Hepatic Disorders

Question 1

True or false

In chronic disease, liver parenchyma is replaced by fibrous tissue, which separates the functioning hepatocytes into isolated nodules. This disruption of the normal tissue structure can become severe and lead to the central characteristics of cirrhosis and liver failure: loss of metabolic and synthetic function at the cellular level, and portal hypertension, ascites formation, and portal-systemic shunting at the gross level.

Answer 1

True

Question 2

True or false

Hepatic disease impairs the liver’s synthetic functions, including production of albumin as well as coagulation and anticoagulation factors.

Answer 2

True

Question 3

True or false

The liver is responsible for production of the vitamin K–dependent clotting factors II, VII, IX, and X; proteins C and S; and other elements of the clotting and thrombolytic processes.

Answer 3

True

Question 4

True or false

Inadequate production of these clotting factors makes uncontrolled bleeding one of the life-threatening features of liver disease and a potentially serious complication of hepatic failure.

Answer 4

True

Question 5

Portal hypertension

Answer 5

is the increased hydrostatic pressure in the portal vein and its feeder vessels caused by resistance to blood flow through the cirrhotic liver.

It eventually causes esophageal and gastric varices and portal-systemic shunting.

Question 6

Pathophysio of ascites in the cirrhotic

Answer 6

Increased hydrostatic pressure in the intraperitoneal veins, hypoalbuminemia, and poor renal management of sodium and water

Question 7

Prehepatic jaundice is caused by

Answer 7

any form of hemolysis, including inborn errors of bilirubin metabolism, which overwhelm the liver’s ability to conjugate bilirubin.

Question 8

causes of hepatic jaundice

Answer 8

Viral infection and ingested toxins are typical

Question 9

posthepatic jaundice produces a rise in

Answer 9

conjugated (direct) bilirubin

Question 10

prehepatic and hepatic jaundice, which present with elevated

Answer 10

unconjugated (indirect) bilirubin

Question 11

True or false

Parasitic infestation and biliary atresia are rare causes of posthepatic jaundice

Question 12

True or false

Alanine aminotransferase is a more specific marker of hepatocyte injury than aspartate aminotransferase.

Answer 12

True
Aspartate aminotransferase is found not only in liver but also in heart, smooth muscle, kidney, and brain. Elevated aspartate aminotrans- ferase can be due to medications, including acetaminophen, NSAIDs, angiotensin-converting enzyme inhibitors, nicotinic acid, isoniazid, sulfonamides, erythromycin, griseofulvin, and fluconazole.

Question 13

True or false

An elevated γ-glutamyl transpeptidase in the setting of hepatitis suggests an alcoholic cause.

Answer 13

True

Question 14

This elevation is associated with biliary obstruction and cholestasis.

Answer 14

Alkaline phosphatase

Question 15

____________ prolongation in liver disease reflects the decreased synthesis of the vitamin K–dependent coagulation factors II, VII, IX, and X and, as such, serves as a true measure of liver function.

Answer 15

Prothrombin time

Question 16

An increased total and indirect bilirubin signifies

Answer 16

1. overwhelming supply of unconjugated bilirubin to the hepatocytes (e.g., hemolytic anemia) or
2. injury to the hepatocytes- damages their capacity to conjugate a normal supply of bilirubin (e.g., acute or chronic viral hepatitis)

Question 17

Total and direct bilirubin is increased when

Answer 17

(+) OBSTRUCTION preventing the secretion of the conjugated bilirubin that is produced by normally functioning hepatocytes (e.g., obstructing gallstone, pancreatic mass, or biliary atresia).

Question 18

Elevations in the hundreds of units per liter Transaminases (aspartate aminotransferase and alanine amino- transferase) suggest

Answer 18

mild injury, or smoldering inflammation

Question 19

Levels in the thousands Transaminases (aspartate aminotransferase and alanine amino- transferase) suggest

Answer 19

extensive acute hepatic necrosis

Question 20

True or false

Transaminases (aspartate aminotransferase and alanine amino- transferase) enzyme levels may be near normal in end-stage liver failure, when the hepatocytes are beyond the stage of acute injury

Answer 20

True

Question 21

True or false

aspartate aminotransferase–to–alanine aminotransferase ratio of greater than 2 is common in alcoholic hepatitis because alcohol stimulates aspartate aminotransferase production.

Answer 21

True

Question 22

True or false

transaminase elevations of three to five times normal and alkaline phosphatase of up to twice normal in diabetic or obese patients suggest the presence of nonalcoholic steatohepatitis in diabetic or obese patients

Answer 22

True

Question 23

True or false

A total WBC count >1000/mm3 or a neutrophil count >250/mm3 diagnoses SBP

Answer 23

True

Question 24

True or false

Low glucose or high protein values suggest infection

Answer 24

True

Question 25

True or false

Gram stains and culture results can be falsely negative 30% to 40% of the time, so empiric antibiotics should be started in the ED based on clinical suspicion.

Answer 25

True

Question 26

Hepatitis A virus transmission

Answer 26

transmitted by fecal–oral contamination

Question 27

In Hep A, most common transmission occurs from

Answer 27

asymptomatic children to adults

Question 28

Hep A incubation period and symptoms

Answer 28

incubation period of 15 to 50 days, followed by a prodrome of nausea, vomiting, and malaise. About a week into the illness, patients may note dark urine (bilirubinuria). A few days later, they develop clay-colored stools and jaundice.

Question 29

Hep B patients can be infectious for ____________ after onset of symptoms if they clear the infection.

Answer 29

5 to 15 weeks

Question 30

Hep B incubation

Answer 30

1 to 3 months

Question 31

True or false

Individuals who develop chronic disease will remain infectious indefinitely.

Chronic infection occurs in only 6% to 10% of patients who contract hepatitis B virus

Answer 31

True

Question 32

Hepatitis C virus transmission occurs primarily through

Answer 32

exposure to contaminated blood or blood products

Question 33

In contrast to hepatitis A virus and hepatitis B virus, hepatitis C virus is

Answer 33

most often asymptomatic in the acute phase of infection

Question 34

The most sinister side effect of Hep C treatment with direct-acting antivirals is the

Answer 34

reactivation of dormant hepatitis B infection.

Question 35

True or false

Along with hepatitis B virus, hepatitis C virus is one of the most common causes of hepatocellular carcinoma.

Answer 35

True

Question 36

True or false

Hepatitis D virus is uncommon and is typically seen in patients with preexisting chronic hepatitis B virus infection. Hepatitis D superinfection can result in a rapidly progressive or fulminant form of liver disease that carries a high short-term mortality rate. This variety of infection is most commonly associated with injection drug use

Answer 36

True

Question 37

How to diagnose Spontaneous Bacterial Peritonitis

Answer 37