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JG Year 2 > 205 Alcoholism and Hepatitis > Flashcards

205 Alcoholism and Hepatitis Flashcards

1
Q

What divides the left and right lobes of the liver?

A

Hepatic vein

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2
Q

Which lobe contains the caudate and the quadrate lobes?

A

Right

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3
Q

How many segments are in the liver?

A

8

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4
Q

Where does blood from the sinusoids drain into?

A

Hepatic vein

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5
Q

Which lobe of the liver drains directly into the IVC?

A

Caudate

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6
Q

Where in the liver is lymph formed?

A

Perisinusoidal space

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7
Q

What is an acinus?

A

Functional unit of the liver

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8
Q

Where are Kupffer cells found and what is their function?

A

Surrounding the sinusoids - phagocytic cells

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9
Q

Where are stellate cells found? What do they contain?

A

In the space of Diss - contain desmin

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10
Q

What is the role of hepatic stellate cells?

A

Relatively quiescent until there is insult then involved in fibrosis

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11
Q

What is the role of lecithin-cholesterol acyltransferase?

A

Catalyses cholesterol to cholesterol ester

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12
Q

What is the role of hepatic lipase?

A

Removes TG from intermediate density lipoproteins –> LDLs

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13
Q

What are bile acids synthesised from?

A

Cholesterol

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14
Q

Which amino acids do cholic acid and chenodeoxycholic acid conjugate with to increase their solubility?

A

Taurine/glycine

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15
Q

Which cells of the liver breakdown RBCs?

A

Kupffer cells

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16
Q

What are the products when haem from a RBC is broken down?

A

Bilirubin and Iron

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17
Q

Which protein does bilirubin conjugate with in the spleen to be transported via blood to liver?

A

Albumin

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18
Q

What does bilirubin conjugate with in the liver?

A

glucuronic acid

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19
Q

Where are varices likely to form in chronic liver disease?

A

Oesophageal veins

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20
Q

What is the mechanism of fatty liver disease?

A

Fatty deposits start to occupy the space of Diss.
NAD+ is used in the metabolism of alcohol but it is also needed in the gluconeogenesis.
It promotes steatosis by stimulating the synthesis of fatty acids and opposing their oxidation

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21
Q

What toxin causes alcoholic hepatitis?

A

Acetaldehyde

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22
Q

Which cells infiltrate hepatocytes in chronic alcoholic hepatitis?

A

Eosinophils

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23
Q

Name 5 clinical features of alcoholic liver disease

7 listed

A 
Palmar erythema
Dupuytrens
Caput Medusae
Spider naevi
Ascites 
Gynaecomastia
Umbilical hernia
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24
Q

Name 3 complications of alcoholic liver disease

A 
Portal HTN
Spontaneous bacterial peritonitis
Acute decompensation
Hepato-renal syndrome
Hepatocellular carcinoma
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25
Q

What is hepato-renal syndrome?

A

Rapid deterioration of kidney function in liver cirrhosis

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26
Q

What is Wernicke’s encephalopathy?

A 
Neuro symptoms (ophthalmoplegia, ataxia, confusion) caused by thymine deficiency (essential for the carboxylation off pyruvate).
Causing damage to the mamillary bodies, medial thalamus, posterior hypothalamus as well as generalised cerebral atrophy.
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27
Q

What can Werincke’s encephalopathy develop into?

A

Korsakoff’s syndrome

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28
Q

What is Korsakoff’s syndrome?

A

Dementia with confabulation

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29
Q

Which 2 types of viral hepatitis is transmitted faeco-orally?

A

A and E

30
Q

Which types of viral hepatitis is transmitted parenterally?

A

B, C, D (in the presence of B)

31
Q

What are the features of the icteric phase of viral hepatitis?
(7 listed)

A 
Dark urine
Pale stool
Jaundice
Abdo pain
Pruritis
Arthralgia
Rash
32
Q

What is the post-exposure prophylaxis for HepB?

A

HBIG

33
Q

What is the commonest cause of acute hepatitis?

A

Hep E

RNA virus

34
Q

What is the incubation time of HepE?

A

40 days

35
Q

Which type of viral hepatitis causes chronic hepatitis?

A

HepB

36
Q

What is the treatment of HBV?

A

peg-interferon

37
Q

Where is HepC most common?

A

Egypt

38
Q

What is the treatment for HCV?

A

peg-interferon alpha 2a or 2b
+
ribavirin

39
Q

Which groups are most at risk of HCV?

4 listed

A

Recipients of clotting factors before 1987
IVDU
Long term haemodialysis pts
Individuals with >50 sexual partners

40
Q

Which type of viral hepatitis is only active in the presence of HBV?

A

HDV

41
Q

Which of the following treatments for hepatitis causes bone marrow suppression?

  • Rivaberin
  • Telaprevir
  • Interferon
A

Interferon

42
Q

Which of the following treatments for hepatitis can cause insomnia?

  • Rivaberin
  • Telaprevir
  • Interferon
A

Ribaverin

43
Q

Which of the following treatments for hepatitis is teratogenic?

  • Rivaberin
  • Telaprevir
  • Interferon
A

Ribaverin

44
Q

Which of the following treatments for viral hepatitis causes a rash in 50% of patients?

  • Rivaberin
  • Telaprevir
  • Interferon
A

Telaprevir

45
Q

What is the route of entry of drugs into the liver?

A

Via space of Disse

46
Q

Which enzyme is involved in phase I reactions in the liver?

A

Cytochrome P450

47
Q

Which 3 endogenous substrates are coupled with products of oxidation, reduction and hydrolysis of drugs in phase II reactions in the liver?

A

Glycine
Acetuc acud
Sulphuric acid

48
Q

Which enzyme acts here:

ethanol ——–> acetaldehyd

(alcohol metabolism in the liver)

A

Alcohol dehydrogenase

49
Q

Which enzyme acts here:

Acetaldehyde ———-> acetate

(alcohol metabolism in the liver)

A

Acetaldehyde dehydrogenase

50
Q

Which type of metabolism happens when there’s a low concentration of alcohol in the blood?

A

First pass

51
Q

Which type of metabolism happens when there’s a high concentration of alcohol in the blood?

A

Second pass

52
Q

How does alcohol affect cell membranes?

A

Increases membrane fluidity leading to increased membrane transport

53
Q

What is the effect of inhibition of NMDA receptor activation by alcohol?

A

Depression and memory loss

54
Q

What lipid accumulates in the liver in chronic alcohol consumption?

A

Triacylglycerol

55
Q

What type of virus is HepB?

A

DNA virus

56
Q

Which viral hepatitis doesn’t cause an acute reaction?

A

HBV

57
Q

What does a raised MCV in alcoholic liver disease suggest?

A

Folate deficiency

58
Q

What is the initial treatment of alcoholic hepatitis?

A

Prednisolone and pentoxyfylline

59
Q

What is the treatment for alcoholic fibrosis?

A

Abstinence
Naltrexone (opioid antagonist)
Baclofen (when severe)

60
Q

What could the outcome be if a large amount of alcohol is consumed in a period of low blood glucose?

A

Hypoglycaemia causing hypothermia

Ratio of NAD+ to NADH pushes equilibrium of lactate dehydrogenase towards lactate production which causes a decreased in pyruvate and therefore there is less available for gluconeogenesis.

61
Q

What are antimitochondrial antibodies associated with?

A

Primary biliary cirrhosis

62
Q

What are smooth muscle antibodies associated with?

A

Autoimmune hepatitis

63
Q

What are antinuclear cytoplasmic antibodies associated with?

A

Primary sclerosing cholangitis

64
Q

What is Gilbert’s syndrome?

A

Decreased activity in bilirubin diglucuronide causing increased unconjugated bilirubin and jaundice - harmless

65
Q

What feature on the LFT would be suggestive of pancreatic cancer?

A

Very high Alk Phos

66
Q

How does alcohol cause a sedative effect?

A

Potentiates the inhibition of GABA

67
Q

What are the 3 opioid receptor subtypes?

A

Mu
Kappa
Delta

68
Q

Give an example of a strong Mu opioid receptor agonist

A

Heroin

69
Q

What is the MOA of psychostimulants?

A

Puts the dopamine and NA transporter into reverse meaning increased concentration –> alertness, euphoria…

70
Q

What is the MOA of hallucinogens?

A

5HT2A receptor partial agonists

71
Q

Which pathway in the CNS is activated in drugs of abuse?

A

Mesolimbic dopamine pathway

JG Year 2 (28 decks)

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