Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
            atty liver ,hepatitis ,cirrhosis
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 Signs and symptoms of liver disease  
may include
• Skin and eyes that appear yellowish (jaundice)
• Abdominal pain and swelling.
• Swelling in the legs and ankles.
• Itchy skin.
• Dark urine color.
• Pale stool color.
• Chronic fatigue.
• Nausea or vomiting.
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Signs of CLD
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Jaundice
Usually detected clinically when plasma bilirubin
exceeds 2.5mg/dl;
Jaundice of 3 types;
1-pre-hepatic,
2-hepatic
3-post-hepatic.
                         
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• Pre-hepatic jaundice , Caused either by  haemolysis or 
congenital hyperbilirubinaemia. characterized by 
isolated rise of
• bilirubin, of 2 types:
• 1.Haemolytic:destruction of RBCs cause increase of 
bilirubin production, usually mild because  the Liver is 
normal & can excrete bilirubin load 6 times of the 
normal before it accumulate  in plasma.
• 2.Non-haemolytic: commonest is Gilbert’s syndrome, 
is inherited disorder of bilirubin  metabolism.
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Hepato-cellular jaundice(Hepatic)
Results from inability of liver to transport 
bilirubin into bile. usually associated with high 
liver enzymes. acute case occurs in viral 
hepatitis, drugs, vascular lesion. chronic case 
occurs in liver cirrhosis.
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Causes of cholestatic jaundice
1.Intrahepatic:
-Primary billiary cholangitis. 
-Primary sclerosing cholangitis.    
-Pregnancy.
-inherited cholestatic liver disease.
-Drugs.        
-Hepatic infiltrates (tumors, granuloma).
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Causes of cholestatic jaundice
2.Extrahepatic:
-Cancer of; ampulla of vater, pancreas, bile duct, 
liver metastasis.
-Parasitic infection.
-Traumatic billiary obstruction.
-Chronic pancreatitis,
-Bile duct stone.
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Hepatitis A ( HAV )
RNA virus is highly infectious, spread by fecal-oral
    route, excreted for 3w before symptoms & for 2w after.
    common in areas of poor sanitation.
Common in children often asymptomatic, or
   mild or atypical in presentation.
Resolve spontaneously without chronicity .
Investigation/Serological test ( IgG/IgM ), liver test.
Management/conservative , no antiviral. 
Prevention by improving sanitation ,vaccination for
   travelers to endemic areas .immunoglobulin after  
   exposure to infection.
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Hepatitis B ( HBV )
DNA virus,1/3rd of world exposed to infection
400m with chronic infection , the most common
Cause of CLD, cirrhosis, HCC.
Acute infection may be asymptomatic & resolve
Spontaneously in 90% of cases,10% progress to
chronicity with subsequent liver cirrhosis & its
Complications & cancer (HCC).
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Hepatitis B
Route of transmission is blood borne , either:
-Horizontal: in 10% of cases by ;drug injection,
  infected unscreened blood products , ta

            Quiz: