Adult liver disease

Question 1

lymphocyte inflammation in hepatitis

Answer 1

can be present in many hepatitides; common in VIRAL

Question 2

neutrophil inflammation in hepatitis

Answer 2

common in steatohepatitis

Question 3

eosinophil inflammation in hepatitis

Answer 3

common in drug injury

Question 4

plasma cell inflammation in hepatitis

Answer 4

autoimmune hepatitis

Question 5

most common cause of chronic liver disease

Answer 5

hep C

Question 6

Labs: evidence of hepatocyte injury

causes: acute viral infection and drug injury
histology: lobular disarray, marked inflammation throughout, widespread hepatocyte injury, NO FIBROSIS

Answer 6

acute hepatitis

Question 7

Causes: chronic viral hepatitis, autoimmune hepatitis, drug injury

histology: less inflammation and injury, portal tract-based inflammation, FIBROSIS

long-standing ( > 6 mo)

Answer 7

chronic hepatitis

Question 8

can accumulate in hepatocyte cytoplasm during liver injury

Answer 8

fat = steatosis
bile = cholestasis
iron = hemosiderosis/genetic hemochromatosis
copper = wilson disease/chronic cholestasis
viral particles = viral hepatitis

Question 9

ground glass hepatocytes

Answer 9

viral infection

Question 10

process of fibrotic change in hepatocytes

Answer 10

chronic cycles of injury/regeneration –> activated stellate cells deposit collagen –> architectural and vascular reorganization –> cirrhosis

Question 11

On biopsy, “stage” refers to:

Answer 11

amount of fibrous tissue deposition

Question 12

On biopsy, “grade” refers to:

Answer 12

amount of inflammation and injury

Question 13

transmitted fecal-oral

Answer 13

hep A, hep E

Question 14

transmitted through parenteral, sexual contact, perinatal routes

Answer 14

hep B

Question 15

transmitted through parenteral route

Answer 15

hep C, hep D

Question 16

viruses that can cause chronic liver disease

Answer 16

hep C > 80%

hep B = 10%

Question 17

hep virus diagnosed via PCR

Answer 17

hep C

Question 18

hep virus diagnosed by presence of surface antigen or antibody to core antigen

Answer 18

hep B

Question 19

what percent of patients who develop cirrhosis secondary to hep C go on to die?

Answer 19

50%

Question 20

major cause of chronic liver disease WORLDWIDE

Answer 20

hep B

Question 21

areas with highest prevalence of chronic HBV

Answer 21

northern canada, alaska, northern amazon, africa, SE asia

Question 22

what percent of patients infected with HBV go on to develop chronic hepatitis?

Answer 22

less than 5%

Question 23

presence of serum HBeAg, HBV-DNA and IgM anti-HBc would signify:

Answer 23

acute, active HBV infection

Question 24

presence of serum IgG anti-HBs and IgG anti-HBc

Answer 24

chronic HBV infection

Question 25

effect of hep D coinfection with HBV

Answer 25

potentiates effects of HBV –> increased risk of fulminant hepatitis, faster progression to end-stage liver disease

Question 26

woman presents with a history of other autoimmune diseases

Answer 26

autoimmune hepatitis

Question 27

serology of autoimmune hepatitis

Answer 27

autoantibodies (ANA, ASMA, anti-LKMB), elevated IgG

Question 28

plasma cell-rich chronic hepatitis

Answer 28

autoimmune hepatitis

Question 29

middle-aged woman presents with pruritus, jaundice; elevated alk phos, GGT, bilirubin

Answer 29

primary biliary cirrhosis

Question 30

serology of primary biliary cirrhosis

Answer 30

anti-mitochondrial antibody, elevated IgM

Question 31

prognosis of primary biliary cirrhosis

Answer 31

25% with liver failure in 10y

Question 32

patient presents with progressive fatigue, pruritus and jaundice. elevated alk phos. history of ulcerative colitis

Answer 32

primary sclerosing cholangitis

Question 33

diagnosis of primary sclerosing cholangitis

Answer 33

cholangiography –> stenosis of ducts

Question 34

histology: periductal “onion skin” fibrosis

Answer 34

primary sclerosing cholangitis

Question 35

what lobule zone is affected by acetaminophen toxicity

Answer 35

zone 3 = centrilobular necrosis

Question 36

causes of hepatic steatosis

Answer 36

metabolic syndrome (T2DM), alcohol, drugs, Wilson disease, viral infection

Question 37

mechanism of steatosis

Answer 37

lipid influx > lipid clearance

Question 38

steatosis with associated hepatocellular injury

Answer 38

steatohepatitis

Question 39

mechanism of alcohol steatosis/steatohepatitis

Answer 39

increased liplysis and de novo lipogensis from carbs; blocked B oxidation and VLDL generation

Question 40

histology: neutrophilic infiltrates, Mallory bodies

Answer 40

alcohol steatosis

Question 41

genetic iron overload disease, throughout the body –> liver disease, diabetes, heart failure

Answer 41

hereditary hemochromatosis

Question 42

hereditary hemochromatosis genetics

Answer 42

autosomal recessive HFE gene mutations (C282Y and H63D) –> abnormal regulation of Fe absorption

Question 43

genetic copper overload throughout the body –> liver disease, neuropsych sx

Answer 43

Wilson disease

Question 44

Wilson disease genetics

Answer 44

autosomal recessive mutation in ATP7B gene –> disrupted bile excretion of copper

Question 45

autosomal recessive disease that most often presents with pulmonary emphysema, but can also involve liver disease

Answer 45

a1-antitrypsin deficiency

Question 46

normal/abnormal genotypes for alpha-1-antitrypsin

Answer 46

normal = PiMM
abnormal = PiZZ

Question 47

histology: PASD stain –> pink globules

Answer 47

alpha-1-antitrypsin deficiency

Question 48

malignant liver masses in adults

Answer 48

hepatocellular carcinoma, cholangiocarcinoma

Question 49

benign liver masses in adults

Answer 49

hemangioma, focal nodular hyperplasia, hepatocellular adenoma