceptable to use during pregnancy. Interferon alfa, lamivudine, and entecavir are category C medications.

A 44-year-old man presents for evaluation of dysphagia, to liquids and solids. An upper endoscopy with esophageal biopsies is unremarkable. He undergoes high resolution esophageal manometry which demonstrates 8/10 peristaltic swallows with an elevated integrated relaxation pressure. 

3. What is his diagnosis?A. Achalasia

B. Gastroesophageal junction (GEJ) outlet obstruction

C. Diffuse esophageal spasm

D. Nutcracker esophagus

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Answer: B. Gastroesophageal junction (GEJ) outlet obstruction

Normal esophageal peristalsis with impaired GEJ relaxation is consistent with GEJ outlet  obstruction. Achalasia consists of aperistalsis and impaired sphincter relaxation. It is possible that GEJ outlet obstruction represents an early variant of achalasia, however long-term data is necessary before that is determined. Diffuse esophageal spasm and nutcracker esophagus are also motility disorders characterized by simultaneous contractions and high amplitude contractions, respectively. In both these conditions, GEJ relaxation should not be impaired.