Portal HTN- GI

Question 1

Cirrhosis cause diffuse bridging fibrosis (via ____ cells) and regenerative _____ which disrupt normal architecture of liver;Increases the risk for _____

Answer 1

stellate
nodules
hepatocellular carcinoma

Question 2

3 unique clinical findings of Cirrhosis

Answer 2

Juandice
Ascities
Splenomegaly

(JAS, girl, you’ve got cirrhosis)

Varices

Question 3

Etiologies of Cirrhosis include alcohol, ______, chronic viral hepatitis (HCV), auto immune hepatitis, ______, genetic/metabolic disorders like _____ & _____

Answer 3

non alcoholic steatohepatitis

biliary disease

ARPKD & Alpha 1 antitrypsin deficiency

Question 4

Cirrhosis is the number 1 cause of

Answer 4

Protal HTN

Question 5

Etiologies of Portal HTN include cirrhosis, vascular obstruction like ___ & ____, and lastly, _____ infection

Answer 5

portal vein thrombosis
Budd-Chiari syndrome
Schistosomiasis

Question 6

Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis

Answer 6

Budd-Chiari syndrome

Question 7

How can you tell its Budd-Chiari syndrome and not cirrhosis yet?

Answer 7

No JVD

Question 8

May cause nutmeg liver (molted bumpy appearance)

Answer 8

Budd-Chiari syndrome

Question 9

Budd-Chiari syndrome can be caused associated with (3)

Answer 9

Post-partum

Polycythemia Vera

Anything making you hypercoagulable (OCPs, Nephrotic syndrome, HCC)

Question 10

Cirrhosis with PAS + globules

Answer 10

Alpha 1 antitrypsin deficiency

Question 11

Dyspnea
Cirrhosis
Non-smoker

Answer 11

Alpha 1 antitrypsin deficiency

Question 12

Caused by misfolded protein aggregates in the hepatocyte Rough Endoplasmic Reticulum

Answer 12

Cirrhosis from Alpha 1 antitrypsin mutation

Question 13

Wilson’s disease (Elf)
Hemachromatosis
can cause

Answer 13

HCC

Question 14

HCC is associated with what elevated marker

Answer 14

alpha fetoprotein

Question 15

Tender Hepatomegaly
Polycythemia (increased RBC count)
Ascites

Answer 15

HCC

Question 16

HCC specific carcinogen

Answer 16

Aflatoxins from Aspergillus

Question 17

In Portal HTN, Esophageal varices are created when ____ vein cannot feed blood to the Portal vein (due to obstruction usually) and anastamoses with the _____ vein (causing it to dilate inside the esophagus) which then drains to _____ vein which goes to the IVC.

Answer 17

Left Gastric
Distal Esophageal
Azygous

Question 18

In Portal HTN, Caput Medusae varices are created when ____ vein cannot feed blood to the Portal vein (due to obstruction usually) and anastamoses with the _____ vein (located on the anterior abdominal wall) which drains into the common iliac vein which goes to the IVC.

Answer 18

Paraumbilical

Epigastric

Question 19

In Portal HTN, Anorectal varices are created when ____ vein (which comes directly from the _____ that cannot feed blood to the Portal vein, due to obstruction usually) and anastamoses with the ___ & ___ vein which drains into the common iliac vein which goes to the IVC.

Answer 19

Superior Rectal

Inferior Rectal and Middle Rectal

Question 20

Treatment of Portal HTN, with a ____ between the portal vein and ____ vein relieves portal hypertension by shunting blood to the systemic circulation, bypassing the liver, but it can precipitate _____ due toclearance of ammonia from shunting

Answer 20

trans jugular intrahepatic porto systemic shunt (TIPS)

hepatic

hepatic encephalopathy

Question 21

Non-alcoholic
Obese or Diabetic
Liver cirrhosis (Juandiced/Portal HTN)
ALT>AST

Answer 21

Non-alcoholic Fatty liver

Question 22

AST>ALT
Mallory bodies (damaged eosinophilic keratin filaments inside cells)
Swollen/Necrotic/Neutrophilic liver

Answer 22

Alcoholic Hepatitis

Question 23

IRREVERSIBLE
Sclerosis around Central Liver vein
Nodules with fibrous septa
Portal HTN

Answer 23

Alcoholic Cirrhosis

Question 24

Hepatic steatosis is a fatty change in the liver that is reversible with

Answer 24

ALcohol Cessation

Question 25

_____ is used to induce natriuresis and resolve ascites without blocking the critical vasoconstrictive effects of angiotensin.

Answer 25

Spironolactone, an aldosterone antagonist

Question 26

Elevated ___ concentrations increase the likelihood of gallstone formation. 

Answer 26

cholesterol

Question 27

High levels of _____ and ____ increase cholesterol solubility and decrease the risk of gallstones.

Answer 27

bile salts | phosphatidylcholine

Question 28

Crohn disease & Terminal Ilieum resection/ disease are prone to developing gallstones due to the _____ which promotes _____ of the bile, resulting in gallstone formation.

Answer 28

decreased bile acid reabsorption | cholesterol supersaturation

Question 29

causes hepatocyte ballooning/swelling degeneration and apoptosis with mononuclear cell infiltration.

Answer 29

Acute hepatitis due to most hepatotropic viruses

Question 30

_____ assessed via prothrombin time, bilirubin, albumin, cholesterol ____intactness assessed via transaminase (AST/ALT) ____ intactness assessed via alkaline phosphatase (AP), γ-glutamyl transferase

Answer 30

Liver functionality Liver structural integrity and cellular biliary tract structural integrity and cellular

Question 31

Serum ___ levels can be of assistance in determining the extent of liver failure, gastrointestinal bleeding, or metabolic conditions

Answer 31

ammonia

Question 32

Measurement of ______ can be of assistance in distinguishing hemolytic conditions from hepatic dysfunction or bile duct obstruction.

Answer 32

unconjugated bilirubin (especially in contrast to conjugated bilirubin)

Question 33

Penicillamine, a first-line treatment for Wilson disease, is a copper chelating agent that increases the ____

Answer 33

urinary excretion of copper

Question 34

Zinc decreases ______ and can be used in conjunction with penicillamine to treat Wilson disease.

Answer 34

intestinal absorption of copper

Question 35

Pathogenesis of Wilson disease involves impaired hepatocellular copper transport, which results in decreased ______

Answer 35

biliary excretion of copper