2. Cell Injury

Question 1

What is the number 1 drug cause of fulminant hepatitis?

Answer 1

Acetaminophen - from free radical damage

Question 2

Where in the liver does acetaminophen toxicity manifest?

Answer 2

Right around the central vein

Question 3

What is the treatment for acetaminophen toxicity?

Answer 3

N-acetylcysteine

Question 4

What is the neutralizer for superoxide?

Answer 4

Superoxide dismutase (SOD)

Question 5

Where does glutathione come from?

Answer 5

HMP shunt (also generates NADPH)

Question 6

What is glutathione’s main function?

Answer 6

Neutralize free radicals - especially anything that comes from peroxide

Question 7

What does N-acetylcysteine do?

Answer 7

N-acetylcysteine is the substrate for glutathione –> body makes more glutathione –> can neutralize the free radicals from acetaminophen

Question 8

How does leucovorin rescue work with methotrexate?

Answer 8

Leucovorin is a substrate for DNA so that body can overcome the block of dihydrofolate reductase?

Question 9

How does acetaminophen affect the kidney?

Answer 9

Destroys the medulla (over years)

Question 10

What are the enzymes involved in signaling of apoptosis?

Answer 10

Caspases

Question 11

What organs would you expect to be pale with infarction?

Answer 11

Organs with good consistency - heart, kidney, liver, spleen

Question 12

What organs would you expect to be hemorrhagic with infarction?

Answer 12

Organs with meshy consistency - lungs, testes, bowel

Question 13

Where do most emboli in systemic circulation arise?

Answer 13

Left side of the heart

Question 14

The arrythmia most associated with embolization in the systemic circulation is?

Answer 14

Atrial fibrillation (stasis of blood in the atria, clot, and then embolus)

Question 15

Dry gangrene foot - problem where?

Answer 15

Diabetes in popliteal artery (atherosclerosis)

Question 16

How do infarcts usually arise?

Answer 16

Lumen narrowing from atherosclerotic plaque (ischemia) then a thrombus

Question 17

What is the most common cause of intestinal infarct?

Answer 17

Adhesions from previous surgery

Question 18

What is the second most common cause of intestinal infarct?

Answer 18

Piece of bowel trapped in indirect inguinal hernia

Question 19

What is the exception to coagulation necrosis underlying the infarction?

Answer 19

Brain - instead see liquefactive necrosis (cystic spaces)

Question 20

What is analogous to the fibroblast in the brain?

Answer 20

Astrocyte

Question 21

What cells mediate liquefactive necrosis?

Answer 21

Neutrophils (acute inflammation/infection) with the one exception being infarct in the brain

Question 22

Why does staph tend to produce an abscess?

Answer 22

Coagulase - tends to localize the infection and neutrophils can’t get out

Question 23

What is the most common cause of bronchopneumonia?

Answer 23

Strep pneumo

Question 24

Where do we see infarction in the lung?

Answer 24

Periphery, wedge-shaped

Question 25

What does caseating granulomas mean?

Answer 25

Mycobacteria or systemic fungal (the lipid in the cell wall gives it the cheese-like consistency)

Question 26

Where does pancreatic inflammation radiate pain to?

Answer 26

Back

Question 27

Where does peptic ulcer disease radiate pain to?

Answer 27

Epigastric

Question 28

What kind of necrosis occurs in pancreatitis?

Answer 28

Fat enzymatic necrosis - unique to the pancreas

Question 29

What does enzymatic necrosis look like?

Answer 29

Saponification - chalky white calcified areas (appear on X ray)

Question 30

What color does calcium appear as?

Answer 30

Blue

Question 31

Which one is more specific for the pancreas - amylase or lipase?

Answer 31

Lipase

Question 32

What tends to be the underlying cause of enzymatic necrosis?

Answer 32

Alcoholism

Question 33

What is fibrinoid necrosis?

Answer 33

Immunologic disease with necrosis that looks fibrin-like

Question 34

What is palpable purpura?

Answer 34

Type III hypersensitivity, small vessel disease

Question 35

How do you get damage in type III hypersensitivity?

Answer 35

Deposition of immune complexes --> activates complement --> C5a --> recruit neutrophils which are really what mediate the damage

Question 36

When do we see nutmeg liver?

Answer 36

Right sided heart failure - congested liver

Question 37

What happens to the liver if you block the portal vein?

Answer 37

Nothing - portal vein is before liver

Question 38

What happens to the liver if you block the hepatic vein?

Answer 38

Congested liver

Question 39

What part of the liver does yellow fever like to hit?

Answer 39

Zone 2

Question 40

What part of the liver is most susceptible to injury?

Answer 40

Zone 3 - right around the central vein because it gets the least amount of oxygen (zone 1 gets the most oxygen from the sinusoids, then zone 2, and finally zone 3)

Question 41

What's the most common cause of fatty change in liver?

Answer 41

Alcohol (NADH and acetyl coA)

Question 42

What acid base change do we tend to see in alcoholics?

Answer 42

Fasting hypoglycemia with lactic acidosis (pyruvate shunted to lactate) and ketoacidosis (lots of acetyl coA)

Question 43

What's the main ketone body?

Answer 43

Beta hydroxybutyrate