In a liver lobule, bile drains toward ______
the portal triad/canal
annular pancreas
- failure of ventral bud of pancreas to meet with dorsal bud
- history of pancreatitis
- circles around duodenum –> vomiting
esophageal atresia
- absence of passage/abnormal narrowing of esophagus
- most common: blind esopheal pouch and tracheoesophageal fistula
- can bring bowel up to connect two parts
- present with throwing up and cyanosis/trouble breathing
Hep b: Total Anti-Hbc
- IgG antibody to core antigen
- indicates previous infection or chronic infection
- stays elevated for life
what causes micronodular cirrhosis?
alcohol and metabolic disease
Autoimmune Hepatitis type 1 antibody
- anti-smooth muscle antibody
- against F actin
- also ANA
Hepatitis A
- non-enveloped RNA picorna virus
- oral-fecal transmission
- common in countries with poor water/food sanitation
- antibody is protective
- symptomatic 3-6 weeks after infection (when ALT is highest)
- viral load lowest by 9 weeks (when IgG is at highest)
- if IgM positive and IgG negative, then acute infection
- if IgG positive but IgM negative, then vaccinated or previous infection
- fever, elevated transaminases (AST and ALT), Jaundice, abdominal pain and diarrhea
Zone __ of the liver is oxygen and nutrient rich, whereas zone ___ is oxygen and nutrient poor
1,3
What are two important tests for liver function?
- albumin and prothrombin time
Hep b: HbsAg
- surface antigen
- active infection
Hep b: HbcAg
- core antigen
- not used much for testing
which vessel solely supplies the hepatic bile ducts (and hepatocellular cancer)
hepatic artery
Hepatitis D
- RNA delta virus
- bloodborne
- DEFECTIVE: NEED Hep B surface antigen in order to survive
- co-infection with hep B (at the same time)
- superinfection (get infected with it with preexisting hep b)
duodenal atresia
- non biliary vomiting
- double bubble sign
- common in down syndrome babies
choledocholithiasis
gallstones in the bile duct
Which zone of the liver is responsible for lipid synthesis and glycolysis?
3
malrotation
- bowel doesn’t do physiological rotation during gestation
- cecum in upper quadrant instead of RLQ due to ladd’s bands
- ladd bands wrap around duodenum (or volvulus, intestine spins around itself)
Histologically, ground glass hepatocytes indicate what?
hepatitis B (or hep b carrier)
Hep b: HbeAg
- antigen (biproduct protein of viral replication)
- indicates active viral replication
pyloric stenosis
- baby boys>baby girls
- non bilious projectile vomiting
- olive sign
biliary atresia
- jaundice
- abnormal LFTs
what is the most common malignant liver tumor
metastatic tumor from a different organ
primary biliary cholangitis antibody
- anti mitochondrial antibody
- against E2 of pyruvate dehydrogenase complex
primary sclerosing cholangitis antibody
- p ANCA
same for ulcerative colitis, which they are at high risk for
Hep b: IgM Anti-Hbc
- IgM antibody to core antigen
- indicates acute/recent infection
In a liver lobule, blood moves from ___ to ____.
from the portal triad to the central vein
omphalocele
- inability of bowel to come back down after physiological hernia (will be stuck in umbilical lining as opposed to gastroschisis)
hirschprung disease
- baby doesn’t excrete meconium by 48 hours
- narrowed rectum, dilated sigmoid colon
- due to neural crest cells not migrating properly, making aganlionosis
Meckel’s diverticulum
- blood in stool (plus anemia)
- remnant of umbilical duct
- usually gastric remnant
- rule of 2’s: 2% of population, 2 yrs old, 2 inches long, 2 feet from cecum
what causes macronodular cirrhosis?
viral hepatitis
autoimmune hepatitis type 2 antibody
- anti liver kidney microsomal antibody
- against CP450
- also ANA
Hepatitis B
- hepaDNAvirus
- bloodborne
- 90 day incubation
- 95% adults clear infection, children more likely to have chronic
- suppress, but never fully clear chronic infection
- jaundice, elevated AST and ALT, fever, rash and arthralgias
- Asia and Africa
Hep b: Anti- Hbs
- antibody to surface antigen
- if you have this and nothing else, = immunity (vaccination)
What is the most common benign liver tumor
cavernous hemiangioma
Which zone of the liver is responsible for gluconeogenesis?
1 (high energy process, gets the most nutrients)
choledochocysts
- congenital dilation of ducts
- jaundice, pain, lipase elevation
- can go undetected as an adult
cholecystolithiasis
gallstones in the gall bladder
Hepatitis C
- RNA flavivirus
- bloodborne
- can be asymptomatic for decades
- 80% develop chronic, 20% clear (cure) on their own
- can form cirrhosis/hepatocellular cancer
- antibody is NOT protective (there is no immunity to hep c, can get infected many times)
Which vessel supplies 2/3 of blood to the liver?
hepatic portal vein
gastroschisis
- congenital formation of abdominal wall
- bowel and contents spill out as opposed to omphalocele
During a liver disease process, what happens to the sinusoids?
- stellate cells in the space of disse lay down collagen
- capillaries of endothelium loose fenestration (“capillarization”)
- -> portal hypertension and ascites
intussusception
- currant jelly stools, palpable mass
- bowel looping into itself
- look for leadpoint lesion (can be caused by viral infection increase lymph/peyer’s patch size)
Hep b: Anti- Hbe
- cleared infection or chronic infection with low transmission rate
reciprocal innervation of gut smooth muscle
- when circular muscle of a region is excited/contracted, the longitudinal muscle relaxes/inhibited and vice versa
- if both were excited, would not result in propulsion
law of intestine
- if an area of the gut were to be stimulated, there would be a stereotypic response with orad contraction and caudad relaxation
type of contraction: segmentation
- localized contractions and relaxations that aren’t designed to move food long distance
- help MIX food with enzymes
- frequency follows slow wave frequency of region (if slow, then slow mixing, if fast, then fast mixing)
- duodenum is fastest and it decreases oral to anal
type of contraction: tonic contraction
- basally contracted
ex: sphincters
type of contraction: peristalsis
- orad contraction, caudad relaxation
- used to move food along gi tract
- in esophagus, vasovagal long arc reflex
- in stomach, short waves
- in intestine: short arc reflex completely within ENS
three types of contraction in the colon
- segmentation/mixing
- haustral
- high amplitude/mass movements (BIG CONTRACTION FOR POOPING)
haustral contractions
- anti- peristalsis in the colon (anal to oral)
- used to store poop in the colon (keep in the colon instead of moving towards rectum)
- allows for microbiota to act on undigested material
migrating motor/myeoelectric complex
- digestive housekeeper
- occurs between meals, stops when you start eating (peristalsis/segmentation takes over)
- clears tract of residue/particles
- phase 1 (10 min)- quiescent, no waves above threshold
- phase 2 (30-45 min)- inconsistent random waves above threshold
- phase 3 (5- 10 min)- all waves above threshold, contractions af
juvenile polyps mutation
SMAD4
what is the most common infection in hospital cirrhotics
spontaneous bacterial peritonitis
which disease presents similarly to budd chiari syndrome, but involves central veins and non hepatic veins and is almost always associated with chemo therapy
hepatic veno-occlusive disease