Aani CP: Kidney & Liver

Question 1

Risk Factors for renal stones?

Answer 1

• Dehydration
• Acidic urine (because citrate inhibits its formation. We make citrate when urine pH is alkaline), therefore red meat & renal acidosis can make acidic urine)
• Certain inflamm conditions e.g. Chrons, Arthritis

Question 2

What can renal stones be made up of?

Answer 2

• Calcium Oxalate/Phosphate
• Phosphate
• Uric Acid
• Cysteine
• Mixed calcium
  + Others

Question 3

Which renal stones are radiolucent?

Answer 3

• Uric Acid
• Cysteine

‘Ur C thru’ - Uric Cysteine

Question 4

Causes of Calcium Oxalate stones?

Answer 4

Increased Oxalate intake, increased calcium intake (or other causes of high calcium)

Question 5

Which calcium do we measure?

Answer 5

Total serum calcium

Question 6

How do we calculate the corrected calcium level?

Answer 6

It takes albumin into account. (Measured - (0.02 x (40-albumin))

Question 7

Pre-renal causes of AKI?

Answer 7

Hypoperfusion
Volume depletion/sepsis
Renal ischaemia
Drugs affecting glomerular flow

Question 8

How to measure AKI severity?

Answer 8

Urine output & creatinine

Question 9

Painless jaundice and an enlarged gallbladder- Diagnosis?

Answer 9

NOT gallstones. Likely pancreatic mass

Question 10

Treatment of acidosis due to CKD?

Answer 10

Sodium bicarbonate

Question 11

Why do you get anaemia in CKD?

Answer 11

Less erythropoietin

Question 12

Why do you get osteomalacia in CKD?

Answer 12

Less 1 alpha hydroxylase so less active Vit D. Vit D deficiency = osteomalacia

Question 13

What is the name of the space between the hepatic sinusoid and the hepatocytes?

Answer 13

Space of Disse

Question 14

Describe the liver cells in alcoholic hepatitis?

Answer 14

Swollen (ballooning)

Question 15

Which cells do you often find in a swollen alcoholic hepatitis liver?

Answer 15

Mallory Denk Bodies

Question 16

What causes portal hypertension?

Answer 16

Fibrosis/scarring of liver tissue

Question 17

Describe the mitochondria in alcoholic hepatitis?

Answer 17

MEGAmitochondria

Question 18

Which enzume is reduced in Gilbert’s?

Answer 18

UPD Glucoronyl Transferase (leading to increased unconjugated bilirubin in blood)

Question 19

Which enzyme conjugates Bilirubin?

Answer 19

UDP glucoronyl transferase

Question 20

What gives poo it’s brown colour?

Answer 20

Stercobilinogen is oxidised in the gut to stercobilin which is brown

Question 21

What happens to billirubin after it has been conjugated?

Answer 21

It is transported into bile canaliculi and then released into the gut. There it is converted into stercobilinogen.
Some stercobilinogen is oxidised in the gut to stercobilin which is brown
Some stercobilinogen is converted into urobilinogen and oxidised to urobilin which is yellow and excreted in the urine

Question 22

What is the name of the transporter that carried conjugated bilirubin into the bile canaliculi ?

Answer 22

MRP2 transporter

Question 23

Which can you directly measure: conjugated or unconjugated bilirubin?

Answer 23

Conjugated can be directly measured (van den bergh)

Question 24

Why does unconjugated bilirubin not enter the urine?

Answer 24

Because it is bound to albumin

Question 25

Explain the symptoms of pancreatic carcinoma?

Answer 25

• High serum bilirubin. The bile duct is blocked so bilirubin cannot be excreted
• The bilirubin cannot be converted into stercobilinogen –> pale stool
• The urobilinogen is not made. Bilirubin leaks into urine –> dark urine