Extras: Liver

Question 1

Hallmark of chronic hepatitis

Answer 1

Increased portal inflammation with lymphocytic inflammation + fibrosis

Question 2

Extrahepatic sx of Hepatitis A

Answer 2

Rash, arthralgias, vasculitis, glomerulonephritis, cryoglobulinemia

Question 3

Two pts who Hep E affects the most

Answer 3

1. Immunocompromised -> chronic

2. Pregnant -> fulminant hepatitis

Question 4

Abs in type I and II AIH

Answer 4

Type I: SMA Abs

Type II: LKM Abs

Question 5

Histo of AIH

Answer 5

Plasma cells in liver

Question 6

Treatment for AIH

Answer 6

Prednisone +/- azathioprine

Question 7

Single best measure of hepatic synthesis function

Answer 7

Coagulation factors

Question 8

Is albumin better for chronic or acute liver disease

Answer 8

Chronic - long half life

Question 9

Two things present in Hep B window phase

Answer 9

1. HBV DNA

2. HBc IgM

Question 10

Classic tetrad of hemochromatosis

Answer 10

1. Hepatomegaly
2. Cirrhosis
3. Bronze skin
4. DM
5. Heart failure

Question 11

Treatment for Wilson Disease + how it works

Answer 11

Oral Penicillamine: chelates Cu for excretion

Question 12

Mutation in Dubin Johnson + what that causes

Answer 12

MRP2 gene -> decreased excretion of conjugated bilirubin

Question 13

What type of liver blood compromise does schistosomiasis cause?

Answer 13

Blocks small intrahepatic veins -> blocks portal vein

Question 14

What condition is associated with bush tea, post-hematopoeitic SC transplants, and chemotherapy

Answer 14

Sinusoidal Obstruction Syndrome (Veno-occlusive disease)

Question 15

Conditions associated with Budd Chiari

Answer 15

1. Hypercoag state
2. Oral contraceptives
3. Polycythemia vera
4. APA syndrome
5. PNH
6. Abdominal cancers like HCC

Question 16

What symptoms separate Budd Chiari from other liver presentations?

Answer 16

Splenomegaly, ascites

Question 17

Child-Turcotte Pugh calculator is for what?

Answer 17

Chronic liver failure

Question 18

Four stages of acetaminophen OD

Answer 18

1. N/V, abd pain, pallor, sweating
2. RUQ pain, LFTs increase
3. Rapid liver failure, coma, +/- death
4. Recovery if survive stage 3

Question 19

Lab values that increase in alcohol induced liver disease

Answer 19

AST:ALT 2:1, bili and ALP are increased too

Question 20

Which of these liver conditions will have increase BNP?

Answer 20

Liver in heart failure

Question 21

Treatment for hepatic encephalopathy

Answer 21

Lactulose

Question 22

Fibropolycystic disease

Answer 22

Group of dz with congenital biliary tree malformation due to ductal plate malformation

Question 23

What liver lesion is well-demarcated with a central scar and no capsule

Answer 23

Focal Nodular Hyperplasia

Question 24

What liver lesion has a map-like pattern on GS stains?

Answer 24

Focal Nodular Hyperplasia

Question 25

Three lesions/benign neoplasms of the liver VS five malignant tumors

Answer 25

``` Lesions/Benign neoplasms 1. FNH 2. Cavernous hemangioma of the liver 3. Hepatocellular adenoma Malignant tumors 1. Hepatoblastoma 2. HCC 3. Intrahepatic cholangiocarcinoma 4. Angiosarcoma 5. Lymphoma ```

Question 26

Lab value to look for in HCC

Answer 26

Alpha-fetoprotein

Question 27

Subtype of HCC and describe it

Answer 27

Fibrolamellar carcinoma: younger adults, large scirrhous tumor, better outcome

Question 28

Two main lymphomas that affect the liver

Answer 28

1. Diffuse large B cell | 2. MALT lymphoma

Question 29

Signs of pre-eclampsia

Answer 29

HTN, proteinuria, peripheral edema, coagulation abnormalities

Question 30

HELLP syndrome

Answer 30

In pregnancy; hemolysis, elevated liver enzymes, low platelets

Question 31

Intrahepatic cholestasis of pregnancy sx

Answer 31

Pruritis, dark urine, light stools, jaundice