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IMF-048-01-0001-en	Why does the liver's dual blood supply expose it to toxins and microbial products, and what does each supply provide?	Portal blood carries nutrients, toxins, and microbial products to the liver, while arterial blood supplies oxygen.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0002-en	Why do raised aminotransferases not tell you how well the liver is functioning?	Alanine and aspartate aminotransferases rise with hepatocyte membrane injury, so they mark injury rather than directly measuring function.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0003-en	Why does prothrombin time reflect failing hepatic synthesis faster than albumin, and what alternative causes must be considered?	Prothrombin time changes rapidly when clotting-factor synthesis fails, whereas albumin reflects synthesis over weeks; vitamin K deficiency and anticoagulants also prolong prothrombin time.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0004-en	What do very high aminotransferases suggest, and why should their height not be used to predict outcome?	They suggest ischaemia, toxins such as paracetamol, or acute viral or immune hepatitis, but the degree of elevation does not reliably predict outcome.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0005-en	Why does conjugated hyperbilirubinaemia darken urine, and what do pale stool and pruritus add?	Conjugated bilirubin is water soluble and passes into urine; pale stool and pruritus suggest that less bile is reaching the intestine.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0006-en	How does the presence of pain and fever change the interpretation of jaundice?	Painful jaundice with fever may be ascending cholangitis, while painless progressive jaundice raises malignant obstruction.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0007-en	What distinguishes acute liver failure from decompensation of existing liver disease?	Acute liver failure is new hepatic injury with coagulopathy and encephalopathy in a person without established cirrhosis.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0008-en	In acute liver failure, why is glucose checked repeatedly and sedation avoided where possible?	Hypoglycaemia can follow hepatic failure, and sedation confuses assessment of encephalopathy, which is part of the diagnosis.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0009-en	How does N-acetylcysteine act in paracetamol toxicity, and is its use limited to paracetamol?	It replenishes glutathione in paracetamol toxicity and may also benefit selected non-paracetamol acute liver failure.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0010-en	How does the architecture of cirrhosis produce both portal hypertension and reduced function?	Cirrhosis reorganises the liver into regenerative nodules separated by scar, which increases intrahepatic resistance and reduces function.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0011-en	Why can cirrhosis go unrecognised, and how does decompensation reveal itself?	Compensated disease may be silent; decompensation appears as ascites, variceal bleeding, encephalopathy, jaundice, infection, or kidney dysfunction.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0012-en	In metabolic dysfunction-associated steatotic liver disease, what determines liver outcomes even when metabolic treatment helps?	Weight reduction and metabolic treatment can improve disease, but fibrosis stage predicts liver outcomes.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0013-en	Why can chronic hepatitis B cause liver cancer even without cirrhosis?	The virus can integrate into hepatocytes, so malignant change does not require prior cirrhosis.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0014-en	Why does a patient cured of hepatitis C with advanced fibrosis still need follow-up?	Direct-acting antivirals cure most hepatitis C, but advanced fibrosis persists and still requires surveillance and complication care.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0015-en	What are the components of managing acute variceal bleeding, and when is a transjugular intrahepatic portosystemic shunt considered?	Resuscitation avoiding excessive pressure, vasoactive splanchnic therapy, antibiotics, and endoscopic control; a shunt is considered if bleeding persists or high-risk criteria are met.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0016-en	Which mechanisms combine to produce ascites in portal hypertension?	Raised portal pressure, splanchnic vasodilation, renal sodium retention, and reduced effective arterial volume.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0017-en	Why is diagnostic paracentesis required for new, worsening, or hospitalised ascites even without abdominal tenderness?	Spontaneous bacterial peritonitis may present only with fever, encephalopathy, or kidney injury and little local tenderness, and sampling also identifies alternative mechanisms.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0018-en	How does lactulose treat hepatic encephalopathy, and why is an ammonia level alone insufficient for diagnosis?	Lactulose promotes colonic ammonia disposal and is titrated to regular soft stool; an ammonia concentration by itself neither confirms nor excludes the syndrome.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0019-en	What circulatory disturbance underlies hepatorenal syndrome, and what can treatment achieve?	Profound renal vasoconstriction amid systemic and splanchnic vasodilation; albumin plus vasoconstrictor therapy can bridge selected patients to transplantation.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0020-en	What is hepatocellular carcinoma surveillance trying to achieve, and what is the limit of alpha-fetoprotein?	It aims to find tumours still suitable for ablation, resection, or transplantation; alpha-fetoprotein supports surveillance or assessment but is not independently diagnostic.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0021-en	What distinguishes episodic biliary pain from acute cholecystitis?	Biliary pain comes from transient cystic-duct obstruction without persistent inflammation; cholecystitis causes prolonged pain, fever, local tenderness, and inflammatory change.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0022-en	Why does cholangitis need urgent biliary drainage, and what are the risks of the usual procedure?	It is infected obstruction, so urgent drainage, usually by endoscopic retrograde cholangiopancreatography, accompanies fluids and antibiotics; the procedure can cause pancreatitis, bleeding, perforation, or infection.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0023-en	Why is enzyme height not used to grade acute pancreatitis, and why are routine prophylactic antibiotics not given?	Severity depends on persistent organ failure and complications rather than enzyme height, and routine prophylactic antibiotics do not treat sterile necrosis.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending
IMF-048-01-0024-en	How do the consequences of chronic pancreatitis shape its management?	Irreversible fibrosis causes exocrine failure, diabetes, and pain, so management includes enzyme replacement with meals, fat-soluble vitamin review, diabetes care, and analgesia.	Integrated Medical Foundations; chapter 48, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: ed13b8f0b9081eb71864bc32f5dcc5ef87b6d1dba723fdb0eacde59735fa2efd; editorial review pending	imf lang::en chapter::048 module::048-01 review::pending