Ch. 38: Liver Diseases Flashcards
The blood supply is delivered to the liver by way of
A. A dual arterial sources
B. The portal artery
C. The hepatic vein
D. Kupffer cells
A. A dual arterial sources
The liver has a dual blood supply, delivering a blood supply (25%) from arterial inflow from the aorta via the celiac trunk and hepatic artery (75%) and from the portal vein via the capillary bed of the alimentary canal and pancreas. The portal vein, not artery, is relevant to the delivery of blood. The hepatic artery, not vein, is relevant to the delivery of blood. Kupffer cells are specialized cells in the liver that destroy bacteria, foreign proteins, and worn-out blood cells
Esophageal varices are a complication of liver disease and are a result of
A. Biliary obstruction
B. Systemic hypertension
C. Elevated portal pressure
D. Weakness of esophageal walls
C. Elevated portal pressure
Esophageal varices result mainly from impaired blood flow through the liver. Increased pressure in the portal system leads to portal hypertension and congestion of the esophageal vessels resulting in varices.
Biliary obstruction could result in jaundice. Systemic hypertension would not result in esophageal varices.
Esophageal vessels, not the esophagus itself, are affected.
The primary signs and symptoms of hepatic derangements
A. Differ among the various types of damage
B. Are a result of infection either bacterial or viral
C. Are similar regardless of primary or secondary causes
D. Tend to be more life-threatening if primary than if secondary
C. Are similar regardless of primary or secondary causes
Whether primary or secondary, all hepatic derangements tend to cause similar signs and symptoms. Whether primary or secondary, signs and symptoms are directly attributable to loss of hepatocellular function or disruption of blood flow through the liver.
What term is used to describe the process of converting bilirubin from its freely lipid-soluble form to the form that is tightly bound to the plasma protein albumin?
A. Transamination
B. Oxygenation
C. Conjugation
D. Reduction
C. Conjugation
Damaged or destroyed red blood cells are lysed and the oxygen-carrying hemoglobin molecule is recycled. Separation of heme from globin yields biliverdin, which is converted to bilirubin and released into plasma and transported to the liver. Free unconjugated bilirubin is lipid-soluble and crosses easily into the brain of the neonate. Conjugation by the liver tightly binds bilirubin to the plasma protein albumin. Transfer of an amino group from one chemical compound to another is referred to as transamination. Oxygenation is the act of to supplying the blood with oxygen. Reduction is a medical procedure to restore a fracture or dislocation to the correct alignment.
What condition occurs when a form of bilirubin diffuses into the brain and causes a type of encephalopathy?
A. Physiologic jaundice
B. Biliverdinicterus
C. Infant hepatitis
D. Kernicterus
D. Kernicterus
Kernicterus refers to brain injury as a result of hyperbilirubinemia. The immature blood-brain barrier allows free unconjugated bilirubin to enter the brain, which causes encephalopathy through unknown mechanisms. Physiologic jaundice results in the yellowish discoloration of the whites of the eyes, skin, and mucous membranes caused by deposition of bile salts in these tissues. It occurs as a symptom of various diseases, such as hepatitis, that affect the processing of bile. As red blood cells age or are damaged by disease, they are normally changed into biliverdin, which in turn is converted by the enzyme bilirubin reductase to bilirubin. This is a normal process. General term to identify the presence of some form of hepatitis in a newborn or infant.
Reye syndrome is characterized by encephalopathy
A. Secondary to severe hepatic dysfunction
B. Primary to fatty infiltration of the brain
C. Primary to aspirin toxicity of the brain
D. Secondary to brain hemorrhage
A. Secondary to severe hepatic dysfunction
The exact pathophysiology of Reye syndrome is unknown, but significant mitochondrial dysfunction of hepatocytes occurs. Reye syndrome is characterized by fatty infiltration of the liver with severe hepatic dysfunction. A strong association with aspirin use during the preceding viral illness has been noted, but other drugs may be causative as well. Brain hemorrhage is not a secondary characteristic of Reye syndrome.
Biliary atresia is classified as a condition of
A. Disordered bilirubin metabolism
B. Intrahepatic ductopenia
C. Extrahepatic ductopenia
D. Enzyme deficiencies
C. Extrahepatic ductopenia
Either congenital or acquired extrahepatic ductopenia is associated with cholestasis and obstruction of the extrahepatic biliary tract. It is often referred to as biliary atresia or progressive obliterative cholangiopathy. Biliary atresia is not related to bilirubin metabolism or an enzyme deficiency, and is extrahepatic, not intrahepatic, in origin.
The major indication of a failed Kasai procedure is
A. Toxic cirrhosis
B. Biliary atresia
C. Malignant neoplasms
D. Late-stage kernicterus
B. Biliary atresia
The major indication for pediatric orthotopic liver transplantation is biliary atresia following a failed Kasai procedure (portoenterostomy) or delayed recognition of the diagnosis. Toxic cirrhosis of the liver results from chronic poisoning. Malignant neoplasms are forms of cancer. Kernicterus refers to brain injury as a result of hyperbilirubinemia. The immature blood-brain barrier allows free unconjugated bilirubin to enter the brain, which causes encephalopathy through unknown mechanisms.
Portal hypertension occurs as a result of which of the following? (Select all that apply.)
A. Obstruction of blood flow in the liver’s venous sinusoids
B. Dysfunctional drainage into the superior vena cava
C. Increased venous pressure distal to an obstruction
D. Impaired drainage into the central veins
E. A buildup of venous pressure
A. Obstruction of blood flow in the liver’s venous sinusoids
D. Impaired drainage into the central veins
E. A build up of venous pressure
Obstructed blood flows through the venous sinusoids of the liver and impaired drainage into the central veins would contribute to the development of portal hypertension<b>. </b>A buildup of venous pressure, regardless of cause, is the root of portal hypertension<b>. </b>The hepatic vein empties into the inferior vena cava. Any obstruction to the flow of blood within the liver may result in a rise in portal venous pressure proximal to the level of blockage.
Which statement characterizes the nature and capabilities of the liver? (Select all that apply.)
A. The liver plays a role in the digestion of fats.
B. Blood detoxification is a function of the liver.
C. Liver function is seriously impaired with even minimal damage.
D. Liver function can be sustained artificially during hepatic failure.
E. The liver is vulnerable to illness, but has considerable repair abilities.
A. The liver playes a role in the digestion of fats.
B. Blood detoxification is a function of the liver.
E. The liver is vulnerable to illness,
The functions of the liver are multiple and include metabolism of fats, proteins, and glucose
detoxification of endogenous and exogenous substances.
Although vulnerable to variety of metabolic, circulatory, toxic, microbial, and neoplastic insults, the liver has a high degree of reserve and the ability to repair itself if circulation remains intact. More than 80% of the liver may be destroyed before life is threatened.
Artificial liver function is not yet perfected.
Which manifestation is typical of hepatocellular failure? (Select all that apply.)
A. Skeletal muscle hypertrophy
B. Hypoalbuminemia
C. Glucose imbalance
D. Masculinization
E. Osteomalacia
B. Hypoalbuminemia
C. Glucose imbalance
E. Osteomalacia
Hepatocellular failure results in a number of typical manifestations that include hypoalbuminemia, glucose imbalance, and osteomalacia. Muscle wasting, not hypertrophy, and feminization, not masculinization, are typical manifestations of hepatocellular failure.
Appropriate early treatment for infants with jaundice-related encephalopathy may include which of the following? (Select all that apply.)
A. Drug therapy that displaces bilirubin from albumin
B. Phenobarbital to increase the levels of UDPGT
C. Phototherapy (bili-lights)
D. Exchange transfusions
E. Antibiotic therapy
B. Phenobarbital to increase the levels of UDPGTCorrect
C. Phototherapy (bili-lights)
D. Exchange transfusions
If recognized early, jaundice-related encephalopathy treatment includes phenobarbital to increase the levels of uridine diphosphate glucuronosyltransferase UDPGT, phototherapy (bili-lights), and exchange transfusions. Drug therapy that displaces bilirubin from albumin is not relevant. Antibiotic therapy is not necessary.
At present, universal vaccination of children is recommended for: Select all that apply
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
A. Hepatitis A
B. Hepatitis B
Hepatitis A vaccination was added to the routine childhood vaccination schedule by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) in 2006. The Public Health Service recommends universal childhood hepatitis B vaccination. A Hepatitis C vaccine is still in the development stage. No specific vaccinations exist for Hepatitis D or E.
The development of hepatocellular carcinoma is which of the following? (Select all that apply.)
A. Diagnosed less frequently among elderly persons than among young adults
B. Frequently associated with a more positive prognosis in older patients
C. Less frequently diagnosed in men than in women
D. Regularly associated with chronic alcohol use
E. Usually associated with chronic viral hepatitis
D. Regularly associated with chronic alcohol use
E. Usually associated with chronic viral hepatitis
Hepatocellular carcinoma is often the result of years of injury from chronic alcohol abuse, chronic viral hepatitis, or injury and is therefore more often seen in older individuals. Unfortunately, the prognosis is negative regardless of age. There is no current research to support that hepatocellular carcinoma is diagnosed less frequently in men than in women..
What identified risk factors make it necessary for liver transplant patients to undergo extensive psychological evaluation before surgery? (Select all that apply.)
A. Current abuse of alcohol
B. High risk for HIV/AIDS
C. Ineffective psychosocial support system
D. Need for patients be thoroughly independent
E. Prevalence of bipolar disorder in this population
A. Current abuse of alcoho
C. Ineffective psychosocial support system
Psychological conditions, such as alcohol or drug addiction, and poor psychosocial support system and psychological instability would normally preclude or diminish the chance of a successful outcome in orthotopic liver transplantation. A risk would not preclude a successful outcome in orthotopic liver transplantation. While independence is a positive factor, it is not vital for a successful outcome in orthotopic liver transplantation. There is no research to support that there is a prevalence of bipolar disorder in this population.
