Exam 4 - Chapter 13. Liver and Gallbladder

Question 1

3

Heme is the substrate of _____.

Question 2

3

What is heme derived from?

Question 3

3

What does heme get degraded to by the enzyme heme oxygenase in mononuclear phagocytes?

Question 4

3

Biliverdin is reduced to bilirubin by the enzyme _____.

Question 5

3

Circulating bilirubin (_____) is bound to ____ and is subsequently taken up by the _____.

Question 6

3

To make bilirubin soluble, it undergoes _____, a reaction catalyzed by __________.

Question 7

3

Conjugated bilirubin (_____) is excreted into ____ and reaches the _____.

Question 8

3

Bilirubin glucoronides are deconjugated by _______ and eliminated in the ______.

Question 9

4

What are two other names for Jaundice?

Question 10

5

What is jaundice?

Question 11

5

Jaundice is not a diagnosis, but rather a _____________.

Question 12

5

Jaundiced patients often present with symptoms related to the underlying pathology, such as:

1. _____
2. ________
3. _______

Question 13

6

What is scleral icterus?

Question 14

6

Clinical presentation of jaundice as scleral icterus is best appreciated only when the serum levels reach ________. Normal serum levels of bilirubin are ________.

Question 15

6

What ages are most commonly affected by jaundice?

Question 16

8

Why do sclerae have a high affinity for bilirubin?

Question 17

8

In jaundice, with further increase in serum bilirubin levels, the skin will progessively discolor ranging from ______ to ______, especially if the process is long-standing.

Question 18

8

Green color in jaundice is due to _____.

Question 19

8

Yellowing of the skin sparing the sclerae is indicative of ______ which occurs in healthy individuals who ________.

Question 20

9

What are 5 pathophysiologies of jaundice?

Question 21

9

What is one thing that could lead to excess production of bilirubin?

Question 22

9

What is one thing that can cause reduced hepatocellular uptake?

Question 23

9

What are two things that could lead to impaired conjugation?

Question 24

9

What are two things that can lead to decreased hepatic excretion of bile?

Question 25

9

What are two things that can cause imapired bile flow?

Question 26

10

What are two effects of prehepatic unconjugated hyperbilirubinemia?

Question 27

10

What is one effect of hepatic unconjugated hyperbilirubinemia?

Question 28

10

What is one effect of posthepatic conjugated hyperbilirubinemia?

Question 29

11

What percent of babies have jaundice in the first week of life?

Question 30

11

Why do 20% of babies have jaundice in the first week of life?

Question 31

11

What are 4 reasons why infants and children would have jaundice?

Question 32

11

Unconjugated hyperbilirubinemia can be _____ in neonates.

Question 33

11

Unconjugated hyperbilirubinemia can be neurotoxic in neonates, causing _______ (_______) and _______.

Question 34

12

How long does it take for mild infant jaundice to disappear on its own?

Question 35

12

What are two treatment modalities for infants with jaundice?

Question 36

12

How does light therapy (phototherapy) work as a treatment for jaundice in infants?

Question 37

14

What are two things that jaundice in adults serve as a marker for?

Question 38

14

Most adult cases of jaundice have a more ____ course.

Question 39

14

Treatment of jaundice in adults varies according to the _____.

Question 40

17

When does hepatic failure occur?

Question 41

17

Hepatic failure can be _____ or _____, without any symptoms until there is ________.

Question 42

17

What are the two most common causes of hepatic failure?

Question 43

17

Which group does hepatic failure affect? What group is it rare in?

Question 43

17

Eventually, liver failure can cause a variety of symptoms, including:

1. ______
2. ______
3. _____
4. ______ (________)

Question 44

18

What is acute hepatic failure?

Question 45

18

What is a commonly used cutoff between acute and chronic hepatic failure?

Question 46

18

______ (_________) and _______ (________) are the two most common causes of acute liver failure worldwide.

Question 47

20

What are 5 symptoms of acute hepatic failure?

Question 48

22

What are three general treatments for acute hepatic failure?

Question 49

22

When can you do specific treatments for acute hepatic failure treatment?

Question 50

22

Acute hepatic failure treatment may involve ________.

Question 51

22

Should all patients with acute hepatic failure be hospitalized?

Question 52

23

In chronic liver failure, progressive deterioration of liver functions for more than 6 months results in the deterioration of:

1. ______
2. _____
3. _________

Question 53

23

Chronic liver failure is a continuous process of inflammation, destruction, and regeneration of liver parenchyma that leads to _____ and ______.

Question 54

23

What are 6 common etiologies for chronic liver failure?

Question 55

24

Chronic liver failure results in:

1. ______
2. ________
3. _______
4. ________

Question 56

24

While fibrosis associated with chronic liver failure is usually irreversible, when can it be reversible?

*Note that the transition time point of reversible fibrosis to irreversible fibrosis is still not completely understood.

Question 57

24

What three things does the development rate of fibrosis depend on?

Question 58

25

What does NAFL stand for?

Question 59

25

What does NASH stand for?

Question 60

26

Signs and symptoms of chronic liver failure can be ____.

Question 61

26

What are the three nonspecific signs and symptoms of chronic liver failure?

Question 62

29

What are two goals for chronic liver failure treatment?

Question 63

31

What is hepatic encephalopathy and in what kind of patients does it occur in?

Question 64

31

Though the precise pathophysiology for hepatic encephalopathy is still under discussion, what does the leading hypothesis focus on?

Question 65

32

Hepatic Encephalopathy Clinical Features include:

1. ______
2. ______
3. _______
4. _______

Question 66

32

What two motor system abnormalities do non-comatose patients with Hepatic Encephalopathy show?

Question 67

32

What sign do non-comatose patients with Hepatic Encephalopathy show?

Question 68

32

Describe the positive Babinski reflex.

Question 69

35

What is cirrhosis of the liver?

Question 70

35

The most common causes of cirrhosis of the liver are:

1. _____
2. _______
3. ________

Question 71

39

What are the four general cirrhosis clinical features?

Question 72

39

There are 4 specific cirrhosis clinical features:

1. _______
2. ______
3. _______
4. ________

Question 73

39

What are three things seen in people with impaired protein synthesis due to cirrhosis?

Question 74

39

What is seen in someone with impaired nitrogen metabolism due to cirrhosis?

Question 75

39

What are 4 things seen in someone with impaired estrogen metabolism due to cirrhosis?

Question 76

39

What are two things seen in someone with impaired biliary excretion due to cirrhosis?

Question 77

42

For cirrhosis treatment, you need to treat the ________.

Question 78

42

What are 4 complications that need to be treated and prevented in cirrhosis treatment?

Question 79

42

With cirrhosis treatment, avoid ______ (_____).

Question 80

42

Cirrhosis treatment requires regular ultrasound surveillance of _______.

Question 81

44

What is hepatitis?

Question 82

44

What are three causes of hepatitis?

Question 83

44

What are the five most common forms of viral hepatitis?

Question 84

45

What are the two forms of transmission for hepatitis A?

Question 85

45

Is Hepatitis A a chronic infection?

Question 86

45

What is the prevention for Hepatitis A?

Question 87

45

What is the treatment for Hepatitis A?

Question 88

45

What are the two forms of transmission for Hepatitis B?

Question 89

45

Is Hepatitis B a chronic infection?

Question 90

45

What is the prevention for Hepatitis B?

Question 91

45

What is the treatment for Hepatitis B?

Question 92

45

What are the two transmissions for Hepatitis C?

Question 93

45

Is Hepatitis C a chronic infection?

Question 94

45

What are two preventions for Hepatitis C?

Question 95

45

What is the treatment for Hepatitis C?

Question 96

45

What are three forms of transmission for Hepatitis D?

Question 97

45

Is Hepatitis D a chronic infection?

Question 98

45

What is the prevention for Hepatitis D?

Question 99

45

What is the treatment for Hepatitis D?

Question 100

45

What are two forms of transmission for Hepatitis E?

Question 101

45

Is Hepatitis E a chronic infection?

Question 102

45

What are two forms of prevention for Hepatitis E?

Question 103

45

What is the treatment for Hepatitis E?

Question 104

46

What are three alcoholic related liver diseases?

Question 105

48

What is the primary site of ethanol metabolism?

Question 106

48

What three things does chronic and excessive alcohol consumption result in?

Question 107

48

What is steatosis?

Question 108

48

What is fibrosis/cirrhosis?

Question 109

49

Is steatosis reversible or irreversible?

Question 110

49

Steatosis is associated with disturbance of metabolism by:

1. ______
2. ______
3. ________
4. ________

Question 111

51

Alcoholic Hepatitis is characterized by rapid onset of:

1. ______
2. ______
3. ________

Question 112

51

Alcholic hepatitis usually progresses to _____ if drinking is continued.

Question 113

51

If alchol is discontibuted, hepatitis returns to normal within _____.

Question 114

52

What is the final and irreversibel stage of alcohol abuse.

Question 115

52

In alcoholic cirrhosis, initially the liver is _____. Thereafter, it becomes _____, _____, and _____.

Question 116

52

End-stage cirrhosis looks the same regardless of ____.

Question 117

54

What are three inherited liver and gallbladder disorders?

Question 118

55

What is hemochromatosis?

Question 119

55

What is the inheritance pattern for hemochromatosis?

Question 120

55

Hemochromatosis results from what three gene mutations?

Question 121

55

In hemochromatosis, over time excess iron is stored in body tissues and organs such as:

1. _______
2. _______
3. ______
4. ______
5. _______

Question 122

56

These are the 5 early symptoms of hemachromatosis:

1. _____
2. _____
3. ______
4. ______
5. _______

Question 123

56

These are the 5 late symptoms of hematochromatosis:

1. ______
2. ______
3. _______
4. ______
5. _______

Question 124

58

Is hematochromatosis greater in males or females?

Question 125

58

Why is hematochromatosis greater in males than people?

Question 126

58

Hematochromatosis is greater in people with what ancestry?

Question 127

58

What is the treatment for Hematochromatosis?

Question 128

59

What is Wilson Disease?

Question 129

59

What is the inheritance pattern of Wilson disease?

Question 130

59

What is the mutation in Wilson Disease?

Question 131

59

What does the ATP7B gene play a role in?

Question 132

59

What may happen if Wilson is not recognized and treated when symptomatic?

Question 133

59

What is Wilson Disease treated with?

Question 134

60

At what age do the first signs and symptoms appear in Wilson disease?

Question 135

60

What is typically the initial feature of Wilson disease?

Question 136

60

What are four features of Liver disease that are typically seen in Wilson disease?

Question 137

60

What are 8 nervous system psychiatric problems seen in Wilson Disease?

Question 138

60

What are two eye problems of the cornea seen with Wilson disease?

Question 139

62

What are two treatments for Wilson Disease?

Question 140

63

Is Reye Syndrome fatal?

Question 141

63

What is Reye Syndrome?

Question 142

63

What is the cause of Reye Syndrome?

Question 143

63

What age group is Reye Syndrome seen in?

Question 144

63

What group does Reye Syndrome most commonly affect?

Question 145

64

What are the 4 symtpoms of Reye Syndrome?

Question 146

64

What is the treatment for Reye Syndrome?

Question 147

67

What is the most common form of liver cancer?

Question 148

67

What percent of the time is Hepatocellular Carcinoma seen for liver cancers?

Question 149

67

What are the two main risk factors for Hepatocellular Carcinoma?

Question 150

69

Diseases of the Biliary Tract:

1. _____
2. ______
3. _______

Question 151

71

What is the common name for Cholelithiasis?

Question 152

71

What is Cholelithiasis?

Question 153

71

What percent of men and women in the US have gallstones?

Question 154

71

Are most cases of Cholelithiasis symptomatic or asymptomatic? Is treatment required?

Question 155

71

Approximately ___% of asymptomatic gallstones in Cholelithiasis will develop symptoms over ___ years of follow-up.

Question 156

72

What are the 3 main pathways of stone formation for Cholelithiasis Pathogenesis?

Question 157

72

What can bile normally do when cholesterol is excreted by the liver?

Question 158

72

What does excess bilirubin cause?

Question 159

72

What effect does gallbladder hypomotility or impaired contractility have?

Question 160

72

What percent of cholelithiasis are cholesterol gallstones?

Question 161

73

Cholelithiasis Risk Factors:

1. ____
2. ______
3. _______
4. ______
5. _____
6. _______ (____ and ______)

Question 162

74

What are three symptoms associated with Cholelithiasis?

Question 163

74

What is a common trigger for gallbladder contraction?

Question 164

74

Cholelithiasis pain usually starts within _____ after a fatty meal.

Question 165

74

How is the pain described in Cholelithiasis

Question 166

74

How long may the constant, sharp pain in the upper right quadrant last for those with Cholelithiasis?

Question 167

74

What are three treatments for Cholelithiasis?

Question 168

76

What is Cholecystitis?

Question 169

76

Causes of Cholecystitis:

1. _______
2. _______

Question 170

76

Symptoms of Cholecystitis:

1. _________
2. ______ (especially _________)
3. ____ and _______
4. ________

Question 171

76

What is the treatment for Cholecystitis?

Question 172

78

What age group is carcinoma of the gallbladder seen in?

Question 173

78

Causes of Carcinoma of the Gallbladder:

1. ______ (______)
2. _______ (________)

Question 174

78

What is the prognosis of Carcinoma of the Gallbladder?