CPC 7/22

Question 1

how is bilirubin formed and transported through the liver into the gut

Answer 1

1) senile RBCs are broken down in the spleen
- releasing hemosiderin (yellow)
2) hemosiderin => biliverdin (green) => bilirubin by oxygenase
3) bound to albumin to get to the liver
4) if it is unbound, it cannot be excreted by the kidney bc it cannot get into the liver
5) in the liver, it is conjugated with glucoronide by glucuronyl transferase
- now it can pass into the bile and enter small intestine
6) broken down in SI by bacterial proteases to urobilinogen
- 90% is excreted in feces, and 10% reenters via portal vein

Question 2

which bilirubin result in choloric and acholoric urin

Answer 2

1)

Question 3

four pathophysiologic mechanisms lead to hyperbilirubinemia

Answer 3

1) unconjugated hyperbilirubinemia
-*acholuric (No bile pigment)
- impaired liver function (no albumin means it will stay in bloodstream)
- excessive bilirubin production
- reduced uptake
- impaired conjugation
2) conjugated hyperbilirubinemia
- gets in liver but cannot get out
- ex. problems with glucuronyl transferase or problems transporting it out
- impaired excretion (bile pigment in urine, choluric)

Question 4

crigler majjar syndrome

Answer 4

1) inherited condition typically affecting neonates that is characterized by deficiency of glucuronyl transferase
2) UCB cannot be metabolized further

Question 5

gilberts disease

Answer 5

1) decreased activity in glucuronyl transferase
2) UGT1A1 gene mutation

Question 6

dubin johnson syndrome

Answer 6

1) inability of CB to be transported across the hepatocyte membrane
2) cannot get to kidneys

Question 7

circumstances in which urine urobilinogen is elevated

Answer 7

1) hemolytic anemias
2) autoimmune hemolytic anemia
3) blockage in biliary system

Question 8

extrahepatic cholestasis

Answer 8

1) gall stones in main bile hepatic duct
1) carcinoma of bile ducts
3) obstruction of flow with retention of bile salts, impaired fat absorption and absorption of fat soluble vitamins (vitamin K)

Question 9

summary

Answer 9

1) when excess RBC breakdown occurs, UB is elevated (acholuria), elevated urobilinogen, and kericterus
2) when bile flow is obstructed due to impaired excretion or blockages, conjugated hyperbilirubinemia
2) choluric

Question 10

serum abumin

Answer 10

1) measures hepatocyte function
2) if decreased, blodo osmotic pressure is decreased , edema and ascites

Question 11

how portal hypertension develops

Answer 11

1) impedance to blood flow in the portal system due to scarring in the liver, elevated venous pressure, portal hypertension
2) ascites and varices in esophagus, hemorroids, umbilical varices
3) if bleeding disorder, it can lead to death

Question 12

cirrhosis forms

Answer 12

1) chronic alcoholic
2) biliary
- bile duct or bladder occlusion
3) postnecrotic
- infection or chemical toxins

Question 13

microscopic changes in laennecs cirrhosis

Answer 13

1) fat mobilization from peripheral stores
2) decreased lipid breakdown
3) more synthesis of TGs
—
1) causes many effects
2) failure of liver to metabolic pharmacologic agents means prolonged effects

Question 14

microscopic changes in biliary cirrhosis

Answer 14

1) periportal cirrhosis around portal triads with perilobular scarring

Question 15

gall stones

Answer 15

1) calcium bilirubinate or cholesterol

Question 16

obstructive jaundice

Answer 16

1) CB followed by some degree of UB
2) latter develops as the hepatocytes degenerate secondary to bile stasis
2) itching, steatorrhea, etc

Question 17

post necrotic cirrhosis

Answer 17

1) viral hepatitis and chemical toxins cause panlobular cirrhosis

Question 18

halothane

Answer 18

1) no longer used as general anesthetic

Question 19

enzymes in diagnostic importance in liver necrosis

Answer 19

1) AST and ALT
2) elevation means damage

Question 20

two forms of liver cancer

Answer 20

1) hepatocellular carcinoma
- alpha fetal globulin can be found in serum of those with this type of cancer
3) cholangiocarcinoma (bile ducts)

Question 21

budd chiari syndrome

Answer 21

1) invasion of central and hepatic veins leading to portal hypertension

Question 22

pancreatic disease

Answer 22

1) amylase and lipase spill into serum

Question 23

pancreatitis on glucose metabolism

Answer 23

1) desctruction of islet cells
- hypo insulinism and hyperglyccemia
2) biliary obstruction and jaundice

Question 24

tumors of islet cells

Answer 24

1) insulinoma
- beta cell adenoma of endocrine pancreas
2) gastrinomas
- increase in acid secretion of stomach
- exocrine pancreas

Question 25

zollinger ellison syndrom

Answer 25

1) islet cell tumors with gastrin secretion and peptic ulcers