Pancrease/Gallbladder/Liver 2

Question 0

What is Kernicterus?

Answer 0

UCB (unconjugated bilirubin) depositing in the basal ganglia leading to neurological defects or death.

Usually seen in physiologic jaundice of newborns.

Question 1

What is urobilinogen?

Answer 1

What bile is turned into by intestinal floura
what makes stool brown
reabsorbed into blood, processed by kidney, making urine yellow

Question 2

What is Gilbert Syndrome? Crigler-Najjar syndrome?

Answer 2

Gilbert: low UGT activity (autosomal recessive), Uridine Glucoronyl Transferase, which conjugates Bilirubin.

Crigler-Najjar: Absence of UGT -> kernicterus, fatal

Question 3

Lab finding of Conjugated Bilirubin can have what 3 causes:

Answer 3

Dubin-Johnson Syndrome: lack of Bilirubin Canalicular transport protein (moves CB into gall bladder)

Biliary Tract obstruction (gallstones, carcinoma, parasites)

Viral hepatitis (increase in both CB and UCB)

Question 4

Pitch Black liver suggestive of

Answer 4

Dubin-Johnson syndrome

Question 5

Xamthomas

are, seen in

Answer 5

Benign tumors made of foam cells (macrophages with lipids inside)
found on skin

Seen in obstructive jaundice

Question 6

Why does acute hepatitis cause both CB and UCB?

Answer 6

CB: bile ductules are destroyed, and CB leaks out of gall bladder
UCB: destroys hepatocytes, so conjugating ability is reduced

Question 7

Dark urine seen in

Answer 7

Conjugated Bilirubin

because it is water soluble, and can be excreted in urine

Question 8

Hepatitis E in pregnant women associated with

Answer 8

Fulminant hepatitis with massive liver necrosis leading to failure

Question 9

HBsAG

what it represents

Answer 9

Surface antigen
First serologic marker to rise
Presence >6 months = chronic state

Question 10

What is window phase of hepatitis infection

Answer 10

When only IgM against the core (HBcAB) is present.
This essentially means that HBsAG, HBeAG, and HBV DNA is gone.
This precedes IgG against surface (HBsAB) which indicates protection.

Question 11

Serologic sign for protection against HBV.

Answer 11

IgG against HBs (HBsAB)

Question 12

Serologic indicator for infective HBV

Answer 12

Envelope antigen (need an envelope to mail a letter)
HBeAG

Question 13

Cirrhosis mediated by what cells

Answer 13

Stellate cells secrete TGF-Beta causing fibrosis.

These cells are beneath the endothelial cells that line sinusoids.

Question 14

Excess estrogen from Cirrhosis produce what symptoms?

Answer 14

Gynecomastia, spider angiomata, palmar erythema

Question 15

Alcoholic Hepatitis damage mediated by what molecule?

Answer 15

Acetaldehyde (C2H4O)

This is what alcohol is broken down into from ethanol

Question 16

What are mallory bodies?

Answer 16

Damaged intermediate filliments in the hepatocytes

Question 17

Why is AST>ALT in alcoholic damage to the liver?

Answer 17

AST is found in mitochondria, and alcohol is a mitochondrial poison.

Question 18

Treatment for Wilson’s disease

Answer 18

Give D-penicillamine, which is a copper chelating agent

Question 19

Copper is usually carried in ______ in body

Answer 19

Ceruloplasmin

Serum ceruloplasmin decreased in Wilson’s disease

Question 20

Primary Sclerosing Cholangitis
What is it
Appearance
Assocation

Answer 20

Inflammation/Fibrosis of intrahepatic and extrahepatic bile ducts.
Onion skin around bile ducts. Uninvolved regions are dilated, so “beaded” appearance.
Association with Ulcerative Colitis***

Question 21

Only instance when you would give a child aspirin

Answer 21

Kawasaki syndrome, which is systemic inflammation of the medium sized vasculature resulting in classic strawberry tongue appearance. Can be deadly if it involves the heart. Treatment is usually IV immunoglobulins and Aspirin. Otherwise, salicylates can cause Reye’s syndrome.

Question 22

Aflatoxin is derived from?

Associated with?

Answer 22

Aspergillus (fungus) - in countries that store grain for a long time, Causes p53 mutaiton
Hepatocellular Carcinoma