hpb patho (incomplete, summarised version)

Question 1

Obstructive jaundice is due to obstruction of the bile duct from different aetiologies.

• _____ conjugated bilirubin
• conjugated bilirubin found in the ____

Answer 1

Obstructive jaundice is due to obstruction of the bile duct from different aetiologies.

• increased conjugated bilirubin
• conjugated bilirubin found in the urine

Question 2

Which of the effects of portal hypertension is a medical emergency?

Answer 2

Oesophageal varices
Hepatorenal syndrome

Question 3

Acute on chronic liver failure is either:
1. An _______________ supervening on a well-compensated late-stage chronic disease
2. Chronic disease has a ___________ that leads directly to liver failure

Answer 3

Acute on chronic liver failure is either:
1. An unrelated acute injury supervening on a well-compensated late-stage chronic disease
2. Chronic disease has a flare of activity that leads directly to liver failure

Question 4

What is chronic liver failure usually associated with?

Answer 4

Cirrhosis

Question 5

What are the causes of chronic liver failure?

Answer 5

NAFLD
ALD
Hepatitis B/C
Crytogenic

Question 6

Gross appearance of cirrhosis?

Answer 6

Shrunken, firm, nodular

Question 7

Histological features of cirrhosis?

Answer 7

Loss of normal vascular structure
Fibrosis
Regeneration

Question 8

How often are liver cirrhosis asymptomatic until most advanced stages?

Answer 8

40%

Question 9

Nonspecific manifestation of liver cirrhosis includes:

Answer 9

anorexia, weight loss, weakness

Question 10

symptoms and signs of liver failure

Answer 10

Coagulopathy
Portal Hypertension
Hyperestrogenemia
Dupuytren’s contracture
Cholestasis

Question 11

What is an additional complication of liver cirrhosis?

Answer 11

HCC

Question 12

What are the most common terminal events in cirrhosis?

Answer 12

hepatic encephalopathy
oesophageal varices
bacterial infection

Question 12

In matrix remodeling in liver cirrhosis

Synthesis (Scarring) is caused by:
Degradation (Regression) is caused by:

Answer 12

In matrix remodeling in liver cirrhosis

Synthesis (Scarring) is caused by: hepatic stellate cells
Degradation (Regression) is caused by: matrix metalloproteinases

Question 13

Whats the concern with splenomegaly that is secondary to portal HTN?

Answer 13

increased venous pressure -> congestive splenomegaly -> accumulation of leukocytes, erythrocytes, platelets in spleen -> facilitates capture, phagocytosis, destruction of blood cells by phagocytes -> peripheral cytopenias

Question 14

Acute liver failure is when there is

Answer 14

massive and sudden destruction of hepatocytes

Question 15

What is acute liver failure associated with?

Answer 15

encephalopathy
coagulopathy

Question 16

What are the causes of acute liver failure?

Answer 16

autoimmune hepatitis
acute hepatitis A/B/E
drugs/toxins

Question 17

Gross appearance of liver in acute liver failure?

Answer 17

shrunken liver with wrinkled liver capsule

Question 18

Histological features of liver in acute liver failure?

Answer 18

loss of hepatocytes
RBC extravasation
florid ductular reaction

Question 19

What are the 5 most common sites for portosystemic shunts? (relate to portal HTN)

Answer 19

lower oesophageal
upper anal canal
umbilicus
retroperitoneal
diaphragm surface of liver

Question 20

The liver has enormous ______________
- so mild liver damage may be clinically masked + liver injury and healing may be asymptomatic
- by the time of clinical presentation, most liver diseases will already be chronic, except acute liver failure

Answer 20

functional reserve

Question 21

What are the parameters for liver function test?

Answer 21

Hepatocyte integrity (cytosolic hepatocellular enzymes)
- {{c1::AST}}
- {{c1::ALT}}
- {{c1::LDH}}

Biliary excretory function (increase in normal secretions)
- {{c1::Serum bilirubin (total, unconjugated, conjugated)}}
- {{c1::Urine bilirubin}}
- {{c1::Serum bile acids}}

Bile canaliculus integrity
- {{c1::ALP}}
- {{c1::GGT}}

Hepatocyte synthetic function
- {{c1::Serum albumin}}
- {{c1::Coagulation factors (PT, PTT, Factors 1,2,5,7,9,10)}}

Hepatocyte metabolism
- {{c1::Serum ammonia}}
- {{c1::Aminopyrine breath test (hepatic demethylation)}}

2. The Child-Pugh liver function test would include (mn “BETA-PTI”)
   - {{c2::Big belly - Ascites}}
   - {{c2::Encephalopathy}}
   - {{c2::Total bilirubin}}
   - {{c2::Serum Albumin}}
   - {{c2::PT Time}}
   - {{c2::INR}}

Question 22

The Child-Pugh liver function test (in chronic liver cirrhosis) would include:

Answer 22

BETA-PTI

Belly - Ascites
Encephalopathy
Total bilirubin
serum Albumin
PT time
INR

Question 23

Hyperbilirubinaemia can be predominantly unconjugated or conjugated.

What is the difference between the 2?

Answer 23

Unconjugated bilirubin is water-insoluble and albumin-bound and cannot be excreted in urine even in high doses but can cross BBB in infants and cause kernicterus

Conjugated bilirubin is water soluble, non-toxic and can be excreted out in the urine

Question 24

Most common cause of post hepatic jaundice is ________

Answer 24

large bile duct obstruction

Question 25

Budd-Chiari syndrome is associated with... They present with a clinical triad of...

Answer 25

Budd-Chiari syndrome is associated with hepatic vein thrombosis They present with a clinical triad of abdominal pain, ascites, liver enlargement

Question 26

In cholangitis (or ascending cholangitis), there is a specific triad and pentad: Charcot's Triad Reynolds' pentad

Answer 26

Charcot's Triad: - Fever - Jaundice - Right upper quadrant pain Reynolds' Pentad: - Charcot's Triad - Hypotension - Altered mental state

Question 27

Choledochal cyst is {{c1::development malformation of biliary tree, usually CBD}} What does choledochal cysts predispose the pt to? {{c1::Stones, stenosis, strictures, pancreatitis, bile duct cancer!!}}

Answer 27

Choledochal cyst is {{c1::development malformation of biliary tree, usually CBD}} What does choledochal cysts predispose the pt to? {{c1::Stones, stenosis, strictures, pancreatitis, bile duct cancer!!}}

Question 28

Focal Nodular Hyperplasia is due to {{c1::focal alterations in hepatic blood supply}}

Answer 28

Focal Nodular Hyperplasia is due to {{c1::focal alterations in hepatic blood supply}}

Question 29

What is Cholangiocarcinoma?

Answer 29

Carcinoma with bile duct origin, arising from either inside or outside the liver 2nd most common primary malignancy of the liver, after HCC

Question 30

What are the risk factors of cholangiocarcinoma?

Answer 30

Hepatolithiasis Fibropolycystic liver disease

Question 31

How does the location of the cholangiocarcinoma affect presentation?

Answer 31

Intrahepatic: late presentation Extrahepatic: early presentation and smaller

Question 32

Factors that affect prognosis of hepatocellular carcinoma (HCC)

Answer 32

Staging Grading Number and size of nodules Vascular spread Presence of cirrhosis

Question 33

Islets of Langerhans neoplasms clinical presentation of insulinoma

Answer 33

Whipple Triad: Hypoglycaemia CNS manifestations during fasting/exercise Symptom relief with administration of glucose

Question 34

Most common site of pancreatic carcinoma is...

Answer 34

Head of pancreas

Question 35

Gross appearance of pancreatic carcinoma

Answer 35

Large pale firm mass with infiltrative borders Adenocarcinoma with desmoplasia Perineural and lymphatic involvement

Question 36

Both acute and chronic pancreatitis are initiated by injuries that led to

Answer 36

autodigestion of pancreas by its own digestive enzymes

Question 37

What are the normal mechanisms that protects the pancreas from self-digestion? Pancreatitis occurs when these protective mechanisms are deranged/overwhelmed!!

Answer 37

- digestive enzymes synthesise inactive proenzymes - trypsin is activated only in the duodenum - inhibitors of trypsin

Question 38

In cases of jaundice, only hepatic and post-hepatic causes will result in ________ being formed. (not pre-hepatic cause)

Answer 38

pale stools

Question 39

Acute pancreatitis = {{c1::Reversible pancreatic parenchymal injury associated with inflammation}}

Answer 39

Acute pancreatitis = {{c1::Reversible pancreatic parenchymal injury associated with inflammation}}

Question 40

What are the main causes of acute pancreatitis?

Question 41

Chronic pancreatitis = {{c1::prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma and fibrosis}}. In the late stages there is destruction of {{c1::the endocrine parenchyma (Islets of Langerhans)}}

Answer 41

Chronic pancreatitis = {{c1::prolonged inflammation of the pancreas associated with irreversible destruction of exocrine parenchyma and fibrosis}}. In the late stages there is destruction of {{c1::the endocrine parenchyma (Islets of Langerhans)}}

Question 42

hepatitis A is associated with the consumption of raw shellfish

Question 43

vaccination for hepatitis B prevents hepatitis D infection

Question 44

hepatitis E has the highest mortality rate in pregnant women

Question 45

between acute viral and chronic viral hepatitis, it is the pattern of injury that is different, not the nature of inflammatory cell infiltrate acute viral hepatitis: lobular hepatitis chronic viral hepatitis: portal hepatitis

Question 46

both hep B and hep C can progress to chronic hepatitis however patients with hep C infection is more likely to progress to chronic hepatitis while only 20-30% of patients with hep B will progress to chronic hepatitis

Question 47

donated blood is usually screened for hep B and hep C

Question 48

hep B is the only DNA virus

Question 49

hep A is the only one with faecal-oral mode of transmission

Question 50

What are the key histologic feature of cirrhosis?

Answer 50

loss of normal vascular architecture fibrosis regeneration

Question 51

State the common aetiologies for cirrhosis

Answer 51

NAFLD ALD Chronic hep B/C a1 anti-trysin deficiency

Question 51

What are the treatment options available for HCC?

Answer 51

Surgical resection Loop Ablation Immunotherapy Liver transplantation

Question 52

Congenital abnormalities of the pancreas:

Answer 52

Pancreatic division Annular pancreas Ectopic pancreas Agenesis

Question 53

histological features of HCC

Answer 53

sinusoidal trabeculae broad and thick trabeculae high N:C ratio, nuclear atypia

Question 54

hepatocellular adenoma is a benign lesion that resembles a normal liver and are typically common in women taking oral contraceptives (using oestrogen-containing meds)