viral and non viral liver diseases [7]

Question 1

Portal HTN can manifest as what things

Answer 1

increase BP in portal system due to cirrhosis → back up of blood →

• esophageal varices
• hemorrhoids
• caput medusae
• hepatic encephalopathy
• ascites
• splenomegaly

Question 2

ground glass

Answer 2

viral inclusion

Question 3

Which hepatitis is the only dsDNA?

Answer 3

Hep B

the rest are ssRNA

Question 4

Which Hep is transmitted via F-O route?

Answer 4

Hep A, Hep E

Question 5

Which Hep is transmitted sexually?

Which Hep is transmitted mother to child?

Answer 5

Hep B, (Hep C minor)

Hep B

Question 6

Which Hep results in chronic liver disease the most?

Answer 6

Hep C - 80%
- cocaine is risk factor

(Hep B is #2 with 10%)

Question 7

Of the acute HCV infxns, how many of them get resolved, and how many go on to develop chronic Hep? How many of those go on to develop cirrhosis? How many of those with cirrhosis die?

Answer 7

85%
20%
50%

Question 8

Of the acute HBV infxns, how many go on to develop into chronic hep and how many resolve?

Answer 8

90% → recover

Question 9

Hep ____ is replication incompetent and depends on Hep ____ coinfection.

Answer 9

Hep D needs Hep B

potentiates the effects of Hep B and causing faster progression to end stage liver disease

Question 10

Primary Biliary Cirrhosis (PBC)

Answer 10

autoimmune liver disease

- immune mediated attack of intrahepatic SMALL caliber bile ducts.

Question 11

Presentation of PBC

• Pop
• test/dx

Answer 11

insidious onset + pruritus before jaundice
middle aged women

elevated GGT, bili, ALT
serology: anti-mitochondrial Ab (90%)

25% will get liver failure after 10 years

Question 12

Histo of PBC

Answer 12

Ductopenia (small-no bile duct)
- duh, PBC is immune med atk of bile ducts
Lymphocytes 
- atk bile ducts
Granulomas
-  atk bile ducts

Question 13

Primary sclerosing cholangitis (PSC)

Answer 13

autoimmune mediated obliterative fibrosis of intrahepatic and extrahepatic LARGE bile ducts

(similar to PBC of small bile ducts)

Question 14

Presentation of PSC

• Pop
• Test/dx

Answer 14

Asymptomatic
Persistent alkaline phosphatase elevation
progressive fatigue
pruritus
jaundice

Men + UC
(PBC is middle aged women)

Cholangiography → alternating biliary strictures + dilatation

Question 15

Does PBC or PSC have increased risk for cholangiocarcinoma?

Answer 15

PSC

Question 16

Histo of PSC

Answer 16

onion skin fibrosis around bile duct → late fibrous obliteration of bile duct

Question 17

Autoimmune hepatitis

• pop
• dx

Answer 17

immune mediated attack directed at hepatocytes
(PBC and PSC are autoimmune against bile ducts)

Women

Serology BIG role

• ANA, ASMA, Anti-LKMB
• ↑ elevated IgG

Question 18

Toxins (drugs) affect which zone?

Answer 18

zone 3

centrilobular necrosis

Question 19

Alcohol steatosis/steatohepatitis

characteristic histo

Answer 19

large load of carbohydrates into liver →
de novo lipogenesis + modifies oxidative state of hepatocytes →
impedes beta oxidation + prevent lipid escapes + impedes packaging

Neutrophil infiltrates and Mallory bodies
(inclusion in hepatocytes due to abnormal accumulation of cytoskeleton in injured hepatocytes)

Question 20

Hereditary hemochromatosis

Answer 20

generic iron overload disease throughout body

Autosomal recessive inheritance of HFE gene mut

Question 21

malignant tumors commonly found in the liver

Answer 21

hepatocellular carcinoma or cholangiocarcinoma

- most common malignant tumor is actually mets from other areas

Question 22

Most common malignant tumor of the liver

- occurs with which diseases?

Answer 22

Hepatocellular carcinoma
- occurs in cirrhosis and those with chronic liver disease
(HCV, HBV, alcohol)

Question 23

Cholangiocarcinoma

Answer 23

malignant neoplasm of bile ducts

PBC + PSC are autoimm dmg against bile ducts

Question 24

Benign neoplasms of liver

Answer 24

hemangioma
focal nodular hyperplasia
hepatocellular adenoma

Question 25

central stellate scar

Answer 25

focal nodular hyperplasia

• benign mass prolif of hepatocytes
• 2nd most common primary hepatic mass (behind hemangioma)
• more common in women

Question 26

Benign neoplasm of hepatocytes associated with oral contraceptives and no underlying chronic liver disease

Answer 26

hepatocellular adenoma

- low risk of malignancy