Liver

Question 1

Liver Anatomy

Answer 1

• portal triad

- Kupffer cells = liver macrophages

Question 2

Bilirubin metabolism

Answer 2

• Heme catabolism
• unconjugated bilirubin binds to albumin
• conjugated bilirubin binds with glucuronic acid

Question 3

Hyperbilirubinemia

Answer 3

Normal = 0.3 - 1.2 mg/dL
jaundice = bilirubin > 2 - 2.5 mg/dL
cholestasis = thick bile
kernicterus = bilirubin > 20 mg/dL

Question 4

Cholestasis

Answer 4

• decreased bile flow
• obstruction: gallstones, bile duct cancer, etc.
• severe itching

Question 5

Acute Liver Failure

Answer 5

• encephalopathy
• AST/ALT&raquo_space; 1,000
• 50% from excess acetaminophen ingestion

Question 6

Liver Failure Complications: portal hypertension

Answer 6

• increased portal venous pressure due to obstruction in portal circuit
• esophagogastric varices
  ascites

Question 7

Liver failure complications: ascites

Answer 7

• tense skin

Question 8

Liver Failure Complications: endocrine

Answer 8

• Males undergo feminization

- compression of central area causes the entire lesion to blanch

Question 9

Cirrhosis

Answer 9

• end stage of chronic liver disease

Question 10

Hepatitis A Virus

Answer 10

• no carrier state

Question 11

Hepatitis B Virus

Answer 11

• core antigen (HBcAg)
• e antigen (HBeAg)
• indicates ongoing viral replication; infectivity
• surface antigen: envelope glycoprotein (HBsAg) (immunologic but not infectious)
• 2 billion infected worldwide
• 400 million chronic carriers worldwide

Question 12

Chronic Hepatitis B

Answer 12

• 2-3% hepatocellular carcinoma

- 0.1-0.5% develop fulminant hepatitis

Question 13

Hepatitis C Virus

Answer 13

170 million worldwide

Question 14

Hepatitis D Virus

Answer 14

• HDV infection requires HBV coinfection

Question 15

Chronic Viral Hepatitis

Answer 15

• cirrhosis

Question 16

Alcoholic Liver Disease

Answer 16

• 60% of alcoholics develop chronic liver disease
• females often experience more severe outcomes
• spectrum: hepatic steatosis, alcoholic hepatitis, cirrhosis

Question 17

Fatty Liver Disease

Answer 17

• steatosis (accumulation of fat in hepatocytes)

Question 18

Alcoholic Hepatitis

Answer 18

• 5-year (90%) if stop drinking AND without jaundice, ascites, hematemesis (vomit blood)
• causes of death: hepatic failure, GI bleed, infection, renal failure, hepatocellular carcinoma (3-6%)

Question 19

Nonalcoholic Fatty Liver Disease

Answer 19

• resembles alcoholic liver disease

Question 20

Liver Transplantation

Answer 20

MELD score (model for end-stage liver)

Question 21

Hemochromatosis

Answer 21

• excessive iron accumulation

- 200X risk for hepatocellular carcinoma

Question 22

Wilson Disease

Answer 22

• excessive copper accumulation

Question 23

alpha1-anti-trypsin deficiency

Answer 23

• most common genetic cause of liver disease in infants/children
• with cirrhosis 2-3% risk for hepatocellular carcinoma

Question 24

Gilbert Syndrome

Answer 24

• jaundice
• medications: Irinotecan (camptosar), protease inhibitors
• any patient who has jaundice needs to undergo a comprehenseive medical assessment

Question 25

Primary Biliary Cholangitis

Answer 25

increase in serum cholesterol: severe

Question 26

Primary Scleorsing Cholangitis

Answer 26

- inflammation and fibrosing of bile ducts

Question 27

Cholestatic Syndromes of Infancy

Answer 27

- giant cell hepatitis

Question 28

Cavernous Hemangioma

Answer 28

- most common benign liver tumor

Question 29

Hepatocellular Adenoma

Answer 29

- benign - oral contraceptives, anabolic steroids - usually solitary encapsulated expanding mass - some risk for malignant transformation

Question 30

Hepatocellular Carcinoma

Answer 30

- malignant; primary liver cancer

Question 31

Cholangiocarcinoma

Answer 31

- intrahepatic/extrahepatic bile duct cancer | - endemic liver fluke = parasite

Question 32

Metastatic Carcinoma to the Liver

Answer 32

- most common malignant liver tumor

Question 33

Relevant Information Needed for a Patient with Liver Disease

Answer 33

``` - current lab values for: PT INR CBC LFTs (ALT, AST) ```

Question 34

Gallbladder features

Answer 34

- release of bile

Question 35

Cholecystitis

Answer 35

- severe abdominal pain (upper right quadrant) lasts greater than 6 hours

Question 36

Pancreas general information

Answer 36

- only 2% of pancreas maintains glucose homeostasis

Question 37

Acute Pancreatitis

Answer 37

- abdominal pain (cardinal symptom) - pseudocysts (50% of cases) - increase serum amylase within first 24 hours - increased serum lipase next 72 hours - 96 hours

Question 38

Chronic Pancreatitis

Answer 38

- chronic alcoholism (most common cause) - increased risk of pancreatic cancer - 40-55% in hereditary pancreatitis

Question 39

Pancreatic Cystic Neoplasms

Answer 39

- increased malignant potential

Question 40

Pancreatic Cancer

Answer 40

- highly invasive/rapidly progressive | - # of cases in US in the past 50 years tripled