The answer is c Seidel 4e pp 532533 Normal liver span is 612 cm in the MCL and 48 cm in the midsternal line MSL Micro

nodular cirrhosis is typically uniform throughout the liver and the nodules are <3 mm in size. It is due to a metabolic insult such as alcohol use. The nodules of macronodular cirrhosis, which are less uniform, are >3 mm in size and are due to drugs or infection.

204. The answer is c. (Fauci, 14/e, pp 1626-1629. Sapira, p 273.) Diabetic patients, especially those with poor control, may develop delayed gastric emptying (autonomic dysfunction). Often patients will have a succussion splash (a splash is heard with the stethoscope when shaking the patient due to air-fluid level). Diagnosis is made by a gastric emptying study. Patients with celiac sprue (also called gluten-sensitive enteropathy) present with bloating, diarrhea, and excessive flatus. They typically have signs of malabsorption, such as hypoalbuminemia, iron-deficiency anemia, hypocholesterolemia, and decreased carotene level. The diagnosis is made by small bowel biopsy and the treatment is a wheat-free diet. Whipple's disease is a multisystemic disorder characterized by arthralgias, abdominal pain, fever, weight loss, lymphadenopathy, heart disease, and neurologic disease. Finding periodic acid-Schiff (PAS) positive-staining foamy macrophages in tissues makes the diagnosis, and treatment for this previously fatal disease is antibiotics (for Tropheryma whippelii). Tropical sprue often responds to antibiotics and may occur months or even years after a patient returns from the tropics.

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