Alcoholic hepatitis Flashcards
How many main lobes does the liver have?
1 - 2
2 - 4
3 - 6
4 - 8
2 - 4
- the 2 main lobes are the right and left lobes
- 2 accessory lobes are the quadrate and caudate
What are the superior border or the liver called?
1 - visceral peritoneum
2 - diaphragmatic surface
3 - visceral surface
4 - right triangular ligament
2 - diaphragmatic surface
What are the inferior border or the liver called?
1 - visceral peritoneum
2 - diaphragmatic surface
3 - visceral surface
4 - right triangular ligament
3 - visceral surface
The liver is covered by a serous membrane and 5 peritoneal folds. What is the name of the large white structure on the anterior section of the liver that anchors the liver to the anterior surface of the abdominal cavity?
1 - round ligament
2 - diaphragmatic surface
3 - falciform ligament
4 - right triangular ligament
3 - falciform ligament
A hilum is a hollow or narrow opening in an organ through which nerves, blood vessels, and tubes enter. What is this called in the liver?
1 - porta hepatis
2 - diaphragmatic surface
3 - falciform ligament
4 - right triangular ligament
- porta hepatis
Which of the following does NOT pass through the hilium of the liver called the portal hepatis?
1 - portal vein
2 - hepatic artery proper
3 - common hepatic duct
4 - nerves and lymphatics
5 - common bile duct
5 - common bile duct
The ligamentum teres (round ligament) is an attachment to the falciform ligament on the anterior section of the liver. What is this a remnant of?
1 - portal vein
2 - hepatic artery
3 - umbilical cord
4 - splenic artery
3 - umbilical cord
Once the hepatocytes have created the bile, it then makes it way to be stored in the gall bladder. Organise the order this process takes place:
1 - common hepatic duct merges with cystic duct
2 - bile canaliculi join to form left and right hepatic ducts
3 - cystic duct merges with common bile duct
4 - left and right hepatic ducts converge into common hepatic duct
2 - bile canaliculi join to form left and right hepatic ducts
4 - left and right hepatic ducts converge into common hepatic duct
1 - common hepatic duct merges with cystic duct
3 - cystic duct merges with common bile duct
Is the majority of blood in the liver from the arterial or venous supply?
- venous
- arterial = 25%
- venous = 75%
The liver is located in the foregut. What is the main artery supplying the foregut?
1 - superior mesenteric artery
2 - inferior mesenteric artery
3 - coeliac artery
4 - abdominal artery
3 - coeliac artery
The liver is located in the foregut. What is the main vein draining the foregut?
1 - superior mesenteric vein
2 - inferior mesenteric vein
3 - superior vena cava artery
4 - portal vein
4 - portal vein
Which of the following is NOT one of the 3 main branches of the coeliac artery?
1 - left gastric artery
2 - splenic artery
3 - hepatic artery
4 - right gastric artery
4 - right gastric artery
- left gastric supplies stomach
- splenic supplies spleen
- hepatic supplies liver
The largest vein in the body supplies blood to the liver, what is this vein called?
1 - inferior vena cava
2 - inferior mesenteric vein
3 - superior vena cava artery
4 - portal vein
4 - portal vein
- it is valveless
The blood arriving in liver via the portal vein is deoxygenated, but what does it contain a lot of?
1 - nutrients from the GIT
2 - toxins from the GIT
3 - drugs from the GIT
4 - all of the above
4 - all of the above
Hepatocytes are the functional cells of the liver. How much of the liver do they make up?
1 - 10%
2 - 20%
3 - 40%
4 - 60%
4 - 60%
The liver contains hepatic lobules that resemble a hexagon. On the peripheries of this hexagon are triads. Which of the following is NOT contained within these triads?
1 - arteriole
2 - lymph nodes
3 - venule
4 - bile duct
2 - lymph nodes
- lymphatic and nerves are present here as well
The triads that are on the peripheries of the hepatic lobules are triads containing arterioles, venules and bile ducts. What is at the centre of the hexagon shaped hepatic lobules?
1 - portal vein
2 - supervior vena cava
3 - porta hepatis
4 - central vein
4 - central vein
- central vein drains into the portal vein that subsequently drains into the superior vena cava
The liver can be separated into 8 segments, called Couinaud segments. Why is this important?
1 - all segments are independent from one anther and can be removed easily
2 - some segments have no physiological relevance and can be used in transplants
3 - identifies which segments are more likely to become cancerous
4 - all of the above
1 - all segments are independent from one anther and can be removed easily
- each segment has its own vascular inflow, bilary and lympahtic
The liver contains the porto-systemic anastomosis, which is a communication between the portal and the systemic venous system. Why is this important?
1 - ensures all blood is filtered in the liver
2 - ensures all bile is reabsorbed by the liver
3 - if the liver is damaged blood can be diverted so it returns to the heart
4 - all of the above
3 - if the liver is damaged blood can be diverted so it returns to the heart
The liver contains the porto-systemic anastomosis, which is a communication between the portal and the systemic venous system. This ensures that if the liver is damaged blood can be diverted so it returns to the heart. Which of the following does this NOT typically cause in chronic liver disease?
1 - haemorrhoid’s
2 - varicose veins
3 - heart failure
4 - umbilicus caput medusae
5 - ascites
6 - splenomegaly
3 - heart failure
- does not typically cause heart failure
What is the weekly recommended alcohol intake in the UK?
1 - <6 units
2 - <12 units
3 - <14 units
4 - <20 units
3 - <14 units
When alcohol reaches the liver where it needs to be metabolised, it typically enters one of 3 pathways, but all eventually lead to the formation of Acetaldehyde. Which one of the following is NOT one of these 3 pathways?
1 - formaldehyde
2 - alcohol dehydrogenase
3 - catalysed by peroxisomes
4 - cytochrome P450
1 - formaldehyde
Once ethanol has been metabolised and turned into Acetaldehyde by the enzyme alcohol dehydrogenase (ADH). ADH then used NAD+ to oxidise the acetaldehyde, which can lead to lots of NADH and few NAD+. What 2 things does this lead to?
1 - increased fatty acids synthesis
2 - reduced fatty acid synthesis
3 - increased fatty acid oxidation
4 - reduced fatty acid oxidation
1 - increased fatty acids synthesis
- creation of free fatty acids
4 - reduced fatty acid oxidation
- using fatty acids for energy
- both of these lead to alcoholic fatty liver due to excessive calories and fat build up
How can excess fat deposited in the liver be seen on histology?
1 - white circles of fat
2 - fibrosis
3 - immune cell infiltration
4 - all of the above
1 - white circles of fat
In addition to alcoholic fatty liver, which of the following can excessive ethanol which leads to excessive levels of Acetaldehyde lead to?
1 - increased ROS and cell damage
2 - increased acetaldehyde adducts
3 - increased immune response, specifically neutrophils
4 - damage and inflammation of hepatocytes called alcoholic hepatitis
5 - all of the above
5 - all of the above
In alcoholic hepatitis, we can see a specific change on histology. What is the most obvious change indicating alcoholic hepatitis?
1 - mallory bodies
2 - cytotoxic T cells
3 - dendritic cells
4 - pseudo-tumours
1 - mallory bodies
Which immune cell is often raised in alcohol hepatitis?
1 - macrophages
2 - eosinophils
3 - neutrophils
4 - dendritic cells
3 - neutrophils
Which of the following are common symptoms a patient with alcoholic hepatitis?
1 - hepatomegaly
2 - raise temp, HR and RR
3 - painful liver
4 - diarrhoea and vomiting
5 - all of the above
5 - all of the above
Which of the following are common clinical signs of a patient with alcoholic hepatitis?
1 - raised neutrophils
2 - hepatomegaly
3 - jaundice (sclera 1st due to high elastin)
4 - raised liver enzymes (AST, ALT, ALP, GGT)
5 - raised WCC and reduced platelets
6 - increased INR and urea
7 - all of the above
7 - all of the above
In alcoholic hepatitis, which liver enzyme is often raised the highest?
1 - Alanine transaminase (ALT)
2 - Aspartate Aminotransferase (AST)
3 - Gamma-glutamyl Transferase (GGT)
4 - Alkaline phosphotase (ALP)
2 - Aspartate Aminotransferase (AST)
- ALT is also much higher than GGT and ALP
In alcoholic hepatitis we can often see clotting problems, why is this?
1 - lower levels of clotting factors
2 - damaged liver cannot make clotting factors
3 - damaged liver cannot process vitamin K
4 - all of the above
4 - all of the above
- factors I (fibrinogen), II (prothrombin), V, VII, IX, X, XI, XII
- remember 2+5=7, 9, 10, 11 and 12
Why does alcoholic hepatitis lead to jaundice?
1 - damaged liver is unable to to conjugate water insoluble unconjugated bilirubin
2 - hepatocytes are damaged and make up bile ducts, so bile leaks out
3 - undamaged hepatocytes are unable to process excessive bilirubin
4 - all of the above
4 - all of the above
What % of patients with alcoholic hepatitis leads to alcoholic cirrhosis?
1 - 10%
2 - 30%
3 - 50%
4 - 80%
4 - 80%
- 10% advance to hepatic failure
Ascites can be common in alcoholic hepatitis, so they must be screened for what?
1 - infection
2 - blood present in drain
3 - spontaneous bacterial peritonitis
4 - all of the above
4 - all of the above
- if SBP is present it must be treated
In a patient with alcoholic hepatitis, stopping alcohol is important. All of the following can be given to help patients in alcohol withdrawal, but which is typically the 1st line?
1 - Lorazepam IM
2 - Chlordiazepoxide PO
3 - prabrinex
2 - Chlordiazepoxide PO
- Lorazepam IM is used if unable to take medication PO
Which vitamins are important in a patient with alcoholic hepatitis and is having alcohol withdrawal?
1 - thiamine (B1)
2 - vitamin K
3 - prabrinex (B1, B2, B6, nicotinamide, vitamin C and glucose)
4 - all of the above
4 - all of the above
Optimising nutrition is important in patients with alcoholic hepatitis is they are malnourished. What is the common recommendation for kcal based on ideal body weight?
1 - 10-20kcal/kg/day
2 - 20-30kcal/kg/day
3 - 35-40kcal/kg/day
4 - 50-60kcal/kg/day
3 - 35-40kcal/kg/day
In patient withy alcoholic hepatitis, should protein be removed from the diets?
- no
- typically give 1.2g/kg/day
- ensuring protein is present reduces the risk of sepsis, encephalopathy and mortality
In addition to abstinence and optimising nutrition, which other medication can be used in patients with alcoholic hepatitis?
1 - steroids
2 - NSAIDs
3 - opioids
4 - muscarinic antagonists
1 - steroids
Decompensated cirrhosis is defined as an acute deterioration in liver function in a patient with cirrhosis. Which of the following is NOT typically present in these patients?
1 - jaundice
2 - ascites
3 - congestive heart failure
4 - hepatic encephalopathy
5 - hepatorenal syndrome
6 - variceal haemorrhage.
3 - congestive heart failure
What is the median survival following the 1st episode of decompensated cirrhosis?
1 - 2 years
2 - 4 years
3 - 8 years
4 - 12 years
2 - 4 years
Which of the following is NOT typically a cause of decompensated cirrhosis?
1 - Infection – e.g spontaneous bacterial peritonitis (SBP) in ascites
2 - Hepatocellular cancer (HCC)
3 - Electrolyte abnormalities
4 - GI bleeding
5 - Congestive heart failure
6 - Natural progression of their liver disease e.g actively drinking
5 - Congestive heart failure
What scoring tool can be used to assess the mortality in liver cirrhosis?
1 - CIWA score
2 - Audit C score
3 - Wells score
4 - Child Pugh Score
4 - Child Pugh Score
- uses ascites, encephalopathy, bilirubin, albumin, INR
