Liver Function (Part 2)

Question 0

ESSAY
Pre-Hepatic jaundice
-Four specific causes

Answer 0

Hemolysis, ineffective erythropoiesis, increased turnover of non hemoglobin heme compounds, hematoma

Question 1

ESSAY
Pre-hepatic jaundice
-general cause

Answer 1

any process that causes premature RBC destruction and increased production of unconjugated bilirubin

Question 2

ESSAY
Pre-hepatic jaundice
-explanation of typical serum total, unconjugated and conjugated bilirubin levels, urine bilirubin level, fecal and urine urobilinogen levels (increased or decreased)

Answer 2

unconjugated: increased; conjugated: Normal; urine bilirubin: Neg/normal; fecal and urine urobilinogen: increased

Question 3

ESSAY
Post-hepatic jaundice
-General cause

Answer 3

caused by any process that prevents excretion of conjugated bilirubin (biliary obstructive disease)

Question 4

ESSAY
Post-hepatic jaundice
-Three specific causes

Answer 4

Ductal occlusion by stones, spasms or strictures, compression by neoplastic diseases (tumors)

Question 5

ESSAY
Post-hepatic jaundice
-Explanation of typical serum total, unconjugated and conjugated bilirubin, urine bilirubin level, fecal and urine urobilinogen levels (increased or decreased)

Answer 5

Serum total: increased; unconjugated: Normal; conjugated: increased; urine bili: positive; fecal and urine urobili: decreased to absent

Question 6

ESSAY
Post-Hepatic jaundice
-four enzymes that are elevated to a significant degree

Answer 6

ALP, GGT, LAP, 5’-NT

Question 7

In hepatic (hepatocellular) jaundice the hepatocyte itself is sick; which functions are impaired?

Answer 7

Normal functions of uptake, conjugation, and/or excretion of bilirubin are impaired

Question 8

ESSAY
Hepatocellular Disease
-Causes

Answer 8

all 3 processes (uptake, conjugation, and exretion of bilirubin) are impaired
Most common cause is HEPATITIS

Question 9

ESSAY
Hepatocellular Disease
-1 Expected serum total, 2 unconjugated, and 3 conjugated bilirubin levels

Answer 9

1 increased 2 increased 3 increased

Question 10

ESSAY
Hepatocellular Disease
-Urine bilirubin level

Answer 10

positive

Question 11

ESSAY
Hepatocellular Disease
-fecal and urine urobilinogen levels

Answer 11

normal to decreased

Question 12

ESSAY
Hepatocellular Disease
-Elevated enzymes in hepatitis

Answer 12

AST, ALT (ALT>AST), ALP, LD4/LD5, ammonia

Remember cannot detoxify ammonia to urea so the BUN will be low!

Question 13

ESSAY
Gilbert’s Disease
-Causes

Answer 13

Pre-conjugation transport failure

Question 14

ESSAY
Gilbert’s Disease
-1 serum total, 2 unconjugated, and 3 conjugated bilirubin

Answer 14

1 increased 2 increased 3 decreased

Question 15

ESSAY
Gilbert’s Disease
-urine bilirubin

Answer 15

Negative

Question 16

ESSAY
Gilbert’s Disease
-fecal and urine urobili

Answer 16

decreased (normal)

Question 17

ESSAY
Crigler-Najjar syndrome
-causes

Answer 17

conjugation failure

Question 18

ESSAY
Crigler-Najjar syndrome
-expected 1 serum total, 2 unconj, and 3 conj

Answer 18

1 increased 2 increased 3 decreased

Question 19

ESSAY
Crigler-Najjar syndrome
-urine bili

Answer 19

NEgative

Question 20

ESSAY
Crigler-Najjar syndrome
-fecal and urine urobili

Answer 20

decreased

Question 21

ESSAY
Physiologic jaundice of the newborn
-Causes

Answer 21

Conjugation failure (common/normal), liver not yet producing UDP-glucuronyl transferase yet b/c immature

Question 22

ESSAY
Physiologic jaundice of the newborn
-1 serum total, 2 unconjugated, 3 conjugated

Answer 22

1* 2 increased 3 NONE

Question 23

ESSAY
Physiologic jaundice of the newborn
-Urine bili levels

Answer 23

*

Question 24

ESSAY Physiologic jaundice of the newborn -fecal and urine urobilinogen levels

Answer 24

*

Question 25

ESSAY Dubin-Johnson Syndrome -Causes

Answer 25

Post-Conjugation transport failure

Question 26

ESSAY Dubin-Johnson Syndrome -1 serum total, 2 unconjugated, and 3 conjugated

Answer 26

1 increased 2 normal 3 increased

Question 27

ESSAY Dubin-Johnson Syndrome -urine bili level

Answer 27

positive

Question 28

ESSAY Dubin-Johnson Syndrome -fecal and urine urobilin levels

Answer 28

decreased/normal

Question 29

Specific range of total bilirubin levels in the blood at which jaundice is observed

Answer 29

>2.0-3.0 mg/dL

Question 30

7 clinical manifestations of liver disease

Answer 30

jaundice, portal hypertension, hepatic failure/encephalopathy, altered drug metabolism, disordered hemostasis, endocrine abnormalities, and immunoglobulin abnormalities

Question 31

Causes of toxic hepatitis

Answer 31

acetamenophen, heavy metals, drugs, poison causing liver necrosis

Question 32

Fecal-oral transmission; infection is often transmitted in restaurants or households

Answer 32

Hepatitis A

Question 33

Routes of transmission of this disease include heterosexual sex, homosexual sex, mother to child, sharing needles, receipt of blood products, and needlestick injury

Answer 33

Hepatitis B

Question 34

Routes of transmission of this disease include blood transfusions, sharing of needles, mother to baby, body piercing, tattooing, and unprotected sex with multiple partners

Answer 34

Hepatitis C

Question 35

This disease coexists with Hep B and shares similar routes of transmission

Answer 35

Hepatitis D

Question 36

This disease is transmitted by fecal-oral route; raw sewage can spread this disease to contaminate food and drinking water

Answer 36

Hepatitis E

Question 37

This virus can live in humans without causing infection; can act as a co-infection with Hep C in order to show symptoms

Answer 37

Hepatitis G

Question 38

a two-phase illness associated with a previous viral illness (flu, cold, chicken pox, etc) for which aspirin or salicylate-containing medications were given

Answer 38

Reye's Syndrome

Question 39

In Reye's Syndrome, abnormal accumulations of fat develop in the _____, along with a severe increase of pressure in the brain

Answer 39

Liver

Question 40

Symptoms of Reye's Syndrome as it progresses

Answer 40

viral illness, repetitive vomiting, lethargy, delirium, decorticate coma, decerebrate coma, flaccid coma; unless diagnosed and treated successfully, death is common within a few days or a few hours

Question 41

4 lab results that are increased in Reye's Syndrome

Answer 41

ALT/AST, PLASMA AMMONIA, hypoglycemia in infants, and fatty deposits in liver

Question 42

Seven causes of cirrhosis

Answer 42

Viral Hep B or Hep C, toxic alcohol or methotrexate administration, Wilson's Disease, Alpha-1-antitrypsin deficiency, and hemochomatosis

Question 43

Metal involved in Wilson's Disease

Answer 43

Copper

Question 44

Results in deposits of copper in brain, liver, kidney, and cornea; neurological degeneration; cirrhosis; and Kayser-Fleischer Rings

Answer 44

Wilson's Disease

Question 45

Expected 1 plasma cerulopasmin, 2 serum copper levels, and 3 urine copper levels in Wilson's Disease

Answer 45

1 decreased 2 increased 3 increased

Question 46

Metal involved in primary hemochomatosis

Answer 46

Iron

Question 47

Expected 1 iron, 2 ferritin, 3 and total iron binding capacity in primary hemochomatosis

Answer 47

1 increased 2 increased 3 decreased

Question 48

Treatment of primary hemochromatosis

Answer 48

Therapeutic phlebotomy

Question 49

autoimmune etiology; many patients have AMA's (anti-mitochondrial antibodies), damage in bile duct causing scarring and altered immunity; itching, weight loss, fatigue; primarily in women 40-60

Answer 49

Primary Biliary Cirrhosis

Question 50

Inflammation and scarring of the bile ducts; primarily in males 20-30; associated with ulcerative colitis

Answer 50

Primary Sclerosing Cholangitis

Question 51

Neonatal (physiologic) jaundice is a transient, ________ occurence

Answer 51

NORMAL

Question 52

Significance of Neonatal jaundice

Answer 52

reaction of mother's milk due to immature liver; can cause kernicterus, infiltrating the brain and causing severe damage

Question 53

Treatment for neonatal jaundice

Answer 53

discontinue breast feeding, treat with UV light source (phototherapy), exchange transfusion in extreme cases