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GI2- AM > Ch.18 > Flashcards

Ch.18 Flashcards

1
Q

What are the serum measurements of hepatocyte integrity

A

AST
ALT
Lactate dehydrogenase (LDH)

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2
Q

What are the tests that look for biliary excretory fxn

A

Serum bilirubin

  • Total: unconjugated and conjugated
  • Direct: conjugated only

Urine bilirubin

Serum bile acids: plasma membrane enzymes from damage to bili canaliculus

Serum alkaline phosphatase
Serum y-glutamyl transpeptidase (GGT)

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3
Q

What are the tests that look for damage to the bile canaliculus

A

Serum alkaline phosphatase

Serum gamma-glutamyl transpeptidase (GGT)

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4
Q

What are the tests that look for hepatocyte synthetic function

A

Serum albumin
Coagulation factors: PT, PTT, Fibrinogen, prothrombin, factors V, VII, IX, X
Hepatocyte metabolism: serum ammonia, aminopyrine breath test

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5
Q

Cholestasis

A

Accumulation of bilirubin in liver

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6
Q

Cytokine released by kupffer cell

A

TGF-beta

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7
Q

Liver hilum is called

A

Porta hepatis

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8
Q

Characteristic sign of acute hepatic failure (2)

A

Asterixis (Encephalopathy)

Nonrhythmic, rapid extension-flexion of the head and extremities

Coagulopathy: impaired clotting due to lack of production of Vit K dep factors
- Easy bruising early sign

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9
Q

Acute hepatic failure is associiated with (3)

A

1) Disseminated intravascualr coagulation
- liver removes activated coagulation factors

2) Portal HTN (leads to ascites and encephalopathy)

3) Hepatorenal syndrome
- kidneys normal
- hyponuria, elevated BUN and creatine

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10
Q

Chronic liver failure is associated with

A

Hepatitis B and C
NAFLD
Alcoholic fatty liver disease

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11
Q

Signs of chronic liver failure (4)

A
  1. Palmar erythema
  2. Spider angiomata
  3. Hypogonadism
  4. Gyencomastia
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12
Q

Ultimate cause of death from liver failure

A
  1. Encephalopathy
  2. Bleeding from esophageal varices
  3. Bacterial infections
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13
Q

Cirrhosis leads to risk of developing

A

Hepatocellualr carcinoma

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14
Q

Hepatitis without chronic or carrier state

A

Hepatitis A virus

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15
Q

Hepatitis that is ds-DNA

A

Hepatitis B virus

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16
Q

Chronic liver failure w/ hepatitis seen inperson who is 20 or 30 years old

A

Hepatitis B virus

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17
Q

Chronic liver failure hepatitis

A

Hepatitis B virus

Hepatitis C virus

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18
Q

Hepatitis that is precursor for hepatocellular carcinoma

A

Hepatitis B virus

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19
Q

Liver biopsy shows finely granular “ground glass” hepatocytes

A

Chronic Hepatitis B virus

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20
Q

Associated with metabolic syndrome

A

HCV

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21
Q

HAV

  • type
  • family
  • transmission
  • chronic
  • diagnosis
  • Sudden hepatitis
A

ssRNA

Hepatovirus (picornavirus)

Fecal-oral (contaminated H2O)

Chronic= never

Diagnosis= serum IgM Ab

Acute hepatitis: Yes

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22
Q

HBV

  • type
  • family
  • transmission
  • chronic
  • diagnosis
  • Sudden hepatitis
A

dsDNA

hepaDNAvirus

parenteral, sexual contact, perinatal

Chronic: 5-10%

Diagnosis: HBsAg, antiHBcAg; PCR for DNA

Acute hepatitis: Yes

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23
Q

HCV

  • type
  • family
  • transmission
  • chronic
  • diagnosis
  • Sudden hepatitis
A

ssRNA

flaviviridae

Parenteral, intranasal cocaine

Chronic: >80%

PCR for DNA, Elisa for Ab

Acute hepatitis: NO

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24
Q

Hallmark for increased portal chronic inflammation

A

Portal tract expansion

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25
Q

Fatty changes indicate what hepatitis

A

Chronic HCV

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26
Q

Interface hepatitis (piecemeal necrosis)

A

associated iwth lymphocytic infiltrate into adjacent parenchyma (beyond limiting plate) with destruction of individual hepatocytes along edges

Feature of chronic viral hepatitis
(as well as autoimmune hepatitis & steatophepatitis)

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27
Q

Hallmark of progressive chronic liver damage

A

Scarring

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28
Q

Cholangiocarcinoma

A

Liver flukes
Fasciola hepatica

Thorotrast

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29
Q

Acetaminophen involves what mechanism

A

CYP450

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30
Q

Oral contraceptives and anabolic steroids –>

A

hepatocellualr adenoma

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31
Q

Vinyl chloride –>

A

Angiosarcoma

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32
Q

DRB1 alleles

A

Autoimmune hepatitis

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33
Q

Type 1 autoimmune hepatitis

A

Middle aged older individuals
ANA (anti-nuclear)
ASMA (anti smoot muscle)

Prognosis better

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34
Q

Type 2 autoimmune hepatitis

A

Children, teenagers

Anti-LKM1 (anti-liver kidney microsome-1) antibodies against CYP2D6

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35
Q

Clinical features

1) Steatosis
2) Steatohepatitis
3) Steatofibrosis/ cirrhosis

A

1) Hepatomegaly
Mildly elevated bilirubin
Mildly elevated alk phos

2) Tender hepatomegaly
Hyperbilirubinemia
AST:ALT 2:1 levels (<300-400)
Elevated Alk phos

3) Hypoproteinemia
Coagulation abnormalities

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36
Q

Intracellualr eosinophilic aggregates of intermediate filaments (keratin) in ballooning hepatocytes

A

Mallory-Denk bodies

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37
Q

Mallory Denk seen in

A

Alcohol hepatitis
NAFLD
Wilson
Chronic biliary tract disease

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38
Q

Scarring in a chicken wire fence pattern

A

Alcohol steatofibrosis

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39
Q

Laennec cirrhosis

A

aka micronodular
Chicken wire
alcoholic steatofibrosis

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40
Q

Mutation for alcohol intolerance

A 
Homozygous ALDH2 (asians)
Flusing nausea lethargy
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41
Q

Most common in
- alcoholic liver disease
-NAFLD
-

A

1) Africans

2) Hispanics

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42
Q

NAFLD has an increased risk of

A

HCC

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43
Q

Pathogenesis of NAFLD

A

1) Insulin resistance leads to hepatic steatosis (fat deposition in liver)

2) Oxidative injury –> liver cell necrosis
Non-alcoholic steatohepatitis (NASH)

–> NASH cirrosis –> Decompensatin or HCC

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44
Q

Metabolic syndrome:

A

dysfunctional adipose tissue (endocrine organ)
Decreased production of adiponectin
Increased TNF-alpha, IL-6
=hepatocyte apoptosis

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45
Q

What also gets activated in NAFLD

A

Stellate cells via SHH

Levels of SHH correlated to stage of fibrosis of NAFLD

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46
Q

NAFLD vs Alcohol liver disease

A

Mononuclear cells more prominent
Portal fibrosis more prominent
Mallory Denk less common

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47
Q

Death of NAFLD most common by

A

Cardiovascular death

48
Q

Alcohol liver disease death by (5)

A 
Hepatic coma
Massive GI hemorrhage
Intercurrent infection
Hepatorenal syndrome
Hepatocelluarl carcinoma
49
Q

“A 45-year-old man has had a fever and a productive cough for the past 3 days. On physical examination there is dullness to percussion over the right upper lung. His temperature is 37.9°C. A chest radiograph reveals right upper lobe consolidation. Laboratory findings include serum total protein of 6.0 g/dL, albumin 2.7 g/dL, AST 185 U/L, ALT 98 U/L, total bilirubin 1.0 mg/dL, alkaline phosphatase 31 U/L, and prothrombin time 20 sec. An abdominal CT scan shows hepatomegaly with decreased hepatic attenuation. Which of the following conditions is the most likely underlying cause of death?”

A

Diabetes Mellitus

NAFLD is associated w/ obesity and diabetes mellitus

50
Q

Metabolic syndrome criteria

A

One of: DM, impaired glucose tolerance, impaired fasting glucose, insulin resistance

Two of:

  • BP >140/90
  • TGs ?1.695 and HDL
51
Q

Only metabolic liver disease not AR

A

NAFLD

Hemochromotosis: AR
Wilson disease: AR
Alpha1-AT: AR

52
Q

Excessive iron absoprtion

A

Hemochromatosis

53
Q

HFE mutation

A

Hemochromatosis

C282Y

54
Q

Juvenile hemochromastosis

A

HJV or HAMP

More severe

55
Q

Prussian blue stain
Small shrunken liver w/ micronodules
Dark brown black liver

A

Hemochromastosis

56
Q 
Pancreas fill w/ brown pigment
Bronze skin
DM
Hypogonadism
Cardiac dysfunction
A

Hemocrhomatosis

57
Q

Hemochromatosis risk of

A

Hepatocellular carcinoma 200x

58
Q

Prussian blue stains for

A

iron

59
Q

Mutation ATP7B

A

Wilson disease

60
Q

Impaired cooper excretion in bile

A

Wilson disease

61
Q

Parkinsonism movement

Elevated direct bilirubin

A

Elevated bilirubin = hemolytic anemia due to copper toxicity to RBC membranes

62
Q

PiZZ

A

Alpha 1- AT def

63
Q

A1-AT leads to

  • age
  • mutation causes accumulation of
A

infants and children

Pulmonary emphysema
Hepatic disease

Accumulation of protein in liver

64
Q

Magenta granules inside hepatocytes

A

Alpha 1- AT

65
Q

Hereditary hyperbilirubinemias (5)

A

(Extrahepatic)

Crigler Najjar Type 1
Crigler Najjar type 2
Gilbert syndrome
Dubin-johnson syndrome
Rotor syndrome
66
Q

Autopsy baby
Unconjugated hyperbilirubinemia

  • inheritence
  • missing
A

Crigler-Najjar type I

AR

No UGT1A1 activity

67
Q 
Clinic baby
Hyperbilirubinemia
Kernicterus
-inheritence
-missing
A

Crigler Najjar type II
AD
Decreased UGT1A1

68
Q

Stressed student with yellow eyes

hyperbilirubin- indirect

A

Gilbert

Decreased UGT1A1

69
Q

Autopsy

black liver

A

Dubin johnson syndrome
AR
MDR protein 2 (MRP2)
conjugated hyperbilirubinemia

70
Q

18 y.o

hyperbilirubin- direct

A

Rotor syndrome

AR

71
Q

Infant to pediatrician, yellow skin. Tired weak, floppy arms. Parents first cousins

A

Crigler Najjar type II

72
Q

Elevated GTT and alk phosphatase

A

Cholestasis
(impaired bile flow)
Accumulation of bile pigment in hepatic parenchyma

73
Q

Fever, RUQ pain, jaundice

A 
Charcot's triad
Ascending cholangitis (gallstones)
74
Q

Primary hepatolithiasis

A

Disease of intrahepatic gallstone formations

Leads to repeat bouts of ascending cholangitis, progressive inflammatory destruction of hepatic parenchyma, and predisposes to biliary neoplasia

75
Q

Hepatolithiasis

A

gallstones in bilary ducts of liver

76
Q

Cholestasis

A

flow of bile stops

77
Q

Panlobular giant-cell transformation of hepatocytes

A

Neonatal hepatitis

78
Q

Most common form of biliary atresia

A

Perinatal form

Rotavirus, CMV, autoimmune

79
Q

Jaundice longer than 2 weeks

Acohlic stools

A

Biliary atresia

80
Q

Inflammatory destruction of intrahepatic ducts

A

primary biliary cirrhosis (PBC)

81
Q

Inflammatory destruction of intrahepatic adn extrahepatic bile ducts

A

Priamry sclerosing cholangitis (PSC)

82
Q

FLorid duct lesions

A

Primary biliary cirrhosis (PBC)

83
Q

Antimitochondrial Ab

A

Primary biliary cirrhosis (PBC)

84
Q

Beading on X ray

A

Primary sclerosing cholangitis (PSC)

85
Q

PANCA

A

atypical perinuclear anti-neutrophilic cytoplasmic antibodies

PSC

86
Q

Onion skin fibrosis

A

PSC

87
Q

PSC associated with

A

IBD

Pancreatitis

88
Q

PBC associated with

A

Sjogren syndrome
Scleoderma
Thyroid disease

89
Q

AMA positive

ANA positive

A

PBC

90
Q

Choledochal cysts

A

congenital dilations of the common bile duct
Females before age 10
Jaundice
Recurring abdominal pain
Cysts may form segmental or cylindric dilations

91
Q

Von Meyen complexes

A

indicative of fibropolycystic disease FPD

92
Q

Caroli disease

A

biliary cysts that occur w/ congenital hepatic fibrosis

indicative of fibropolycystic disease FPD

93
Q

Congenital hepatic fibrosis

A

portal tracts enlarged by irregular broad bands of collagenous tissue that form septa to divide liver into irregular islands

indicative of fibropolycystic disease FPD

94
Q

Schistosomiasis

A

parasitic worm

95
Q

Obstruction of two or more hepatic veins leads to hepatomegaly, pain ascites

A

Budd-Chiari syndrome

96
Q

Liver is swollen red-purple

A

Budd-chiari syndrome

Obstruction two or more hepatic veins

97
Q

Obliteration of terminal hepatic venules by subendothelial swelling and collagen depostiion

-Causes

A

Sinusoidal obstruction syndrome
(Veno-occlusive disease)

  • Jamaican bush tea drinkers
  • 3 weeks after stem cell transplant
98
Q

Hemolysis
Elevated liver enzymes
Low platelets
Pregnant

A

HELLP

Preeclampsia

99
Q

Maternal HTN
Proteinuria
Peripheral edema
Coagulation problems

A

Preeclampsia

Becomes eclampsia w/
- hyperreflexia convulsons occur

100
Q

Third trimester
Elevated serum aminotransferases
Bleeding, nausea vomiting
Jaundice

A

Acute fatty liver disease

101
Q 
Pregnant 3rd trimester
Dark urine
Light acholic stools
Jaundice
Bile salt level increased greatly

-risk (3)

A

Intrahepatic cholestasis of pregnancy

  • fetal distress
  • stillborn
  • prematurity
102
Q

Autopsy
Plump hepatocytes are surrounded by rims of atrophic hepatocytes
Multiple nodules on liver
No fibrosis

A

Nodular regenerative hyperplasia (NRH)

103
Q

Single well demarcated lesion with central scar on liver

A

Focal nodular hyperplasia FNH

104
Q

Blood vessel tumor of liver

A

Cavernous hemangioimas

105
Q

Red blue nodules under capsule

A

Cavernous hemangiomas

106
Q

Tumor of liver associated with oral contraceptives

A

Hepatocellualr adenoma

- beta-catenin

107
Q

3 types hepatocellular adenomas

A

1) HNF1-alpha
-inactive
no risk

2) Beta-Catenin
- active
- high risk
- oral contraceptives

3) Inflammatory
- small risk
Assoc w/ NAFLD

108
Q

Single large scirrhous tumor with fibrous bands coursing through it
<35
well differentiated cells rich in mitochondria in cords separated by parallel lamellae of dnse collagen bundles

A

Fibrolamellar carcinoma

109
Q

Perihilar tumors located at junction of hepatic ducts

A

Klatskin tumors

Cholangiocarcinoma (CCA)

110
Q

Liver flukes

A

Opisthorchis
Clonorchis

Cholangiocarcioma CCA

111
Q

Most common gallbladder anomaly

A

Phrygian cap

Fundus that folded inward

112
Q

Cholelithiasis

A

Gallstones

113
Q

Family history, female, fat, fourty, fertile, fair risk factors for

A

Cholelithasis gallstones

114
Q

Pigment stones

A

Stones of unconjugated bilirubin
Bacterial contamination
Brown stones

115
Q

Cholesterol stones

A

only in gallbladder

pale yellow –> black (sterile bile duct)

116
Q

Carcinoma of gallbladder

A

adenocarcinoma

women
risk factor gallstones

117
Q

ERBB2 (HER2) oncoprotein overexpressed

A

Carcinoma of gallbladder

Adenocarcinoma

GI2- AM (11 decks)

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