18-1

Question 1

What may be the first/only sign of liver disease?

Answer 1

Laboratory abnormalities

Question 2

Hepatocellular lab changes?

Answer 2

Increased ALT/AST and LDH

Question 3

Cholestasis lab changes?

Answer 3

Increased Bilirubin, Alkaline Phosphatase and GGT

Question 4

Hepatocyte Synthetic Function lab changes?

Answer 4

Decreased Coagulation factors and Albumin

Increased Ammonia

Question 5

Albumin changes are likely associated with _____ liver disease

Answer 5

Chronic liver disease

Question 6

Coagulation factors, specifically factor ____ due to its short half life are likely associated with ______ liver disease

Answer 6

Factor VII (PT)
Acute liver disease

Question 7

What is the blood supply to the liver?

Answer 7

Portal vein

Hepatic artery

Question 8

What 3 things make up the porta hepatis?

Answer 8

Bile ducts
Portal vein
Hepatic artery

Question 9

The lobules of the liver can be divided into zones. Which zone is the most likely to suffer from hypoxia?

Answer 9

Zone 3

– Zone 1 is closest to the hepatic artery and portal vein

Question 10

What test type is the best at showing liver changes due to injury?

Answer 10

Biopsy

Question 11

List Reversible liver injury changes

Answer 11

• Fat and bilirubin accumulation
• Ballooning of cells with cytoplasmic clearing
• Clumping of intermediate filaments into mallory hyaline

Question 12

List Reversible liver injury changes

Answer 12

• Fat and bilirubin accumulation
• Ballooning of cells with cytoplasmic clearing
• Clumping of intermediate filaments into mallory hyaline

Question 13

List Irreversible liver injury changes

Answer 13

Necrosis - cells rupture and release contents

Apoptosis - shrinkage

Question 14

With Apoptosis fo liver cells, what can be seen on biopsy?

Answer 14

Acidophil bodies = eosinophilic staining

- Also shrinkage of cells

Question 15

What liver cells have the primary role of repair via scar deposition?

Answer 15

Stellate cells

Question 16

Under normal conditions, what is the job of the stellate cells?

Answer 16

Lipid storage

Question 17

During scar deposition/repair, what things will activate stellate cells?

Answer 17

TNF-alpha
ECM changes
Toxins and ROS

Question 18

Once Stellate cells are activated, they convert to?

Answer 18

Myofibroblasts

Question 19

What things will activate Myofibroblasts (stellate cells converted)?

Answer 19

TGF-beta

IL-17

Question 20

What is a major sign that Myofibroblasts (stellate cells converted) are attempting to repair/deposit scarring?

Answer 20

Sinusoidal capillarization

loss of fenestrations

Question 21

2 main ways that the liver can regenerate?

Answer 21

1. Proliferation of remaining hepatocytes

2. Repopulation from progenitor cells

Question 22

Sudden, massive destruction of the liver cells

Answer 22

Acute liver failure

Question 23

What are the common causes of Acute Liver Failure?

Answer 23

ABCDEF

• Acetaminophen, Hep A, Autoimmune Hepatitis
• Hepatitis B
• Hepatitis C, Cryptogenic
• Hepatitis D, drugs/toxins
• Hepatitis E
• Fatty changes

Question 24

What produces Factor VIII and vWF?

Answer 24

Sinusoidal endothelial cells

Question 25

Liver illness associated with encephalopathy and coagulopathy within 26 weeks of initial injury

Answer 25

Acute liver failure

Question 26

Fulminant liver failure

Answer 26

Very rapid onset of massive necrosis usually due to drugs/toxins

Question 27

What are the signs/progression of Acute Liver Failure?

Answer 27

- Jaundice, N/V, encephalopathy and coagulopathy - AST/ALT elevated with enlarged liver - Liver shrinks and AST/ALT fall = worsening jaundice, multi-organ failure and death

Question 28

What are the leading causes of Chronic Liver Failure?

Answer 28

Hepatitis B and C NAFLD Alcohol-induced liver disease

Question 29

Chronic Liver Failure is often associated with Cirrhosis. What is that?

Answer 29

Response to injury | = Fibrosis with regenerative nodules and shunting of blood

Question 30

Chronic Liver Failure is usually ____ until end stage

Answer 30

Asymptomatic

Question 31

Initial symptoms of Chronic Liver Failure?

Answer 31

Weight loss, weakness and jaundice | Encephalopathy and coagulopathy

Question 32

What are the unique findings with Chronic Liver Failure?

Answer 32

Itching due to cholestasis | Hypestrogenemia = palmar erythema, spider angiomas, hypogonadism and gynecomastic (males)

Question 33

What causes palmar erythema, spider angiomas and hypogonadism with Chronic Liver Failure?

Answer 33

Hyperestrogenemia

Question 34

What are the unique findings with Chronic Liver Failure?

Answer 34

Itching due to cholestasis | Palmar erythema, spider angiomas, hypogonadism

Question 35

What options do those with Chronic Liver Failure die from?

Answer 35

Hepatic encephalopathy Variceal bleeding Infections HCC

Question 36

What are common etiologies with Portal HTN?

Answer 36

Prehepatic - portal vein thrombosis Intrahepatic - cirrhosis Posthepatic - right side heart failure, budd-chiari

Question 37

What are 4 signs seen with Portal HTN?

Answer 37

Hepatic Encephalopathy Ascites Venous shunts Congestive Splenomegaly

Question 38

What are 4 signs seen with Portal HTN?

Answer 38

Hepatic Encephalopathy Ascites Venous shunts Congestive Splenomegaly

Question 39

What are 4 signs seen with Portal HTN?

Answer 39

Hepatic Encephalopathy Ascites Venous shunts Congestive Splenomegaly