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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
What is hepato-renal syndrome?
Rapid deterioration of kidney function in liver cirrhosis
26
What is Wernicke's encephalopathy?
``` 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. ```
27
What can Werincke's encephalopathy develop into?
Korsakoff's syndrome
28
What is Korsakoff's syndrome?
Dementia with confabulation
29
Which 2 types of viral hepatitis is transmitted faeco-orally?
A and E
30
Which types of viral hepatitis is transmitted parenterally?
B, C, D (in the presence of B)
31
What are the features of the icteric phase of viral hepatitis? (7 listed)
``` Dark urine Pale stool Jaundice Abdo pain Pruritis Arthralgia Rash ```
32
What is the post-exposure prophylaxis for HepB?
HBIG
33
What is the commonest cause of acute hepatitis?
Hep E | RNA virus
34
What is the incubation time of HepE?
40 days
35
Which type of viral hepatitis causes chronic hepatitis?
HepB
36
What is the treatment of HBV?
peg-interferon
37
Where is HepC most common?
Egypt
38
What is the treatment for HCV?
peg-interferon alpha 2a or 2b + ribavirin
39
Which groups are most at risk of HCV? | 4 listed
Recipients of clotting factors before 1987 IVDU Long term haemodialysis pts Individuals with >50 sexual partners
40
Which type of viral hepatitis is only active in the presence of HBV?
HDV
41
Which of the following treatments for hepatitis causes bone marrow suppression? - Rivaberin - Telaprevir - Interferon
Interferon
42
Which of the following treatments for hepatitis can cause insomnia? - Rivaberin - Telaprevir - Interferon
Ribaverin
43
Which of the following treatments for hepatitis is teratogenic? - Rivaberin - Telaprevir - Interferon
Ribaverin
44
Which of the following treatments for viral hepatitis causes a rash in 50% of patients? - Rivaberin - Telaprevir - Interferon
Telaprevir
45
What is the route of entry of drugs into the liver?
Via space of Disse
46
Which enzyme is involved in phase I reactions in the liver?
Cytochrome P450
47
Which 3 endogenous substrates are coupled with products of oxidation, reduction and hydrolysis of drugs in phase II reactions in the liver?
Glycine Acetuc acud Sulphuric acid
48
Which enzyme acts here: ethanol --------> acetaldehyd (alcohol metabolism in the liver)
Alcohol dehydrogenase
49
Which enzyme acts here: Acetaldehyde ----------> acetate (alcohol metabolism in the liver)
Acetaldehyde dehydrogenase
50
Which type of metabolism happens when there's a low concentration of alcohol in the blood?
First pass
51
Which type of metabolism happens when there's a high concentration of alcohol in the blood?
Second pass
52
How does alcohol affect cell membranes?
Increases membrane fluidity leading to increased membrane transport
53
What is the effect of inhibition of NMDA receptor activation by alcohol?
Depression and memory loss
54
What lipid accumulates in the liver in chronic alcohol consumption?
Triacylglycerol
55
What type of virus is HepB?
DNA virus
56
Which viral hepatitis doesn't cause an acute reaction?
HBV
57
What does a raised MCV in alcoholic liver disease suggest?
Folate deficiency
58
What is the initial treatment of alcoholic hepatitis?
Prednisolone and pentoxyfylline
59
What is the treatment for alcoholic fibrosis?
Abstinence Naltrexone (opioid antagonist) Baclofen (when severe)
60
What could the outcome be if a large amount of alcohol is consumed in a period of low blood glucose?
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
What are antimitochondrial antibodies associated with?
Primary biliary cirrhosis
62
What are smooth muscle antibodies associated with?
Autoimmune hepatitis
63
What are antinuclear cytoplasmic antibodies associated with?
Primary sclerosing cholangitis
64
What is Gilbert's syndrome?
Decreased activity in bilirubin diglucuronide causing increased unconjugated bilirubin and jaundice - harmless
65
What feature on the LFT would be suggestive of pancreatic cancer?
Very high Alk Phos
66
How does alcohol cause a sedative effect?
Potentiates the inhibition of GABA
67
What are the 3 opioid receptor subtypes?
Mu Kappa Delta
68
Give an example of a strong Mu opioid receptor agonist
Heroin
69
What is the MOA of psychostimulants?
Puts the dopamine and NA transporter into reverse meaning increased concentration --> alertness, euphoria...
70
What is the MOA of hallucinogens?
5HT2A receptor partial agonists
71
Which pathway in the CNS is activated in drugs of abuse?
Mesolimbic dopamine pathway

JG Year 2 (28 decks)

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