Hepatology Flashcards by Mahfuz mithu

Anatomy

What is functional unit of liver?

Acinus

How well did you know this?

Not at all

Perfectly

Anatomy

How liver is anatomically and functionally divided?

Anatomically by falciparum ligament & functionally by blood supply

How well did you know this?

Not at all

Perfectly

Anatomy

How many segments liver contains?

How well did you know this?

Not at all

Perfectly

Anatomy

Liver segments consists of?

Lobules

How well did you know this?

Not at all

Perfectly

Anatomy

Hepatic lobule contains?

1.Central vein
2.Radiating sinusoids (এরা সিংগেল হেপাটোসাইট প্লেট দিয়ে আলাদা করা থাকে)
3.peripheral portal tract(Portal vein,hepatic artery, bile duct)

How well did you know this?

Not at all

Perfectly

Anatomy

From portal tract blood flow outwards..T/F
Bile flows in opposite..(inward) T/F

How well did you know this?

Not at all

Perfectly

Anatomy

Zones of hepatocyte?

Zone 1/peripheral/portal Triad এর পাশের zone :

Highest oxygen,Nutrients and Toxins

Function:
Gluconeogenesis
Bile salt formation

বাকী গুলা zone 3(pericentral/portal triad থেকে দুরের zone) তে হবে

How well did you know this?

Not at all

Perfectly

Anatomy

Function of zone 3?

1.Glycolysis
2.lipolysis
3. Monooxygenation
4.Glucoronidation

How well did you know this?

Not at all

Perfectly

Anatomy

Why liver injury is patchy in nature?

Due to different zone of hepatocytes

How well did you know this?

Not at all

Perfectly

Anatomy

Fibrosis occurs by?

Stellate /ito cell.. Ito cell থাকে space of Disse তে।এটা হচ্ছে Hepatocyte আর sinusoid এর মাঝের স্পেস

How well did you know this?

Not at all

Perfectly

Anatomy

About sinusoid?

No basement membrane
Contains fenestrae 0.1 micrometer
Lined by endothelial cell

How well did you know this?

Not at all

Perfectly

Anatomy

For pathogenesis of fibrosis, ito cell differentiating into?
Main factor?

Into Myo fibroblasts.
Mainly by TGF beta 1

How well did you know this?

Not at all

Perfectly

Anatomy

Activated stillete cell causes portal hypertension by?

ET1 (endothelin 1)
Vasoconstrictor

How well did you know this?

Not at all

Perfectly

Anatomy

Function of stellate C ll

1.fibrosis
2.Vit A store
3.Defense

How well did you know this?

Not at all

Perfectly

Anatomy

Liver get nutrition & oxygen from?

Nutrient for portal vein & o2 from Hepatic artery

How well did you know this?

Not at all

Perfectly

Anatomy

Who provide driving force for bile flow in liver?

Hepatocyte by osmotic gradient

How well did you know this?

Not at all

Perfectly

Anatomy

Hepatocyte secret bile into?

Biliary canaliculi

How well did you know this?

Not at all

Perfectly

Length and width of common bile duct?

5cm and 5 mm apprx

How well did you know this?

Not at all

Perfectly

Anatomy

How common bile duct pressure is maintained?

Rhythmic contraction of sphinchter of oddi (Normally exceeds GB prsr in fasting state)

How well did you know this?

Not at all

Perfectly

Anatomy

GB tone is maintained by?

1.Vagal activity
2.CCK

So after feeding cck cause GB contraction and overcome the prsr of CBD and sphincter relaxed,thus bile flows to duodenum

How well did you know this?

Not at all

Perfectly

Anatomy

Which portion of biliary channel contain valves of heister(cresentic fold)?

Cystic duct..Beaded appearance on cholangiography

How well did you know this?

Not at all

Perfectly

Anatomy

How much albumin is produced in liver per day?

8-14 g

How well did you know this?

Not at all

Perfectly

Anatomy

Excretory function of liver?

Bile salt
Bilirubin
Drugs
Phospholipids
Cholesterol

How well did you know this?

Not at all

Perfectly

Anatomy

Protein synthesis in liver?

Albumin
Coagulation factors
Complements
Haptoglobulin
Alpha 1 anti trypsin

মনে থাকবে না ২ টা
Cerruloplasmin
Transferrin

How well did you know this?

Not at all

Perfectly

#Anatomy After conjugation Bilirubin is secreted into?

Bile canaliculi

#Anatomy Components of Bile

1.Bile Acid(from cholesterol) 2.Bilirubin 3.phospholipid 4 Cholesterol মানে লিভারের এক্সক্রিটরি ফাংশান গুলাই

#Anatomy Minerals and vitamins stored in liver?

Iron(ferritin and hemosiderin),Cu Vit-ADB12K Also convert 7 dehydrocholesterol to 25 hydroxy vit D

#Anatomy Most abundant tissue macrophage?

Kupffer cell

LFT includes?

1.Bilirubin 2.Albumin 3.AST,ALT,ALP,GGT

Liver function best assessed by?

Bilirubin,Albumin and PT

T/F PT is included in LFT

T/F albumin fall in Acute liver disease.Explain

F..T1/2 is 2 wks.. so in Acute liver disease it may be normal.. Fall of Albumin indicates chronic liver disease

Normal AST:ALT = 0.8 When altered?[>]

1.Alcohol 2.An indicator of advanced fibrosis(ex:NAFLD, HEP C)

Marked raised ALP&GGT with mild raise Transaminase?

Cholestasis

Marked raise transaminase with mild ALP,ggt?

Hepatitic

Isolated raise of ggt?

Alcoho/Inducer drug/NAFLD

Raised ALP with normal GGT?

Non liver cause(Bone/Pregnancy)

Site of ALP in liver?

Memrane of Sinusoid & biliary canaliculi

Hyponatremia in cirrhosis indicates?

Poor prognosis

Serum urea reduces in liver disease..when icrease indicates?

GI hemorrhage

In CLD macrocytosis indicates?

Alcohol/Hemolysis

Normal half life of K dependant clotting factors?

5-72 Hrs

What test is complementary to MRCP?

EUS

What are the indirect fibrosis markers?

Platelet count Bilirubin AST/ALT ratio Mnemonic: B-PL ratio

Fibrotest include?

Alpha 2 macroglobulin Haptoglobin Apolipoprotein A1

What test is alternative to serological fibrosis marker?

Fibroscan(Transient elastography)

Scoring system for fibrosis?

NAFLD FIBROSIS SCORE FIB-4

Conditions causing both acute and chronic liver injury?

1.Alcoholic liver disease. 2.wilsons disease 3.Autoimmune hepatitis

Virus causing both Acute and chronic liver injury?

Hep-B

Causes of moderate elevation of ALT? (100-300)

Wilsons NASH autoimmune এর বাইরে ক্রোনিক কজ গুলা

Causes of major elevation of ALT? >300

Drugs+Toxin(amanita)+Autoimmune+Hep B flare+acute viral hepatitis

what are the late features of cholestasis?

Malabsorption of ADEK WT LOSS STEATORRHOEA OSTEOMALACIA BLEEDING TENDANCY XANTHELASMA XANTHOMA BLEEDING TENDANCY

Unconjugated hyper bilirubinemia+neonatal death..Dx?

Absent Glucoronyl transferase (Type 1 crigler najar)

Mild jaundice(conjugated hyperbilirubinemia+ Pigmentation of liver biopsy) Dx?

Dubin johnson Pigmented DJ 😎

Alternate to PT to assess degree of liver damage?

Factor 5 levels

When Acute liver failure is considered severe?

In presence of jaundice and coagulopathy

Causes of static jaundice?

1.Carcinoma 2.PBC 3.PSC(also causes fluctuating)

Acute liver failure without jaundice?

1.paracetamol toxicity 2.Reyes syndrome etc

T2 HRS is clinically characterised by?

Diuretic resistant ascities

In HRS -AKI what shows to improve sort term servival?

IV albumin+terlipressin

High Na and Na retaining drugs?

High Na হলো PANCa -paracetamol, phenytoin -aspirin,alginate,antacids,antibiotica -Na valporate -Ca Na রিটেইনিং গুলা আলাদা মনে রাখব NSAID OCP STEROID METOCLOPRAMIDE CARBENOXOLONE

Snake skin in proximal stomach? Watermalon skin in distal stomach?

Portal HTN Cirrhosis

Which hepatitis spread through saliva?

ABC

Cholestatic hepatitis is caused by?

Which Gene is important for susceptibility of cirrhosis in ALD & NAFLD?

PNPLA-3/ ADIPONUTRIN

Dupuytren contracture, due to chronic Alcohol is predictive of underlying liver Disease..T/F?

F..Not predictive

Rapid onset of jaundice with recent heavy drinking with tender hepatomeghaly.. Diet after 2 days of admission.Cause lf death?

Sepsis/Renal failure

Macrocytosis without Anemia! Next history you Will take?

Alcohol

Most important prognostic factor for ALD?

Alcohol cessation..Best advice is life time abstinence

Best determinant of outcome in NAFLD

Fibrosis

Which vitamin &Mineral is associated with prostate cancer?

Vit E Cadmium

#Autoimmune hepatitis Young female(5:1) 1.Precipitating factors? 2.Antibodies? 3.Antibody specific for Children 4.Ab specific for adult Typical diagnostic picture? 5.confirmatory Dx? And finding?

1.Drug: Nitrofurantoin,Virus:EBV & HAV 2.IgG...ANA, ASMA,AMA,LKM,SLA 3.Anti LKM 4.Anti SLA High titre of ANA and/or ASMA with raised IgG level in young adult female 5..Liver biopsy...portal lymphoplasmacytic hepatitis

What is portal Lymphoplasmacytic hepatitis?

Abundant lymphocyte and plasma cell around portal tracts in autoimmume hepatitis

Life saving therapy for Autoimmune hepatitis? Maintenance therapy? Drug for Refractory disease?

1.glucocorticoids 2.Azathioprine 3.Tacrolimus

#A1 Anti trypsin deficiency. 1.system affected? 2.Gene and chromosome? 3.Homozygous?

1.Liver and lung 2.SERPINA1 Chr-14 3.Pizz usually produce disease

Brown crumbly pigment stone in GB?

Almost always due to bacterial or parasitic biliary infection

Which infection carries risk of Ca GB?

Chronic salmonella

How you confirm ampulla of vater ca?

Duodenal endoscopy with biopsy Imaging shows - Double duct sign Staging:EUS

Triad of Budd chiari syn?

Severe upper abdominal pain Rapidly developed ascities Acute livere failure,tender hepatomeghaly Dependent edema if IVC obstruction