Jaundice Jigsaw

Question 1

The liver’s cells (hepatocytes) excrete bile into

Answer 1

Canaliculi

Question 2

Intercellular spaces between the liver cells

Answer 2

Canaliculi

Question 3

These canaliculi drain into the right and left hepatic ducts, after which bile travels in the common hepatic duct and into the

Answer 3

Gallbladder

Question 4

Has a capacity of 50 mL and concentrates the bile 10 fold by removing water and stores bile until a person eats

Answer 4

Gallbladder

Question 5

Supplies the gall bladder

-a branch of the right hepatic artery 90% of the time

Answer 5

Cystic Artery

Question 6

Venous return is carried either through small veins that enter directly into the liver or, rarely, to a large cystic vein that carries blood back to the

Answer 6

Portal vein

Question 7

An imaging procedure that helps track the production and flow of bile from your liver to your small intestine

Answer 7

Hepatobiliary Scintigraphy (HIDA Scan)

Question 8

Creates pictures of your liver, gallbladder, bile ducts, and small intestine

Answer 8

HIDA scan

Question 9

Technetium-99m-labeled iminodiaceticacid analogues are a new class of organic anions taken up and secreted by hepatocytes into

Answer 9

Hepatic Bile

Question 10

The only mechanism the body has to eliminate cholesterol

Answer 10

Bile acids in their feces

Question 11

The primary bile acids differ from cholesterol in being composed of

Answer 11

24 carbon atoms

Question 12

The mixture of primary and secondary bile acids and salts circulates between the liver and the small intestine, with storage in the

Answer 12

Gall bladder

Question 13

If more cholesterol enters the bile than can be excreted, cholesterol may precipitate/crystallize in the gallbladder, leading to

Answer 13

Gallstone disease (cholelithiasis)

Question 14

Gallstones are caused by a decrease of

Answer 14

Bile acids in bile

Question 15

Gallstone disease can be caused by gross malabsorption of bile acids from the intestine, as seen in patients with severe

Answer 15

Ileal disease

Question 16

Obstruction of the biliary tract, interrupting the enterohepatic circulation, can result in

Answer 16

Gall stones

Question 17

An excessive feedback suppression of bile acid synthesis as a result of an accelerated rate of recycling of bile acids can cause

Answer 17

Bile acids

Question 18

What percentage of patients with asymptomatic gallstones develop symptoms within 10 years

Answer 18

Only 25%

Question 19

Generally indicated in patients who have experienced symptoms or complications of gallstones

Answer 19

Removal of Gallbladder (Cholecystectomy)

Question 20

Drainage of pus from the gallbladder, which may be preferred in some cases to allow stabilization and later cholecystectomy

Answer 20

Cholecystostomy

Question 21

If surgical removal of common bile duct stones is not immediately feasible, we can use

Answer 21

Endoscopic, retrograde sphincterotomy

Question 22

Can prevent gallstone formation

Answer 22

Ursodeoxycholic acid (UDCA) treatment

Question 23

Used in the treatment of cholestatic liver diseases, gallstone dissolution, and for patients with hep C

Answer 23

UDCA

Question 24

UDCA is used in patients with hepatitis C virus infection to ameliorate elevated

Answer 24

Alanine aminotransferase levels

Question 25

A bile acid with fewer hepatotoxic properties than endogenous bile acids -competes with endogenous bile acids for absorption in the terminal ileum

Answer 25

Ursodeoxycholic acid (UDCA)

Question 26

Ursodeoxycholic acid (UDCA) competes with endogenous bile acids for absorption in the

Answer 26

Terminal ileum

Question 27

Appears to promote the endogenous secretion of bile acid and reduce the cytotoxic potential of endogenous bile acids

Answer 27

UDCA

Question 28

Alters and reduces inflammatory cytokine production, protects cell membranes from disruption, and reduces the display of aberrant HLA antigens

Answer 28

UDCA

Question 29

Breaks one of the methynyl bridges holding the four part ring together, releasing the green pigmented biliverdin, iron, and CO

Answer 29

Heme oxygenase

Question 30

The products of heme oxygenase are shown to be

Answer 30

Cytoprotective

Question 31

Biliverdin is a substrate for biliverdin reductase, producting the red-orange colored

Answer 31

Bilirubin

Question 32

In the liver, adds two molecules of glucuronic acid to bilirubin, making the more water-soluble bilirubin diglucuronide

Answer 32

Bilirubin glucuronyl transferase

Question 33

Bilirubin diglucuronide is secreted into the bile ducts and stored in the gall bladder until they are released into the

Answer 33

Intestine

Question 34

Bacteria in the gut hydrolyze bilirubin and reduce it to a colorless

Answer 34

Urobilinogen

Question 35

Gives urine its yellow color

Answer 35

Urobilin

Question 36

May result due to excess hemolysis of red blood cells

Answer 36

Jaundice

Question 37

Thallasemia, sickle cell anemia, G-6-P dehydrogenase deficiency, etc. may lead to

Answer 37

Jaundice

Question 38

A plasma glycoprotein that binds extracorpuscular hemoglobin (Hb) in a tight noncovalent complex

Answer 38

Haptoglobin

Question 39

Approximately 10% of hemoglobin that is degraded each day is released into the circulation and is thus

Answer 39

Extracorpuscular

Question 40

Too large to pass through the glomerulus

Answer 40

Hemoglobin0haptoglobin complex

Question 41

Low levels of haptoglobin are found in patients with

Answer 41

Hemolytic anemias

Question 42

This is because the Hb-Hp complex has a short

Answer 42

Half-life

Question 43

Thus, during hemolytic anemia when lots of RBC are breaking down and releasing Hb into plasma, we have low levels of

Answer 43

Haptoglobin

Question 44

A condition characterized by yellow discoloration of the skin, conjunctivae, and mucous membranes as a result of widespread tissue deposition of the pigmented metabolite bilirubin

Answer 44

Jaundice

Question 45

Stems from a mechanical obstruction of the bile duct, preventing the "draining" of conjugated bilirubin into the intestines

Answer 45

Obstructive jaundice

Question 46

Both the liver uptake of bilirubin and the conjugation of bilirubin can be affected by

Answer 46

Hepatocellular Jaundice

Question 47

Defect due to the complete absence of the EDP-GT gene

Answer 47

Criggler-Najar syndrome: Type I

Question 48

What is the extent of jaundice in Criggler-Najar syndrome: Type I?

Answer 48

Severe, causing Kernicterus in the brain of the newborn

Question 49

Defect due to a mutation in the UDP-GT gene

Answer 49

Criggler-Najar syndrome: Type II

Question 50

What is the extent of jaundice in Criggler-Najar syndrome: Type II?

Answer 50

Benign

Question 51

Defect caused by the reduction in transcription of UDP-GT due to a mutation in the promoter region

Answer 51

Gilbert Disease

Question 52

What is the extent of Jaundice in Gilbert Disease?

Answer 52

Mild jaundice with physiological stress

Question 53

Common and affects 2-10% of the population -appears during or after adolescent years

Answer 53

Gilbert Disease

Question 54

Defect due to a mutation in MRP2 resulting in diffuse deposition of coarse granular, dark brown pigment in hepatocytes

Answer 54

Dubin-Johnson

Question 55

Appears during adolescence or early adulthood and is more common in iranian and moroccan jews

Answer 55

Dubin-Johnson

Question 56

Jaundice is the only symptom of

Answer 56

Dubin-Johnson

Question 57

Defect due to biallelic mutations in OAT1B1 and OAT1B3

Answer 57

Rotor

Question 58

Rotor occurs shortly after

Answer 58

Birth or in childhood

Question 59

What is the extent of jaundice in Rotor?

Answer 59

Mild conjugated and unconjugated hyperbilirubinemia

Question 60

The jaundice seen in Rotor is

Answer 60

Intermittent

Question 61

Low haptoglobin means

Answer 61

Intravascular Hemolysis

Question 62

If direct levels of bilirubin are high

Answer 62

Obstructive Jaundice

Question 63

Increased levels of unconjugated bilirubin

Answer 63

Hepatocellular Jaundice