Hepatobiliary system

Question 1

Hepatobiliary system fn

Answer 1

prod bile
syn plasma prtn
syn plasma lipoprtn
remove old rbc
detoxify drugs
detoxify metabolic waste products

Question 2

Blood flow

Answer 2

portal vein
hepatic artery
sinusoids
lobule
central vein
hepatic vein => IVC

Question 3

Bilirubin

Answer 3

solubilized in liver, excrete into bile, into bowel, altered by B. in bowel

• urobilinogen: reabsorbed; yellow urine
• stercobiliogen: not reabsorbed; brown stool

Question 4

Cirrhosis

• def
• causes (5)
• complications

Answer 4

End stage liver disease
fibrosis and regenerative nodules

causes:

• alcohol
• HBV, HCV
• metabolic and hereditary (hemochromatosis, Wilson disease)
• drugs
• biliary cirrhosis

complications:
- portal hypertension: varices, ascites, splenomegaly

Question 5

Heptatitis causes
- noninfectious
(3 metabolic)
(2 drug/toxin induced)

Answer 5

metabolic disorders

• hemochromatosis: auto rec. Fe metabolism; incr deposition of Fe in liver, heart, pancreas, etc
• Wilson disease: auto rec. Cu metabolism; incr deposition of Cu in liver, brain, eye
• Alpha-1-antitrypsin deficiency: autosomal rec; decr antitrypsin, may cause emphysema, cirrhosis

drug/toxin- induced

• acetaminophen (Tylenol): dose related necrosis of liver cells
• alcohol: 3 pathological changes
  a. steatosis (fatty yellow liver)
  b. alcoholic hepatitis (acute inflamm with fibrosis)
  c. cirrhosis

Question 6

Viral Heptatitis (A and B)

Answer 6

Hep A

• fecal oral route
• no chronic state
• rarely lethal
• vaccine

Hep B

• parenteral, perinatal, sexual
• 5-10% progress to chronic hep
• uncommon massive hepatic necrosis/death
• incr inc of hepatocellular carcinoma
• vaccine

Question 7

Viral Hepatitis (C, D, E, G)

Answer 7

Hep C

• parenteral, sexual
• 50-70% to chronic hep
• incr inc of hepatocellular carcinoma
• no vaccine!

Hep D

• parenteral, possibly sexual
• req coinfection with B

Hep E
- fecal oral

Question 8

Hepatic abscess

• loc
• caused by

Answer 8

in liver parenchyma

caused by B. or parasite (ameba)

Question 9

Hydatid

Answer 9

parasite: echinococcus- cestode (tapeworm)
- disease of various organs
- form cysts

Question 10

Schistosomiasis

Answer 10

parasite: schistosome deposits eggs in branches of portal vein

Question 11

Ascariasis

Answer 11

parasite obstructs bile ducts

Question 12

1º sclerosis cholangitis

• def
• etiology
• pop at risk
• most also have

Answer 12

lymphocytes and macrophages destroy intra and extra-hepatic bile ducts
etiology unknown

• younger males
• most also have IBD (UC>CD)
• incr inc of cholangiocarcinoma

Question 13

Auto-immune hep

• def
• pop at risk
• Tx

Answer 13

autoAb to specific Ag

chronic hep in young females
assoc with other autoimmune diseases

Tx: steroids

Question 14

1º biliary cirrhosis

• def
• pop at risk
• Tx

Answer 14

(T cell?) destroy small intra-hepatic bile ducts and eventual cirrhosis (10-15 yrs)
- antimito Ab in 95%

autoimmune disease in middle age females
etiology uknown
Tx: none!

Question 15

Cavernous hemangioma

Answer 15

benign
endothelial origin

most common benign neoplasm

Question 16

Hepatocellular adenoma

• origin
• pop

Answer 16

hepatocyte origin

• young females on OCP

Question 17

Hepatocellular carcinoma (HCC)

• def
• risk factors (4)
• tumor types
• tumor marker

Answer 17

malignant neoplasm of hepatocytes

risk factors

• cirrhosis
• HBV, HCV
• hemochromatosis
• alpha-1-antitrypsin deficiency

Tumors: diffuse, solitary, or multiple nodules

AFP: HCC tumor marker (usu sec by fetal hepatocytes)

Question 18

Metastatic carcinoma

• most common_
• loc

Answer 18

most common malignancy of liver

usu 1º sites: GI tract, lungs, breast

Question 19

Cholelithiasis

Answer 19

stones in gallbladder

Ch (10%)
pigment (15%)
mixed (75%)

Dx: ultrasound

complications:

• cholecystitis
• obstructive jaundice
• ascending cholangitis
• gallstone ileus

Question 20

Cholecystitis

Answer 20

inflamm of gallbladder (acute and chronic)

cause: usu gallstones but may be acalculus

Question 21

Choledocholithiasis

Answer 21

stone in common bile duct

Question 22

Neoplasm of Biliary Tract

2 types

Answer 22

adneocarcinomas

cholangiocarcinomas (assoc with PSC, clonorchiasis)

Question 23

Exocrine pancreas fn

Answer 23

sec enz: lipase, amylase, peptidase (aid food dig)

Question 24

Acute Pancreatitis

• def
• caused by_
• complications (5)

Answer 24

acute inflamm with tissue necrosis due to pancreatic enz release

cause: alcohol and gallstones (80% cases)

complications:

• abscess
• pseudocyst
• peritonitis
• chronic pancreatitis
• diabetes

Question 25

Chronic Pancreatitis

Answer 25

Persistence of inflamm after original inciting agent is removed

• progressive fibrosis
• impt factor: alcohol

Question 26

Pancreatic carcinoma

Answer 26

adenocarcinoma arising from duct epith cells

poor prognosis