Liver, Gallbladder, Pancreas

Question 1

Portal triad

Answer 1

Hepatic portal vein (80%)
Hepatic artery (20%)
Bile duct
Lymphatic vessel

Question 2

Bridging fibrosis

Answer 2

Fibrous tissue made in response to inflammation. Fibrous strands link w liver

Question 3

Labs for hepatocyte integrity

Answer 3

AST, ALT

Question 4

Labs for biliary tract integrity

Answer 4

Alk phos (also in bones)
GGT- specific for biliary tract

Question 5

Hepatocytes function test

Answer 5

Serum albumin, serum ammonia, PT

Question 6

Consequences of hepatic dysfunction: 12

Answer 6

Jaundice, cholestasis, hypoalbuminemia, hyperammonemia, hypoglycemia, fetor hepaticus, hypogonadism, gynecomastia, palmar erythema, spider angiomas, wt loss, muscle wasting

Question 7

Hepatic portal hypertension in liver disease leads to: 5

Answer 7

Ascites, esophageal varicies, hemorrhoids, caput medusae, splenomegaly

Question 8

Liver disease
Life threatening complic
6

Answer 8

Mult organ failure, coagulopathy, hepatic encephalopathy, hepatorenal syndrome, esophageal varicies rupture, hepatocellular carcinoma

Question 9

Causes of jaundice 5

Answer 9

Excess bilirubin production, reduced hepatic uptake, impaired conjugation, decreased hepatocellular excretion, impaired bile flow

Question 10

Which causes of jaundice result in increased unconjugated bill

Answer 10

Excess production, reduced uptake, imp conjugation

Question 11

Process of increased unconjugated bilirubin

Answer 11

Insol in water, bound to albumin, not excreted in kidney. Unbound plasma fraction diffuses into tissue, produces toxic injury, inc in hemolytic dis of newborn, can cause neuro damage

Question 12

What leads to inc in conjugated bilirubin

Answer 12

Decreased hepatocellular excretion, impaired bile flow

Question 13

Process of inc conjugated bilirubin

Answer 13

Soluble in water, weakly bound to albumin, excreted by kidney. Dark urine.

Question 14

Cholestasis

Answer 14

Hepatocytes get occlusion in bile duct, leads to hepatocyte death

Question 15

Hepatic failure
% func lost
Special problems

Answer 15

80-90%

Hepatic encephalopathy and hepatorenal syndrome

Question 16

Cirrhosis does what to liver and causes what

Answer 16

Imp BF thru it, hepatic portal htn. Leads to ascites, portosystemic shunts (varicies, hemorrhoids, medusae), splenomegaly

Question 17

HAV and HEV similarities 7

Answer 17

Self limiting, 2-8 wk incubation, no carrier state or chronic state, no cancer, oral trans, not in US

Question 18

Hep B, C, D 5 traits

Answer 18

Carrier states, chronic, can cause cancer, parenteral transmission, in US

Question 19

Alcoholic liver disease

Answer 19

Progression from hepatic steatosis, to alcoholic hepatitis, to cirrhosis

Question 20

Hemochromatosis

5 traits

Answer 20

Uncontrolled iron uptake.males mainly. Autosomal recessive, heterozygous carriers 10%. Appear late, in 50s.

Question 21

Problems in fully developed hemochromatosis

Answer 21

Cirrhosis in all, DM and skin pigmentation most

Question 22

Secondary iron overload diseases

Answer 22

Transfusions (each gives .25g iron)

Ineffective erythropoietin in b thalassemia and sideroblastic anemia

Question 23

Secondary biliary cirrhosis
Obstruction of
4 causes

Answer 23

Extrahepatic biliary tract

Gallstones, biliary atresia, malig of biliary tree or pancreas, strictures from surgery

Question 24

Primary biliary cirrhosis
Destruc of
Elev: 4
Often __

Answer 24

Intrahepatic bile ducts.
Alk phos, cholesterol, hyperbilirubinemia late in disease, AMA
Fatal

Question 25

Primary sclerosing cholangitis 
Where it affects 
Assoc with 
Elev: 
Without:

Answer 25

Intrahepatic and extrahepatic bile ducts
UC
Alkaline phosphatase
AMA

Question 26

Hepatic vein outflow obstruction

Causes

Answer 26

Hepatic vein thrombosis (budd chiari) or veno occlusive disease. High pressure in IVC or RA

Question 27

Hepatic vein outflow obstruction

Manifestations

Answer 27

Ascites
Hepatomegaly*
Abd pain, elev transaminases, jaundice

Question 28

Impaired intrahepatic blood flow

Causes

Answer 28

Cirrhosis*, sinusoid occlusion, systemic circulatory compromise

Question 29

Impaired intrahepatic bf

Manifestations

Answer 29

Ascites (cirrhosis)
Esophageal varicies (cirrhosis)
Elev transaminases

Question 30

Impaired portal vein inflow cause

Answer 30

Obstruction by thrombosis or tumor

Question 31

Impaired portal vein inflow

Manifestations

Answer 31

Ascites, esophageal varicies, splenomegaly, intestinal congestion

Question 32

Impaired hepatic artery inflow

Cause

Answer 32

Complications of transplant (hooking up ducts and vasculature)

Question 33

Impaired hepatic artery inflow

Manifestations

Answer 33

Ischemia to bile ducts and parenchyma. Potential graft loss

Question 34

Hepatocellular carcinoma
Arise from:
Causes: 5
Mean survival

Answer 34

Hepatocytes
HBV, chronic liver disease (etoh or HCV), aflatoxin, tyrosinemia, cirrhosis
7 months

Question 35

Risk factors for cholesterol gall stones, incidence in us

Answer 35

80%

Fair (Indians 75%), forty (inc w age), female, fertile, fat, gallbladder stasis, hyperlipidemia

Question 36

Risk factors for pigment stones and incidence

Answer 36

20%

Chronic hemolytic syndromes, biliary infections, GI disorders (crohns), Asian > wester

Question 37

Choledocholithiasis

What happens

Answer 37

Gallstone movement, blocks cystic duct or common bile duct

Question 38

Choledocholithiasis

Problems assoc: 6

Answer 38

Biliary obstruction, pancreatitis, cholangitis, hepatic access, chronic liver disease w biliary cirrhosis, acute calculus cholecystitis

Question 39

Acute pancreatitis
Pneumonic/causes
I GET S

Answer 39

Idiopathic, gallstone, ethanol, trauma, steroidS

Question 40

Acute pancreatitis

MASHED

Answer 40

M (mumps, ebv, CMv), a (autoimmmune dis), scorpion sting, hypercalcemia/lipidemia/hypothermia, ercp, drugs