Liver 1

Question 1

In the classic hexagonal concept of the liver, what represents the center?

Answer 1

Central vein, surrounding is the portal triads

Question 2

True or false, most liver diseases affect each lobule so even a small biopsy can tell you what is happening in the entire liver?

Answer 2

TRUE

Question 3

What are the forms of intrahepatic biliary disease?

Answer 3

• primary biliary cirrhosis

- primary sclerosing cholangitis

Question 4

What systemic viral infections cause hepatitis? [4]

Answer 4

CMV, EBV, HSV, Adenovirus

Question 5

How high are the transaminases in acute liver damage? What can severe cases lead to?

Answer 5

• > 1000

- fulminant hepatic necrosis

Question 6

What are the steps to cirrhosis in chronic diseases?

Answer 6

inflammation–> necrosis–> fibrosis

Question 7

What is the most common cause of acute/fulminant hepatic necrosis in the US population?

Answer 7

acetaminophen

Question 8

Does hepatitis A B or C have an acute/fulminant symptoms?

Answer 8

A and B and (sometime/rarely) C

Remember that A does not form chronic disease, but B and C do

Question 9

Being itchy all over can be a sign of liver disease, but severe itchiness is very characteristic of what liver disease?

Answer 9

Primary biliary cirrhosis

Question 10

With jaundice, what other color changes can we see (3)?

Answer 10

yellow mucous membranes, pale stool, dark urine

Question 11

hemolysis and genetic problems with conjugation lead to what type of elevated bilirubin?

Answer 11

Unconjugated bilirubin

Question 12

What leads to elevated levels of both unconjugated and conjugated bilirubin?

Answer 12

Liver damage- cirrhosis and hepatocellular carcinoma

Question 13

Elevated outflow obstruction of bile leads to what type of elevated bilirubin?

Answer 13

conjugated bilirubin

Question 14

What is the main thing the liver detoxifies?

Answer 14

ammonia from breakdown of protein in ingested food or blood

so elevated ammonia means the liver is failing

Question 15

What are the two main biliary enzymes?

Answer 15

alk phos

GGT (gamma glutamyl transpeptidase)

Question 16

When are alk phos or GGT elevated?

Answer 16

PBC
PSC
Adverse drugs
Obstruction of biliary tree

Question 17

ALT and AST elevation occurs because of what basic thing in hepatocytes?

Answer 17

necrosis-(death and damage)

Question 18

Review other important tests to measure besides ALT, AST, ALK phos, and GGT

Answer 18

Viral serologies 
Autoimmune serologies
Glucose, HgbA1c, lipids
iron
ceruloplasmin
alpha1-antitrypsin

Question 19

What biliary disease is related to AMA serology?

Answer 19

PBC

Question 20

What biliary disease is UC anca associated with?

Answer 20

primary sclerosing cholangitis

Question 21

What are the signs of acute disease with viral A, B or the occasional C?

Answer 21

malaise, fatigue, jaundice
>1000 transaminases
- lasts several weeks

Question 22

What percentage of HBV goes on to chronic viral hepatitis?

Answer 22

less than 10%

Question 23

What percentage of HCV goes on to chronic viral hepatitis?

Answer 23

75%

Question 24

Is HBV or HCV often transmitted with sexual contact? what about vertical transmission?

Answer 24

1. HBV

2. HBV- very common in underprivileged countries

Question 25

IS HCV and HBV fecal oral like hep A?

Answer 25

No- mostly parenteral

Question 26

Is there a vaccine for hep C?

Answer 26

no

Question 27

Is Hep C or Hep B more of a problem in US?

Answer 27

HEp C, Hep B is a huge global problem

Question 28

What is the histological hallmark for Hep C? Hep B?

Answer 28

1. rounded portal lymphoid aggregates | 2. Ground glass hepatocytes

Question 29

A high degree of numerous plasma cells and activity is strongly suggestive of?

Answer 29

Autoimmune hepatitis

Question 30

What sex predominates autoimmune hepatitis?

Answer 30

female 70-75%

Question 31

True or false- we see hypergammaglobulinemia in autoimmune hepatitis ?

Answer 31

True

Question 32

Is ANA or ASMA more specific in autoimmune hepatitis?

Answer 32

ASMA

Question 33

T-F- Hep A histology often mimics autoimmune hepatitis?

Answer 33

True- plasma cells prominent

Question 34

True or false- hep A screen is only positive if IgG is present?

Answer 34

False- IgM

Question 35

Why is an adverse drug reaction not found on our huge algorithm chart?

Answer 35

can mimic virtually anything, a mixed picture that doesn't fit with anything can often clue that a drug reaction is causing the damage

Question 36

How do we recognize an adverse drug reaction?

Answer 36

temporal relationship - when was the drug started - when was the jaundice or abnormal test noted

Question 37

when does acetaminophen toxicity occur?

Answer 37

hours to a few days. other idiosyncratic reactions can typically take 2 to 10 weeks (75% are less than 4 months)

Question 38

T-F-- herbal reactions can account for liver injury?

Answer 38

True- so if they say no medications but started a new herb etc. Pay Attention!!