Hepatobiliary Disease

Question 1

liver functions

Answer 1

BG regulation, digestion, endocrine, hematologic, excretory

Question 2

jaundice

Answer 2

excess bilirubin in blood

prehepatic: hemolytic anemia

hepatic jaundice: liver dysfunction, viral hepatitis, drugs, cirrhosis

post-hepatic: biliary obstruction, gallstones, pancreatic cancer

Question 3

Fatty liver disease

Answer 3

steatosis: reversible fat accumulation in hepatocytes

RF: ETOH, DM, obesity, high TG

Question 4

Cirrhosis

Answer 4

patterned fibrosis of the entire liver with nodules + dense fibrous tissue that is irreversible and can lead to variable results (portal HTN or decreased liver function)

Question 5

causes of cirrhosis

Answer 5

HCV, Alcohol Liver Disease, Both, Cryptogenic Cirrhosis (NAFLD risk factors)

Question 6

portal HTN

Answer 6

decreased hepatic blood flow, congested GI drainage, splenomegaly

anorexia, varices, ascites

Question 7

ascites

Answer 7

more than 500 ml of fluid in peritoneal cavity from the blood (most common complication of cirrhosis)

indicates advanced liver disease
increases hydrostatic pressure and decreases oncotic pressure

Question 8

hepatic failure

Answer 8

80-90% loss of liver function

jaundice, portal HTN, Ascites, Fetor Hepaticus (breath), hypoalbuminemuria, hypoglycemia, hyperammoniumuria, bleeding disorders

M: gynecomastia, impotence, testes atrophy, female hair
F: irregular menses, palmar erythema, spider angiomas

Question 9

causes of hepatic failure

Answer 9

chronic liver disease (ETOH or hepatitis), hepatic necrosis from Fulminant Viral Hepatitis, hepatic dysfunction without necrosis from pregnancy, tetracycline, Reyes syndrome

Question 10

Fulminant Viral Hepatic Failure

Answer 10

rapid progression to hepatic failure and encephalopathy (weeks)

most commonly caused by APAP (46%)

Question 11

effects of alcohol liver injury

Answer 11

direct cell toxicity, toxic metabolic products (ALDH), and altering lipid metabolism

inflammation, fat storage, collagen synthesis, neutrophils initiation

Question 12

Acute Viral Hepatitis

Answer 12

symptomatic pre jaundice: malaise, fatigue, N, anorexia

symptomatic jaundice: symptoms fade

convalescence: jaundice fades, infectivity declines, antibodies found in blood

carrier in C > B

Question 13

HAV

Answer 13

oral-fecal contamination

Question 14

HBV and HCV

Answer 14

needle stick or sexually transmitted

Question 15

HDV

Answer 15

co-infection with HBV

Question 16

HEV

Answer 16

oral-fecal contamination

Question 17

chronic hepatitis

Answer 17

dx with liver biopsy

enlarged tender liver, splenomegaly and red palms and spider angiomas

Question 18

reyes syndrome

Answer 18

very rare fatty liver and encephalopathy in children due to aspirin + viral infection in children under 15 years old

hepatomegaly + hypoglycemia (stupor, coma, vomit, convulsions)

Tx: infusions of glucose, plasma, mannitol

Question 19

hepatocellular carcinoma

Answer 19

usually metastatic cancer from colon, lungs, breast

Alpha-Fetoprotein (70% cases)

Question 20

hepatolenticular degeneration

Answer 20

copper excretion dysfunction + toxic accumulation of copper in liver, brain, etc

Autosomal Recessive Disease

Low serum ceruloplasm (transporter)

Leads to disruption of neurotransmission and Kayser Fleischer Rings (deposits in cornea)

Question 21

gallbladder

Answer 21

located below the liver + concentrates/stores bile which emulsifies fat in food

stimulated by fat in duodenum

Question 22

gallstones

Answer 22

supersaturated bile from stomach contents or physical dysfunctions (75% is cholesterol issue)

RF: high estrogen, obesity, over 40 years old, comorbidities (DM, cirrhosis)

Gallbladder attack: blocks the exit of bile duct and leads to spasm

Question 23

pancreas

Answer 23

exocrine products to duodenum: proteases, amylase, lipase, protease inhibitor

Endocrine products to blood: insulin + glucagon

Question 24

pancreatic disease

Answer 24

usually exocrine component affected

digestive function de to premature activation of PI or obstruction of bile duct

Question 25

pancreatic malignancies

Answer 25

usually asymptomatic for years but because it is isolated organ, it grows undetected

80% mortality rate

Question 26

pancreatitis

Answer 26

bleeding, tissue damage, infection, blood-borne distribution of digestive enzymes

Acute: usually resolves + 50% related to gallstones

Chronic: progressive destruction of pancreas + 60% related to ETOH