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MOD Exam 3 (part 2) > Hepatic Disease > Flashcards

Hepatic Disease Flashcards

1
Q

Which zone of the liver is susceptible to congestion from R-sided CHF?

A. Zone 1
B. Zone 2
C. Zone 3

A

C. Zone 3—Central lobule; this is where the hepatic venule/central vein is that drains into the hepatic vein

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2
Q

T or F:

Cor pulmonale can result in an increase in liver enzymes.

A

True

Cor pulmonale is the R heart strain that results withe acute or chronic pulmonary hypertension from LEFT-sided CHF.

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3
Q

T or F:

80% of the blood supply to the liver comes from the hepatic artery.

A

False…20%

80% is from the portal vein

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4
Q

T or F:

Zone 1 (triad) is more susceptible to oxidative and toxic damage than is Zone 3.

A

True

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5
Q

The type of liver damage can be differentiated based on the lysosomal accumulation of copper in different zones of the liver (Zone 1 vs. zone 3). If you find Cu accumulating in Zone 3, you know it is:

A.Primary deficiency in Cu metabolism
B. Cholestasis causing buildup of Cu
C. What?!

A

A. Primary Cu-associated hepatitis

She said this wrong in the lecture!!!

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6
Q

Why might a patient in liver failure be pu/pd?

A. Hypoproteineimia
B. Excess levels of cortisol in the blood
C. Edema inhibiting release of ADH
D. Secondary GI loss of fluids

A

B

Liver metabolizes cortisol, and it will go up in liver failure because cortisol competes with ADH receptors remember!

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7
Q

T or F:

Liver function tests will be abnormal if there is 70% loss of liver function.

A

False,

Liver function tests do not show abnormalities until there is at least 80% loss of liver

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8
Q

T or F:

ALT, AST, and ALP are significantly elevated. This indicates liver dysfunction.

A

False! Only indicates liver DAMAGE
Need 80% of liver function to be lost to be considered dysfunction!
Just because there is damage does not mean there is dysfunction necessarily—you need to do liver function tests!

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9
Q

Biliary mucocoeles can develop from what?

A. hypothyroidism
B. dislipidemia
C. pancreatitis
D. dismotility of the gall bladder
E. Any of the above
A

E

These conditions cause dismotility of GB, bile to accumulate, loss of solubility of the bile salts, irritation to the mucosa—mucocoele—devastating

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10
Q

T or F:

Change in solubility of bile acids from hydrophobic to hydrophilic can result in colitis.

A

False

Want them to be hydrophilic—if they become hydrophobic, they irritate the canaliculi and the intestine

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11
Q

Which of the following is NOT a feature of Ito (stellate) cells

A. Function to store Vitamin A/AKA retinoid storage cells
B. Can be activated by Kupffer cells
C. Become myofibroblasts in the inflammatory state.
D. Can synthesize collagen and result in fibrosis
E. Reside in the hepatic sinusoid

A

E. They reside in the SPACE OF DISSE

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12
Q

Which of the following is NOT a feature of Kupffer cells?

A. Resident macrophages of liver
B. Can activate Stellate cells to produce collagen in the inflammatory state
C. Produce inflammatory mediators and cytokines
D. Store Fe and Cu
E. Reside in the Space of Disse

A

E

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13
Q

T or F:

Hepatocellular injury is characterized by hydropic degeneration and lipid accumulation.

A

T

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14
Q

T or F:

Gastric ulceration can contribute to or worsen hepatic encephalopathy.

A

True

Bleeding—protein—urea—-ammonia

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15
Q

Which of the following is NOT a cause of vomiting in the liver disease patient?

A. concurrent pancreatitis
B. CRTZ stimulation
C. Gastritis due to hypergastrinemia
D. Alteration of solubility of bile acids

A

D.

This would result in colitis more directly

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16
Q

Which of the following are recommended treatments for hepatic encephalopathy?

A. Low protein diet
B. H2 blockers and Proton pump inhibitors
C. Lactulose
D. Sucralfate
E. B, C, and D only
F. All of the above
A

F

All of the above

A low protein or “high quality” protein diet is encouraged with HE, and gastric bleeding due to ulcers contributes to HE

17
Q

T or F:

A low protein diet is recommended as adjunct treatment in portosystemic shunts.

A

False!!!

Old school—has been found to not be true. However, the TYPE of protein is important…plant based proteins are less neuroexcitatory and thus a soy based diet is recommended.

18
Q

T or F:

Amino acid transfusions are indicated in cases of hepatocutaneous syndrome.

A

True

Liver’s ability to metabolize amino acids is compromised (complex etiology)

19
Q

T or F:

You can get a pure transudate (very low albumin) from portal hypertension due to cirrhosis or congenital portosystemic shunt.

A

False

If it said Acquired portosystemic shunt it would be true

20
Q

T or F:

The presence of icterus (after ruling out pre-hepatic and post-hepatic causes of liver disease) is considered a liver function test in and of itself; it is specific but NOT sensitive.

A

True

21
Q

T or F:

Liver disease can cause an acquired CENTRAL diabetes insipidus by way of increased cortisol causing a decrease in the release of ADH.

A

True!!!

So, apparently high cortisol can cause both nephrogenic and central

22
Q

Which will NOT cause necrosis or apoptosis of liver cells?

A. Endocrinopathies
B. Leptospirosis
C. Amantadine mushroom
D. Phenobarbital

A

A.

Cushings, Hypothyroidism, chronic stress, glucocorticoid administration causes glycogen buildup or lipidosis

23
Q

T or F:

An insulinoma would be an example of post-hepatic cause of icterus.

A

True

If large enough to obstruct bile flow, which it sometimes is.

24
Q

T or F:

With chronic hepatitis, you are likely to see a thrombocytosis due to a compensatory response of the bone marrow to the anemia of chronic disease.

A

True

25
Q

What are two major blood work findings that might indicate the liver disease is in the very end stage (cirrhosis)?

A. Microcytic anemia
B. Thrombocytopenia
C. Prolonged PT and aPTT
D. All of the above
E. B and C only
A

E

Microcytic anemia would be seen with PSS

26
Q

Which tests for liver disease are specific AND sensitive?

A. ALT
B. AST
C. ALKP
D. GGT
E. All of the above
A

E

27
Q

Which is the most SPECIFIC test for acute liver injury?

A. ALT/AST/GGT
B. Bilirubin
C. Ammonia
D. Cholesterol
E. Bile acids
A

C

28
Q

T or F:

Albumin is not specific but IS sensitive for liver function.

A

False- not very specific or sensitive

Can be helpful if you rule out all the other stuff

29
Q

What can cause only a hypoglycemia, but no other liver function abnormalities although liver function is compromised?

A. Blue green algae
B. Sago palm
C. Aflatoxicosis
D. Corticosteroid administration

A

C

30
Q

Which of the following is considered the most specific for liver dysfunction?

A. Low cholesterol
B. Icterus
C. Abdominal transudate with normal [Alb]
D. Abdominal transudate with low [Alb]

A

C

MOD Exam 3 (part 2) (2 decks)

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