Liver Path III

Question 1

consequences of cirrhosis, male

Answer 1

hepatic encephalopathy
esophageal varices
splenomegaly

Question 2

consequences of cirrhosis, females

Answer 2

oligomenorrhea, amenorrhea, sterility, hypogonadism

Question 3

jaundice

Answer 3

yellow staining of membranes by bilirubin

Question 4

cholestasis

Answer 4

inability to excrete bile

Question 5

bile salts

Answer 5

can lead to pruritis - itching

also malabsorption of fats - no Vit K dependent clot factors

Question 6

cholesterol retention

Answer 6

eruptive xanthomas - periorbital or tendinous

Question 7

canal of hering

Answer 7

travel of bile - to portal tract

Question 8

small ductule cholangioncytes

Answer 8

canal of hering

imflammation/proliferation

Question 9

large ductule cholangiocytes

Answer 9

volume/alkalinity

Question 10

cholestasis and parenchyma

Answer 10

enlarged hepatocytes, dilated canalicular spaces, apoptotic cells, kupffer cells present

Question 11

portal tract and cholestasis

Answer 11

edema, bile pigment retention, neutro inflammation

Question 12

UDP

Answer 12

uridine diphosphatase - conjugates bilirubin with glucuronic acid

Question 13

unconjugated bilirubin

Answer 13

binds albumin

-not excreted in kidney

Question 14

conjugated bilirubin

Answer 14

does not bind albumin - lost in urine

Question 15

urobilinogen

Answer 15

brown color of stool and yellow color of urine

Question 16

choluria

Answer 16

dark urine

Question 17

pale stool

Answer 17

in cholestasis

-no bilirubin to darken stool - stercobilinogen

Question 18

unconjugated hyperbilirubinemia

Answer 18

hemolysis
gilbert
crigler najjar

Question 19

mixed hyperbilirubinemia

Answer 19

look at AST, ALT, alk phos, and GGT

high AST, ALT - hepatic
high alk phos and GGT - cholestatic

Question 20

AST < ALT

Answer 20

viral serology

Question 21

AST > ALT

Answer 21

alcoholic liver disease

Question 22

20-30yo with black liver

Answer 22

dubin johnson

Question 23

high conjugated bilirubin

Answer 23

dubin johnson

rotor syndrome

Question 24

gilbert

Answer 24

shortage of enzyme
-jaundice under stress

unconjugate bilirubin high

Question 25

crigler najjar type 1

Answer 25

no enzyme -kerniceterus - levels >20 bad unconjugated bilirubin high

Question 26

crigler najjar type 2

Answer 26

some enzyme bilirubin 6-20 unconjugated bilirubin high

Question 27

bilirubin in urine

Answer 27

always pathological - detected on dipstick

Question 28

delta-bilirubin

Answer 28

in plasma bound to albumin not measured longer half life this is why after hepatitis starts to resolve or obstruction treated - conjugated levels take some time to return to normal

Question 29

neonatal jaundice

Answer 29

cannot conjugate 2 weeks old physiologic jaundice of newborn that goes away -unconjugated worse with breast feeding deconjugating enzymes in milk

Question 30

alpha1 antitrypsin deficiency

Answer 30

can cause neonatal jaundice

Question 31

neonatal jaundice causes

Answer 31

biliary atresia - require surgery non-biliary disorders - alpha1 antitrypsin deficiency idiopathic

Question 32

panlobular giant cell transformation of hepatocytes

Answer 32

neonatal hepatitis

Question 33

biliary atresia

Answer 33

jaundice before 8 weeks old in neonate -elevated conjugated** two forms - fetal and perinatal

Question 34

fetal biliary atresia

Answer 34

aberrant intrauterine development of biliary tree - situs inversus, congenital heart disease

Question 35

perinatal biliary atresia

Answer 35

most common** bile ducts destroyed after birth - unknown etiology type 1 - common duct type 2 - right or left hepatic bile duct type 3 - common - above porta hepatis - not correctable**

Question 36

cholestasis histo

Answer 36

zone 3 bilirubin in hepatocytes and bile canaliculi zone 1 ductule proliferation and fibrosis

Question 37

large bile duct injury

Answer 37

classically obliterative cholangitis immunohisto stain IgG4 positive plasma cells surrounding bile duct

Question 38

ampulla of vater

Answer 38

bile ducts dump into duodenum

Question 39

acute jaundice

Answer 39

flu-like, RUQ pain, acholic stool, choluria, pruritis, eruptive jaundice, encephalopathy

Question 40

chronic jaundice

Answer 40

cirrhosis portal HTN, ascites, variceal hemorrhage

Question 41

spider angiomata

Answer 41

chronic jaundice - estrogenic

Question 42

ALT/AST measure of hepatocyte integrity

Answer 42

viral infection - destroy hepatocyte | cirrhosis - can have normal levels

Question 43

most common cause of elevated AST/ALT

Answer 43

NASH

Question 44

AST:ALT greater than 1

Answer 44

more likely alcohol and never >500 greater than 300 - consider infection, toxic insult

Question 45

more specific indicator

Answer 45

ALT

Question 46

GGT

Answer 46

specific to liver can isolate liver as source of problem

Question 47

mild increase in GGT

Answer 47

more than 3 drinks/day

Question 48

alk phos and GGT

Answer 48

induced enzymes

Question 49

albumin

Answer 49

measure of hepatocyte function | -half life 20 day - slow changes

Question 50

protime

Answer 50

measure of hepatocyte function must rule absorption of vit K factors**

Question 51

IgA

Answer 51

alcoholic liver disease

Question 52

IgM

Answer 52

primary biliary cirrhosis

Question 53

IgG

Answer 53

autoimmune hepatitis

Question 54

liver biopsy

Answer 54

gold standard cholestasis - ultrasound hepatitis - lab tests

Question 55

child pugh score

Answer 55

used in chronic liver disease - cirrhosis class determines one and 3 year survival - based on looking at bilirubin, albumin, PT, ascites, and hepatic encephalopathy