Liver and Pancreas - Final Exam

Question 1

Function of liver (4)

Answer 1

1. Excretion (bile)
2. Metabolic (fats, carbohydrates, proteins, drugs)
3. Storage (carbohydrates, fats, vitamins)
4. Synthesis (albumin)

Question 2

Chronic liver disease

Answer 2

Many diseases
Liver has only few stereotypic ways to respond to injury
Most liver diseases result in cirrhosis (nodular fibrosis)

Question 3

Clinical signs of chronic liver disease (6)

Answer 3

1. Jaundice
2. Varices
3. Splenomegaly (black up in portal vein and splenic vein)
4. Kidney and lung symptoms
5. Ascites
6. Encephalopathy

Question 4

Ascites

Answer 4

Fluid accumulation in abdominal cavity - expanded stomach

Question 5

Encephalopathy

Answer 5

Mental difficulties

Increase ammonia in blood

Question 6

Hepatotropic viruses

Answer 6

Cause chronic liver disease
Viruses that specifically target hepatocytes
Hepatitis A, B, C, D, E
May present as acute or chronic

Question 7

Hep A virus composition

Answer 7

Single stranded RNA

Question 8

Hep A spread

Answer 8

Faecal-oral route by contaminated food or water

Question 9

Hep A clinical features

Answer 9

15-45 days after exposure
Brief illness - days unless immunocompromised
No chronic disease
Vaccine available
Acute hepatitis: inflammation with areas of hepatocyte necrosis

Question 10

Hep B virus composition

Answer 10

dsDNA

Question 11

Hep B spread

Answer 11

Parenteral, vertical (from mom), or sexual transmission

Question 12

Hep B clinical features

Answer 12

40-180 days
Can cause acute and chronic liver disease (chronic more likely if at birth(
Vaccine available

Question 13

Hep B histology

Answer 13

Hepatocytes contain ground-glass cytoplasm inclusions of HBV
Pink, glassy inclusion (usually granular)
Expanded endoplasmic reticulum
Retraction artifacts around inclusion

Question 14

Hep C virus composition

Answer 14

ssRNA

Question 15

Hep C spread

Answer 15

Via sexual and parenteral transmission (blood products, shared needles, tattoos, neddlestick)

Question 16

Hep C clinical features

Answer 16

Major cause of chronic liver disease
May be asymptomatic for many years
Cancer associated
No vaccine, but successful treatment (>95%, but expensive)
HCV infection with portal-based inflammation and lymphoid aggregate

Question 17

Hep D virus composition

Answer 17

ssRNA - incomplete

Needs HBV to replicate

Question 18

Coinfection of HDV and HBV

Answer 18

Infected at the same time

Often more aggressive than HBV alone

Question 19

Superinfection of HDV and HBV

Answer 19

Infected with HDV after HBV

May cause fulminant liver failure

Question 20

Hep E virus composition

Answer 20

ssRNA

Question 21

Hep E spread

Answer 21

Faecal-oral and zoonotic roots of infection

Question 22

Hep E clinical features

Answer 22

Mild-severe acute hepatitis

May cause chronic liver disease in certain population (immunosuppressed)

Question 23

Fatty liver disease

Answer 23

Chronic liver disease
Alcoholic or non-alcoholic
Normal liver is 5% fat
Steatohepatitis

Question 24

Steatosis

Answer 24

Fat accumulation in liver

>5% fat

Question 25

Steatohepatitis

Answer 25

Fat injures cell organelles and membrane Eventual necrosis and collapse of cytoskeleton Necrosis resulting in inflammation and inducing fibrosis Deluming degeneration

Question 26

Non-alcoholic fatty liver disease risk factors (4)

Answer 26

1. Obesity 2. Diabetes 3. Metabolic syndromes 4. Certain drugs

Question 27

Autoimmune hepatitis

Answer 27

Autoimmune disorder Immune cells (plasma cells) injure hepatocytes Commonly in young females Most patients have other autoimmune disorders Areas of necrosis and plasma cell inflammation

Question 28

Clinical features of autoimmune hepatitis

Answer 28

Asymptomatic to fulminant liver failure | Steroids and immunosuppression to treat

Question 29

Primary biliary cholangitis

Answer 29

Sclerosis Autoimmune disease Middle-aged females Immune mediated destruction of small bile ducts URSO treatment Granulomatous inflammation - florid duct lesions

Question 30

URSO treatment

Answer 30

To treat primary biliary cholangitis Bile acid mimic Tricks body to produce less bile acid

Question 31

Primary sclerosing cholangitis

Answer 31

Unknown etiology, possible autoimmune component Patients usually young adult males Associated with ulcerative colitis Fibro-obliterative destruction of large bile ducts No treatment, only transplant Periductal onion-skin fibrosis surrounding destroying bile duct

Question 32

Alpha-1-anti-trypsin deficiency

Answer 32

Autosomal recessive disorder | SERPINA gene on chromosome 14

Question 33

SERPINA gene

Answer 33

Protease inhibitor

Question 34

Alpha-1-anti-trypsin deficiency in liver

Answer 34

Accumulation of A1AT protein leads to hepatocyte injury - droplets in cells Stained with PAD-S, pink/fuscia, found varying sizes

Question 35

Alpha-1-anti-trypsin deficiency in lungs

Answer 35

Absence of A1AT enzyme allows elastase to proceed uninhibited Destruction of lung parenchyma - emphysema

Question 36

Hereditary haemochromatosis

Answer 36

``` Autosomal recessive HFE gene (chromosome 6) Hepcidin production is altered and intestine absorbs too much ison Deposited into hepatocytes and other both sites causing injury ```

Question 37

Hepcidin

Answer 37

Binds to transglutaminase in small intestinal cells and regulates iron absorption

Question 38

Wilson's disease

Answer 38

``` Autosomal recessive ATP7B gene (chromosome 13) Low or decrease in ceruloplasmin Leads to accumulation of copper in tissues Irreversible psychosis ```

Question 39

Ceruloplasmin

Answer 39

Copper carrier protein

Question 40

Cirrhosis

Answer 40

Caused by viral infection or alcohol Viral: necrosis, inflammation, fibrosis Alcohol: scarring, regeneration (liver cells in fibrous nodules)

Question 41

Cirrhosis leads to (3)

Answer 41

1. Increased risk of death (liver failure, bleed from varices, coma) 2. Possible liver transplantation 3. Increased risk of cancer

Question 42

Liver cancer (2)

Answer 42

1. Hepatocellular carcinoma | 2. Cholagiocarinoma

Question 43

Hepatocellular carcinoma

Answer 43

Cancer arising from hepatocytes

Question 44

Cholagiocarcinoma

Answer 44

Cancer arising from bile ducts

Question 45

Pancreas function (2)

Answer 45

1. Exocrine pancreas | 2. Endocrine pancreas

Question 46

Exocrine pancreas

Answer 46

Secretes digestive enzymes into duodenum Amylase: starch Lipase: lipids Peptidases: protein

Question 47

Endocrine pancreas

Answer 47

Secretes hormones into circulation | Insulin and glucagon

Question 48

Acini

Answer 48

Pancreas cells that secrete thing going into ducts

Question 49

Beta cells

Answer 49

Produce insulin

Question 50

Diabetes

Answer 50

Systemic disorder characterized by hyperglycemia | Type 1 or type 2

Question 51

Symptoms of diabetes (4)

Answer 51

1. Polyuria (excess urination) 2. Polydypsia (thirst) 3. Polyphagia (hunger) 4. Organ damage

Question 52

Type 1 diabetes

Answer 52

Sudden onset in childhood Patients typically not obese Autoimmune disease with autoantibodies targeting insulin-producing endocrine pancreatic cells Patients require exogenous insulin therapy

Question 53

Type 2 diabetes

Answer 53

Typically middle-aged Gradual onset Obese and other metabolic syndrome components Insulin-producing cells of endocrine pancreas preserved Insulin receptors on target tissues have insulin resistance Lifestyle alterations, oral medications and insulin

Question 54

Acute pancreatitis

Answer 54

``` Alcohol + bile stones + unknown = 95% Exocrine pancreatic cell death Release of digestive enzymes, damaging remaining pancreas and adjacent fat (autodigestion) Gallstones Alcohol (slows down secretion) ```

Question 55

Chronic pancreatitis

Answer 55

Fibrosis and mild inflammation of pancreas Gradual onset May be preceded by acute pancreatitis Alcohol is 70% etiology

Question 56

Clinical features of chronic pancreatitis (4)

Answer 56

1. Endocrine insufficiency 2. Exocrine insufficiency (malabsorption, diarrhea) 3. Pain (fibrosis entraps nerves) 4. Increased risk of pancreatic cancer

Question 57

Pancreatic ductal adenocarcinoma

Answer 57

``` Most common pancreatic cancer Usually middle aged to elderly Mostly at head of pancreas Lead to jaundice (common symptom) 80% have cancer outside their pancreas at time of diagnosis ```