Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI Week 4 > Ch 18 Robbins part I > Flashcards

Ch 18 Robbins part I Flashcards

1
Q

Serum alkaline phosphatase tests look for damage to the?

A

Bile canaliculus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some tests that look for hepatocyte synthetic function?

A

1) Coagulation factors: PT, PTT, fibrinogen, prothrombin, factors V, VII, IX, and X
2) Serum ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are reversible changes in hepatocytes?

A

Steatosis and cholestasis (Accumulation of fat and bilirubin in the liver respectively)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hepatocyte necrosis is the predominant mode of death in what type of injury?

A

Ischemic/hypoxic injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are signs of hepatocyte apoptosis?

A

1) Councilman bodies (aka acidophil bodies)

2) Yellow fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Regarding regeneration in the liver, stem cell replenishment is not a significant part of?

A

Parenchymal repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute hepatic failure is associated with what potential complications?

A

Encephalopathy and coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are common causes of acute hepatic failure?

A

1) Acetaminophen
2) Hepatitis A
3) Hepatitis B
4) Hepatitis C
5) Hepatitis D
6) Drugs
7) Hepatitis E
8) Fatty change of microvesicular type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What distinct morphology of acute hepatic failure is characterized by diffuse poisoning of liver cells without obvious cell death and parenchymal collapse; related to fatty liver of pregnancy or idiosyncratic reactions to toxins?

A

Diffuse microvesicular steatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinically, what levels are moderately increased with acute hepatic failure?

A

Liver transaminases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The decline in serum transaminase is not an indication of recovery but instead an indication of?

A

Fewer viable hepatocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What features of acute hepatic failure would indicate poor prognosis?

A

1) Decrease in liver enzymes
2) Depleted hepatocytes
3) Worsening jaundice, coagulopathy, and encephalophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What characteristic sign of hepatic encephalopathy causes nonrhythmic, rapid extension-flexion of the head and extremities?

When is it seen in arms?

A

1) Asterixis

2) Extension and dosriflexed wrists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Coagulopathy which is a sequelae of acute hepatic failure is characterized by?

What is an early sign?

What can it lead to?

A

1) Impaired clotting due to lack of production of Vitamin K dependent factors
2) Easy bruising
3) Intracranial bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What sequelae of acute hepatic failure is characterized by the liver failing to remove activated coagulation factors from circulation?

A

Disseminated intravascular coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Portal HTN which is a sequelae of acute hepatic failure can lead to?

A

Ascites and hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What sequelae of acute hepatic failure is characterized by decreased GFR, elevated serum BUN and creatinine?

A

Hepatorenal syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which forms of hepatitis are associated with chronic liver failure?

A

Hepatitis B and C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cirrhosis is defined as diffuse transformation of the entire liver into?

A

Regenerative parenchymal nodules surrounded by fibrous bands and variable degrees of vascular shunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What helps monitor the decline of the patients on the path to chronic liver failure?

What is classified as “well compensated” and what is “decompensated”?

A

1) Child-Pugh classification of cirrhosis

2) Class A and C respectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Broad bands of dense scar with dilated lymphatic spaces and less parenchyma increases the incidence for?

A

Portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Palmar erythema, spider angiomata, hypogonadism, and gynecomastia are clinical symptoms of cirrhosis before it becomes end-stage in males due to?

A

Hyper-estrongenemia from impaired metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common cause of portal HTN?

A

Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Ascites is characterized by excess fluid in?

How is the fluid described?

A

1) Peritoneal cavity

2) Serous fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Splanchnic vasodilation which is a mechanisms leading to ascites is characterized by?

A

Transudation (protein-poor) into the abdominal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What portosystemic shunt is associated with 40% of patients with advanced cirrhosis and its rupture can cause massive hematemesis?

A

Esophageal varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What portosystemic shunt is associated with the rectum?

A

Hemorrhoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Hepatopulmonary syndrome is exacerbated in what body position and why?

A

Upright position due to gravity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which form of hepatitis is benign and self limited?

What does it not cause?

A

1) Hepatitis A

2) Chronic hepatitis or a carrier state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What confers long term immunity in hepatitis A?

A

IgG

31
Q

Chronic hepatitis B virus is an important precursor for?

A

Hepatocellular carcinoma

32
Q

Which serum marker for HBV appears before the symptoms, peaks during the overt disease, and lasts for about 12 weeks?

A

HBsAg

33
Q

Which serum marker for HBV may persist for life and confers protection?

Which form provides the immunity?

A

1) Anti-HBs Ab

2) IgG form

34
Q

Which serum marker for HBV is an indicator of continued viral replication, infectivity, and probably progression to chronic hepatitis?

A

Persistent HBeAg

35
Q

Which serum marker for HBV appears just before the onset of symptoms and shows up with increased aminotransferase levels?

A

Anti-HBc Ab

36
Q

What association causes an increased probability of chronicity for HBV?

A

Younger age

37
Q

In chronic HBV what does the liver biopsy show?

A

Finely granular ‘ground glass’ hepatocytes packed with HBsAg

38
Q

Which form of Hepatitis is clinically milder than HBV but 80-90% of patients develop chronic infection and 20% get cirrhosis?

A

Hepatitis C virus

39
Q

What clinical finding is associated with HCV?

Chronic HCV infection results in persistent elevations of?

What is found in ~35% of individuals with chronic hepatitis C infection?

When is HCV-RNA detected in the blood?

A

1) Repeated bouts of hepatic damage
2) Serum aminotransferases
3) Cryoglobulinemia
4) During active infection

40
Q

Chronic HCV shows what distinctive morphology?

A

1) Lymphoid aggregates

2) Fatty change of scattered hepatocytes

41
Q

The vaccine for HBV also prevents?

A

HDV infection

42
Q

HDV has the highest rate of acute hepatic failure in what population?

A

IV drug users

43
Q

What does a superinfection mean in terms of hepatitis?

A

When a chronic carrier of HBV is exposed to a new inoculum of HDV

44
Q

What occurs during the acute phase of a superinfection?

A

1) Active HDV replication

2) Suppression of HBV with high transaminase levels

45
Q

What occurs during the chronic phase of a superinfection?

A

1) HDV replication decreases
2) HBV replication increases
3) Disease progresses to cirrhosis and sometimes hepatocellular carcinoma

46
Q

What is the characteristic feature of HEV?

A

Higher mortality rate among pregnant women

47
Q

Which form of hepatitis is most likely to progress to a chronic state?

Which never progress to a chronic state?

A

1) HCV

2) HAV and HEV

48
Q

What is the morphology for severe acute hepatitis?

A

Confluent necrosis of hepatocytes around central veins

49
Q

What circulating antibodies are present in type 1 autoimmune hepatitis?

Which are present in type 2 autoimmune hepatitis?

A

1) ANA (anti-nuclear) and ASMA (anti-smooth muscle)

2) Anti-LKM1 (anti-liver kidney microsome-1)

50
Q

What is seen in the early phase of severe parenchymal destruction followed by rapid scarring?

A

Hepatocyte ‘rosettes’ in areas of activity

51
Q

What are a prominent and characteristic component of the inflammatory infiltrate in biopsy specimens showing autoimmune hepatitis?

A

Plasma cells

52
Q

What drug is the most common cause of acute liver failure necessitating liver transplant in the USA?

It is due to a toxic metabolite produced from the CYP450 breakdown in?

A

1) Acetaminophen

2) Acinus zone 3 hepatocytes

53
Q

What are intracellular eosinophilic aggregates of intermediate filaments (keratin 8 & 18, ubiquitin) in ballooning hepatocytes?

When can these be seen?

A

1) Mallory-Denk bodies

2) Alcoholic hepatitis and NAFLD

54
Q

What is damaged with Mallory-Denk bodies?

A

Intermediate filaments

55
Q

What does the scarring look like with alcoholic steatofibrosis?

What type of cirrhosis is involved in this?

A

1) Chicken-wire fence pattern

2) Laennec cirrhosis

56
Q

What effect does alcoholic hepatitis have on the CYP450 system?

A

1) Induces it

2) Decreases glutathione levels

57
Q

At what AST:ALT ratio is alcoholic liver disease suspected?

A

AST:ALT > 2:1

58
Q

What is the most common cause of chronic liver disease in the USA?

A

Nonalcoholic fatty liver disease (NAFLD)

59
Q

Nonalcoholic fatty liver disease has increased incidence with?

A

1) Obesity

2) Metabolic syndrome

60
Q

In the pathogenesis of NAFLD, what does insulin resistance lead to?

Mitochondria is further damaged by decreased autophagy and forms?

What correlates with stage of fibrosis in NAFLD?

A

1) Hepatic steatosis
2) Mallory-Denk bodies
3) Level of hedgehog pathway activity

61
Q

While NAFLD overlaps with histology of alcoholic hepatitis, what is the difference?

A

1) Mononuclear cells more prominent
2) Portal fibrosis more prominent
3) Mallory-Denk less common

62
Q

Hereditary hemochromatosis is caused by a mutation in?

This leads to what being abnormal?

A

1) HFE gene

2) Intestinal absorption of dietary iron

63
Q

What is the main regulator of iron absorption?

A

Hepcidin

64
Q

What effect does hemochromatosis have on the liver?

On the heart?

On the skin?

A

1) Small, shrunken liver with micronodular cirrhosis
2) Brown coloration
3) Gray-slate coloration

65
Q

Hemochromatosis has a 200x increased risk of?

A

Hepatocellular carcinoma

66
Q

How is hemochromatosis diagnosised?

A

Presence of iron in tissues with Prussian blue stain

67
Q

What is due to an autosomal recessive disorder via mutation of ATP7B?

What does it lead to?

A

1) Wilson disease

2) Copper excretion into bile is reduced leading to copper accumulation in liver

68
Q

What distinct morphological changes are seen in Wilson disease?

A

1) Mallory-Denk bodies

2) Basal ganglia atrophy

69
Q

What happens to urinary excretion of copper in Wilson’s disease?

What happens to plasma ceruloplasmin?

A

1) Elevated

2) Low

70
Q

What is the most sensitive and accurate way to diagnose Wilson’s disease?

A

Increased hepatic copper content

71
Q

What is the most commonly diagnosed inherited hepatic disorder in infants and children due to a PiZZ genotype?

A

α1-antitrypsin deficiency

72
Q

What can α1-antitrypsin deficiency lead to because activity of destructive proteases is not inhibited?

A

Pulmonary emphysema

73
Q

α1-antitrypsin deficiency is positive for what following diastase digestion of the liver?

A

PAS (+)

GI Week 4 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions