Lecture 3- Liver, gall bladder, pancreas

Question 1

the liver has an enormous …. and regenerative capacity can mask early hepatic injury

Answer 1

functional reserve

Question 2

the liver maintains…. and synthesizes … and is the primary site for ….

Answer 2

metabolic hemostasis

serum proteins

detox of xenobiotics and waste products

Question 3

causes of cirrhosis of the liver

Answer 3

EtOH abuse***

viral hepaitits

non-EtOH steatohepatitis

biliary disease

iron overload

Question 4

morphologic changes of cirrhosis are….

end result?

Answer 4

1. bridging fibrous septa
2. parenchymal nodules
3. fibrosis and parenchymal injury

decreased fxn

Question 5

consequences of portal HTN

Answer 5

ascites

hepatic encephalophathy

esophageal varices

splenomegaly

hypogonadism

Question 6

excess bilirubin is greater than … mg/dl

Answer 6

2

Question 7

Is unconjugated bilirubin solube and/or toxic?

Answer 7

insoluble

toxic

Question 8

Is conjugated bilirubin soluble or toxic?

Answer 8

soluble

nontoxic

Question 9

1 cause of jaundice

Answer 9

hemolytic anemias

Question 10

other causes of jaundice

Answer 10

bilirubin overproduction

hepatitis

obstruction of bile flow

Question 11

T/F patterns of liver injury are usually the same regardless of causative agent

Answer 11

true

Question 12

Hepatitis …. is a benign self limiting disease caused by an RNA virus and is a transient viremia

Answer 12

A

Question 13

transmission of hep A?

Answer 13

fecal-oral which is seen with overcrowding/ unsanitary conditions. Ingestion of contaminated water and food

Question 14

incubation of Hep A?

Answer 14

2-6 weeks

Question 15

T/F Hepatitis A has a carrier state

Answer 15

false

Question 16

T/F Hep A can be a chronic disease

Answer 16

false

Question 17

…. induced liver disease is an important precursor for hepatocellular carcinoma

Answer 17

hepatitis B

Question 18

Hep B transmission?

Answer 18

parenteral/sexual

Question 19

incubation period of hep B?

Answer 19

4-6 weeks

Question 20

hep B is caused by a … virus

Answer 20

DNA

Question 21

… is excessive accumulation of body iron

Answer 21

hemochromatosis

Question 22

classic triad of hemochromatosis

Answer 22

cirrhosis wuth hepatomegaly

DM

skin pigmentation

Question 23

…. results from a failure to incorporate copper into ceruloplasmin– consequently getting accumulation of toxic copper levels in liver, brain and eye

Answer 23

wilsons disease

Question 24

… arises in bile ducts inside and outside of liver it is very aggressive but asymptomatic until late stage

Answer 24

cholangiocarcinoma (bile duct carcinoma)

Question 25

... is benign and is associated with increased exposure to estrogens (oral contraceptives / pregnancy)

Answer 25

hepatocellular adenoma

Question 26

... is distinct from HCC and occurs in younger patients (20s-40s) and there are no known risk factors. "Scirrhous tumor"

Answer 26

fibrolamellar carcinoma

Question 27

which is more common? primary tumors in the liver or mets?

Answer 27

mets

Question 28

...% of people have a common orifice between the gall bladder and pancreas

Answer 28

60-70%

Question 29

... stones of the gall bladder are usually radiolucent

Answer 29

cholesterol

Question 30

... stones of the gall bladder are usually radiopaque

Answer 30

bilirubin

Question 31

risk factors of cholesterol gall stones?

Answer 31

older, female, caucasian, estrogens

Question 32

risk factors for pigment gall stones

Answer 32

hemolysis GI disorders biliary infection

Question 33

... is almost always associated with gallstones and it can be acute or chronic, more common in females and occurs in the 4th-6th decades

Answer 33

cholecystitis

Question 34

Actue cholecystitis presents with .... pain, fever, anorexia, tachycardia, nausea, vomiting

Answer 34

severe RUQ

Question 35

Chronic cholecystitis presents with ... symptoms, fibrosis/inflammation and stones in 90%

Answer 35

vague

Question 36

The endocrine function of the pancreas regulates glucose homeostasis via .. and ..

Answer 36

insulin | glucagon

Question 37

The exocrine function of the pancreas arise from ... cells that produce enzymes (primarily released as proenzymes) used in digestion

Answer 37

acinar

Question 38

iron overload can lead to hepatocyte death and inflammation. complications involve...

Answer 38

reduced liver fxn portal HTN increased risk for hepatocellular ca

Question 39

liver responses to injury

Answer 39

degeneration of hepatocytes or accumulation of toxic products necrosis inflammation regeneration fibrosis

Question 40

clinical manifestations of cirrhosis of the liver

Answer 40

nonspecific: weight loss, weakness (reserve may mask symptoms) liver failure portal HTN

Question 41

portal HTN can occur 3 ways:

Answer 41

1. prehepatic (obstructive thrombi) 2. intrahepatic (cirrhosis) 3. posthepatic (R. sided heart failure)

Question 42

4 possible results of Hep B infection

Answer 42

acute hepatitis with recovery and clearance (self limited in 90% of cases) nonprog. chronic hepatitis progressive dz ending in cirrhosis asymptomatic carrier state

Question 43

Hep C is caused by a ... virus and is transmitted by...

Answer 43

RNA parenteral contact/sexual spread

Question 44

is there a vaccine for hep C?

Answer 44

no b/c of genomic instability

Question 45

incubation phase of hep C is ... weeks

Answer 45

7-8

Question 46

3 overlapping forms in alcohol liver disease

Answer 46

hepatic steatosis (fatty liver) alcoholic hepatitis cirrhosis

Question 47

tx of hemochromatosis

Answer 47

phlebotomy, Fe chelators

Question 48

Wilsons disease is autosomal.... and occurs between ages of ....

Answer 48

recessive | 6-40

Question 49

morphology of wilsons disease

Answer 49

acute/chronic steatosis necrosis cirrhosis

Question 50

screening test for wilsons?

Answer 50

copper levels in urine or copper levels in liver (definitive diagnosis)

Question 51

T/F serum testing is best for wilsons disease

Answer 51

false