Cirrhosis

Question 1

Fibrosis Mediators

Answer 1

Stellate cells, which lie beneath endothelial cells lining sinusoids, which release TGF-Beta

Question 2

Coagulopathy Measure in Cirrhosis

Answer 2

Reduction in clotting factor production so degree of deficiency measured by PT (even though PTT also increased)

Question 3

Mallory Bodies (when you see, what they consist of)

Answer 3

Seen once alcoholic hepatitis starts mediated by acetaldehyde
Consist of damaged intermediate/cytokeratin filaments

Question 4

NAFLD

Answer 4

Same 3 stages as alcoholic liver disease (fatty change, hepatitis, cirrhosis) but without exposure to alcohol so ALT>AST, often associated with obesity

Question 5

Alcohol Liver Enzymes

Answer 5

AST>ALT because AST is in the mt and alcohol is mitochondrial poison

Question 6

Hemochromatosis vs. Hemosiderosis

Answer 6

Hemosiderosis is the deposition of iron in the tissues, hemochromatosis is end-organ damage

Question 7

Primary vs. Secondary Hemochromatosis Cause

Answer 7

Primary: Mutation in HFE gene causing enterocytes to just let all iron in
Secondary: Long-term transfusions

Question 8

Hemochromatosis Labs and Histo

Answer 8

Increased ferritin (increased stores), decreased TIBC, increased serum Fe, Increased % saturation
See accumulation of brown pigment in hepatocytes: use Prussian blue to distinguish Fe from lipofucsin

Question 9

Wilson Disease (what it is, signs/labs, treatment)

Answer 9

Defect in ATP mediated hepatocyte copper transport resulting in decreased ceruloplasmin (Cu transport prot)
Get cirrhosis, neuro manifestations like Parkinsonian like symptoms, Kayser-Fleischer rings
Labs show increased urinary copper, decreased ceruloplasmin (so decreased total copper), increased copper on liver bx
Treat with D-penicillinamine (Cu chelator)

Question 10

Primary Biliary Cirrhosis (what it is, demographic, test)

Answer 10

AI granulomatous destruction of intrahepatic bile ducts, usually in women around 40, causing obstructive jaundice
Antimitochondrial Ab present

Question 11

Primary Sclerosing Cholangitis (what it is, histo, radio, 2 associations, increased risk)

Answer 11

Inflammation/fibrosis of intra and extrahepatic bile ducts which can also cause obstructive jaundice
Periductal fibrosis with onion skin appearance
Uninvolved regions dilated so “beads on a string”
Associated with UC and p-ANCA
Increased risk for cholangiocarcinoma

Question 12

Reye’s Syndrome

Answer 12

Fulminant liver failure and encephalopathy in children from aspirin ingestion after viral illness, likely related to mt damage of hepatocytes

Question 13

Hepatic Adenoma Association and Risk

Answer 13

Oral contraceptives, risk of rupture and intraperitoneal bleeding, especially during pregnancy (diff dx for ectopic)

Question 14

HCC (3 risk factors, complication, serum marker)

Answer 14

Chronic hepatitis (HBV/HCV), anything causing cirrhosis, and Aflatoxins from Aspergillus (in countries where they store wheat for awhile) which causes p53 mutation
Can mets via hepatic vein and cause Budd-Chiari with painful hepatomegaly
Alpha-fetoprotein

Question 15

Clinical Finding on Mets to Liver

Answer 15

Nodular free edge of liver (there are nodules on the free edge)