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Pathoma > 11.3 - Liver > Flashcards

11.3 - Liver Flashcards

1
Q

what protein carries unconjugated bilirubin to the liver?

A

albumin

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2
Q

what enzyme conjugates bilirubin?

A

uridine glucuronyl transferase (UGT)

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3
Q

what converts conjugated bilirubin to urobilinogen?

A

intestinal flora

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4
Q

intestinal flora convert conjugated bilirubin to _____________

A

urobilinogen

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5
Q

what happens to urobilinogen after being converted from conjugated bilirubin by intestinal flora?

A

oxidized to stercobilin and urobilin

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6
Q
  • dark urine due to increased urine urobilinogen

- increased risk for pigmented bilirubin gall stones

A

extravascular hemolysis or ineffective erythropoiesis

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7
Q

what is the etiology of extravascular hemolysis or ineffective erythropoiesis?

A

high levels of UCB overwhelm the conjugating ability of the liver

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8
Q

what is the what is the lab finding in extravascular hemolysis or ineffective erythropoiesis?

A

increased UCB

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9
Q

what does phototherapy do for neonatal jaundice?

A

makes UCB more soluble (does NOT conjugate it)

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10
Q

what is the etiology of physiologic jaundice of the newborn?

A

newborn liver has transiently low UGT activity

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11
Q

what is the lab finding in physiologic jaundice of the newborn?

A

increased UCB

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12
Q

jaundice during stress (infection), otherwise not clinically significant

A

gilbert syndrome

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13
Q

what is the etiology of gilbert syndrome? what is the inheritance?

A
  • mildly low UGT activity

- AR

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14
Q

what is the lab finding in gilbert syndrome?

A

increased UCB

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15
Q

presents with kernicterus, usually fatal

A

crigler najjar syndrome

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16
Q

what is the etiology of crigler najjar syndrome?

A

absence of UGT

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17
Q

what is the lab finding in crigler najjar syndrome?

A

increased UCB

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18
Q

black / dark liver, otherwise not clinically significant

A

dubin-johnson syndrome

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19
Q

what is the etiology of dubin-johnson syndrome? what is the inheritance?

A
  • deficiency of bilirubin canalicular transport protein

- AR

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20
Q

what is the lab finding in dubin-johnson syndrome?

A

increased CB

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21
Q
  • dark urine
  • pale stool
  • pruritis
  • hypercholesterolemia with xanthomas
  • steatorrhea with malabsorption of fat soluble vitamins
A

biliary tract obstruction (obstructive jaundice)

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22
Q

what is the etiology of obstructive jaundice?

A

associated with gall stones, pancreatic carcinoma, cholangiocarcinoma, parasites, liver fluke

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23
Q

what are the lab findings in biliary tract obstruction?

A
  • increased CB
  • decreased urine urobilinogen
  • increased alk phos
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24
Q
  • dark urine

- urine urobilinogen normal or decreased

A

viral hepatitis

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25
Q

what are the lab findings in viral hepatitis?

A

increase in both CB and UCB

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26
Q

an increase in both CB and UCB should make you think of what etiology for dark urine?

A

viral hepatitis

27
Q

what hepatitis antigen signifies infectivity?

A

HBeAg

28
Q

what is the only marker seen during the window period of HBV?

A

HBcAb (IgM)

29
Q

the inflammation in viral hepatitis predominantly involves what structure(s)?

A

portal tract

30
Q

what is cirrhosis?

A

end stage liver damage characterized by disruption of the normal hepatic parenchyma by bands of fibrosis and regenerative nodules of hepatocytes

31
Q

the fibrosis in hepatitis is mediated by __________, which comes from _________

A

TGF-B from stellate cells

32
Q

the degree of deficiency of clotting factors in hepatitis is followed by measuring what parameter?

A

PT

33
Q

what molecule mediates the damage of alcohol related liver disease?

A

acetaldehyde

34
Q

what is the histological appearance of alcohol related liver disease?

A

swelling of hepatocytes with formation of Mallory bodies

35
Q

what are mallory bodies composed of? in which condition are they seen?

A
  • damaged cytokeratin filaments

- alcohol related liver disease

36
Q

where is AST located within hepatocytes?

A

mitochondria

37
Q

what is the ALT : AST ratio in nonalcoholic fatty liver disease?

A

ALT greater than AST

38
Q

tissue damage in hemochromatosis is mediated by ___________

A

free radicals

39
Q

what is the inheritance of hemochromatosis?

A

AR

40
Q

primary hemochromatosis is due to mutations in what gene?

A

HFE

41
Q

what is the triad for hemochromatosis?

A
  • cirrhosis
  • secondary DM
  • bronze skin
42
Q

what are the labs in hemochromatosis?

A
  • increased ferritin
  • low TIBC
  • high serum iron
  • high % sat
43
Q

what does biopsy show for hemochromatosis?

A

accumulation of brown pigment in hepatocytes

44
Q

what is the treatment for hemochromatosis?

A

phlebotomy

45
Q

wilson disease is due to a mutation in what gene?

A

ATP7B

46
Q

wilson disease presents in childhood with:

A
  • cirrhosis
  • neuro manifestations (behavior, dementia, chorea, parkinsonian symptoms)
  • kayser fleisher rings in cornea
47
Q

where does copper accumulate in the brain of patients with wilson disease?

A

basal ganglia

48
Q

what are the labs for wilson disease?

A
  • high urine copper
  • low serum Cp
  • high copper on liver biopsy
49
Q

what is the treatment for wilson disease?

A

D-penicillamine (chelator)

50
Q

what auto antibody is present in primary biliary cirrhosis?

A

AMA

51
Q

primary biliary cirrhosis is an autoimmune granulomatous destruction of ___________ (intrahepatic / extrahepatic) bile ducts

A

intrahepatic

52
Q

primary sclerosing cholangitis is inflammation and fibrosis of __________ (intrahepatic / extrahepatic / both) bile ducts

A

both

53
Q

onion skin appearance - which biliary condition? what is the cause?

A
  • primary sclerosing cholangitis

- periductal fibrosis

54
Q

“beads on a string” - which biliary condition?

A

primary sclerosing cholangitis

55
Q

primary sclerosing cholangitis is associated with what colon disease?

A

UC

56
Q

what autoantibody is present in primary sclerosing cholangitis?

A

p-ANCA

57
Q

how does reye syndrome present?

A
  • hypoglycemia
  • elevated liver enzymes
  • N / V
  • possible coma and death
58
Q

which liver tumor is associated with contraceptive use?

A

hepatic adenoma

59
Q

subcapsular liver tumor that carries a risk of rupture and intraperitoneal bleeding; grow with exposure to estrogen

A

hepatic adenoma

60
Q

aflatoxins from aspergillus can cause ____________ (cancer type) due to induction of _________ mutations

A
  • hepatocellular carcinoma

- p53

61
Q

hepatocellular carcinoma carries an increased risk for what syndrome?

A

budd chiari syndrome

62
Q

what is budd chiari syndrome? how does it present?

A
  • liver infarction due to hepatic vein obstruction

- painful hepatomegaly and ascites

63
Q

what is the serum tumor marker for HCC?

A

AFP

64
Q

what are the most common sources for metastatic HCC?

A
  • colon
  • pancreas
  • lung
  • breast

Pathoma (120 decks)

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