Liver Pathology

Question 1

What is the most severe type of liver disease?

Answer 1

Hepatic failure

Question 2

What are two pathways of hepatic failure?

Answer 2

Chronic/progressive liver disease and acute/massive liver damage

Question 3

How much of the liver must be lost before failure ensues?

Answer 3

80 to 90%

Question 4

What are five complications of hepatic failure?

Answer 4

Coagulopathy, hepatic encephalopathy, hepatorenal syndrome, portopulmonary hypertension, hepatopulmonary syndrome

Question 5

What are two major causes of acute liver failure with massive hepatic necrosis?

Answer 5

Drugs (acetaminophen) and viral hepatitis B and C

Question 6

List two examples of hepatic dysfunction without overt necrosis

Answer 6

Reye syndrome, drug/toxin induced

Question 7

What are six clinical signs of hepatic failure?

Answer 7

Jaundice, hypoalbuminemia, hyperammonemia, encephalopathy, Palmar erythema, spider angioma

Question 8

Why does hypoalbuminemia lead to edema?

Answer 8

Causes impaired protein (albumin) synthesis which leads to decreased osmotic pressure

Question 9

What are the four types of liver disease?

Answer 9

Hepatic failure, cirrhosis, portal hypertension, cholestasis

Question 10

What are some signs of hepatic encephalopathy?

Answer 10

Behavioral changes, confusion, stupor leading to coma

Question 11

What are neurological signs of encephalopathy?

Answer 11

Hyperreflexia, EEG changes, seizures, asterixis (flapping tremor)

Question 12

What are potential effects of elevation of blood ammonia (NH4+)?

Answer 12

Impaired neuronal function, brain edema

Question 13

At what level of serum bilirubin does jaundice occur?

Answer 13

Greater than 2 mg/dL

Question 14

What is the most common cause of jaundice with accumulation of conjugated bilirubin?

Answer 14

Hepatitis and intra- or extra-hepatic obstruction of bile flow

Question 15

What is the most common cause of accumulation of unconjugated bilirubin?

Answer 15

Hemolytic anemia

Question 16

What is cholestasis?

Answer 16

Impairment of bile flow resulting in retention of bilirubin, bile acids, and cholesterol

Question 17

What is cirrhosis of the liver?

Answer 17

Fibrosis of liver (normal liver architecture converts to form structurally abnormal nodules)

Question 18

List five causes of cirrhosis

Answer 18

Viral Hepatitis (B and C), alcoholic steatohepatitis, nonalcoholic steatohepatitis, autoimmune hepatitis, and hemochromatosis

Question 19

What are three complications of cirrhosis?

Answer 19

Progressive liver failure, portal hypertension, hepatocellular carcinoma

Question 20

What conditions can occur as a result of portal hypertension?

Answer 20

Ascieties, varices, splenomegaly, encephalopathy

Question 21

List examples of intrahepatic resistance

Answer 21

Cirrhosis or non-cirrhotic occlusion/increased vascular tone

Question 22

List examples of pre-hepatic resistance

Answer 22

Portal vein thrombosis

Question 23

List examples of post-hepatic resistance

Answer 23

Hepatic vein thrombosis, Budd Chiari syndrome

Question 24

What is ascities?

Answer 24

Collection of serous fluid in peritoneal cavity containing large amount of protein and influx of PMNs

Question 25

What is a portosystemic shunt?

Answer 25

Divergence of blood between shared capillary beds in response to rise in portal venous pressure

Question 26

What is caput medusae?

Answer 26

Distended paraumbilical veins that radiate from umbilicus to systemic veins in response to portal hypertension

Question 27

What is hepato- renal syndrome?

Answer 27

Acute renal failure secondary to liver failure (unknown cause) causing drop in urine output and azotemia

Question 28

List potential causes of nonalcoholic fatty liver disease

Answer 28

Obesity, type two diabetes, metabolic syndrome, hyperlipidemia, rapid weight loss and parenteral feeding

Question 29

Which antibody is present in person is protected against HBV?

Answer 29

Anti-HBs

Question 30

Outline the timeline of HBV infection

Answer 30

Symptom onset is four weeks after exposure (3 antigens have formed), recovery onset is 16 weeks after exposure, most antibodies form 16 to 22 weeks after exposure and remain in system (anti-HBs last to form)

Question 31

Contrast antibodies formed in hep B versus hep C

Answer 31

Antibodies formed in hep B are protective | Hep C antibodies are only useful as markers for the disease

Question 32

How long is the incubation period for HCV?

Answer 32

Average of 6 to 12 weeks

Question 33

What are the most common symptoms of chronic hepatitis?

Answer 33

Fatigue, weight loss/loss of appetite, occasional bouts of jaundice

Question 34

What are two clinical signals of cholestatic liver damage?

Answer 34

Elevations in bilirubin and alkaline phosphate

Question 35

When would you perform a proactive cholecystectomy?

Answer 35

For a polyp greater than 1 cm or gallstones greater than 3 cm

Question 36

What comprises a typical gallstone?

Answer 36

80% are made of cholesterol, 20% consist of calcium salts with bilirubin

Question 37

What three factors contribute to gallstone formation?

Answer 37

Abnormalities in bile composition, bile stasis, gallbladder inflammation

Question 38

What are risk factors for cholelithiasis?

Answer 38

Obesity, advanced age, female sex, multiple pregnancies, oral contraceptives, malabsorption disorders (of bile salts), certain drugs