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My Notes > Hepatology > Flashcards

Hepatology Flashcards

1
Q

Anatomy

What is functional unit of liver?

A

Acinus

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2
Q

Anatomy

How liver is anatomically and functionally divided?

A

Anatomically by falciparum ligament & functionally by blood supply

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3
Q

Anatomy

How many segments liver contains?

A

8

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4
Q

Anatomy

Liver segments consists of?

A

Lobules

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5
Q

Anatomy

Hepatic lobule contains?

A

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

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6
Q

Anatomy

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

A

T

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7
Q

Anatomy

Zones of hepatocyte?

A

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

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8
Q

Anatomy

Function of zone 3?

A

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

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9
Q

Anatomy

Why liver injury is patchy in nature?

A

Due to different zone of hepatocytes

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10
Q

Anatomy

Fibrosis occurs by?

A

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

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11
Q

Anatomy

About sinusoid?

A

No basement membrane
Contains fenestrae 0.1 micrometer
Lined by endothelial cell

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12
Q

Anatomy

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

A

Into Myo fibroblasts.
Mainly by TGF beta 1

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13
Q

Anatomy

Activated stillete cell causes portal hypertension by?

A

ET1 (endothelin 1)
Vasoconstrictor

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14
Q

Anatomy

Function of stellate C ll

A

1.fibrosis
2.Vit A store
3.Defense

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15
Q

Anatomy

Liver get nutrition & oxygen from?

A

Nutrient for portal vein & o2 from Hepatic artery

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16
Q

Anatomy

Who provide driving force for bile flow in liver?

A

Hepatocyte by osmotic gradient

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17
Q

Anatomy

Hepatocyte secret bile into?

A

Biliary canaliculi

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18
Q

Length and width of common bile duct?

A

5cm and 5 mm apprx

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19
Q

Anatomy

How common bile duct pressure is maintained?

A

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

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20
Q

Anatomy

GB tone is maintained by?

A

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

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21
Q

Anatomy

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

A

Cystic duct..Beaded appearance on cholangiography

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22
Q

Anatomy

How much albumin is produced in liver per day?

A

8-14 g

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23
Q

Anatomy

Excretory function of liver?

A

Bile salt
Bilirubin
Drugs
Phospholipids
Cholesterol

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24
Q

Anatomy

Protein synthesis in liver?

A

Albumin
Coagulation factors
Complements
Haptoglobulin
Alpha 1 anti trypsin

মনে থাকবে না ২ টা
Cerruloplasmin
Transferrin

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25
Q

Anatomy

After conjugation Bilirubin is secreted into?

A

Bile canaliculi

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26
Q

Anatomy

Components of Bile

A

1.Bile Acid(from cholesterol)
2.Bilirubin
3.phospholipid
4 Cholesterol

মানে লিভারের এক্সক্রিটরি ফাংশান গুলাই

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27
Q

Anatomy

Minerals and vitamins stored in liver?

A

Iron(ferritin and hemosiderin),Cu

Vit-ADB12K

Also convert 7 dehydrocholesterol to 25 hydroxy vit D

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28
Q

Anatomy

Most abundant tissue macrophage?

A

Kupffer cell

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29
Q

LFT includes?

A

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

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30
Q

Liver function best assessed by?

A

Bilirubin,Albumin and PT

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31
Q

T/F
PT is included in LFT

A

F

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32
Q

T/F albumin fall in Acute liver disease.Explain

A

F..T1/2 is 2 wks.. so in Acute liver disease it may be normal..

Fall of Albumin indicates chronic liver disease

33
Q

Normal AST:ALT = 0.8

When altered?[>]

A

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

34
Q

Marked raised ALP&GGT with mild raise Transaminase?

A

Cholestasis

35
Q

Marked raise transaminase with mild ALP,ggt?

A

Hepatitic

36
Q

Isolated raise of ggt?

A

Alcoho/Inducer drug/NAFLD

37
Q

Raised ALP with normal GGT?

A

Non liver cause(Bone/Pregnancy)

38
Q

Site of ALP in liver?

A

Memrane of Sinusoid & biliary canaliculi

39
Q

Hyponatremia in cirrhosis indicates?

A

Poor prognosis

40
Q

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

A

GI hemorrhage

41
Q

In CLD macrocytosis indicates?

A

Alcohol/Hemolysis

42
Q

Normal half life of K dependant clotting factors?

A

5-72 Hrs

43
Q

What test is complementary to MRCP?

A

EUS

44
Q

What are the indirect fibrosis markers?

A

Platelet count
Bilirubin
AST/ALT ratio

Mnemonic: B-PL ratio

45
Q

Fibrotest include?

A

Alpha 2 macroglobulin
Haptoglobin
Apolipoprotein A1

46
Q

What test is alternative to serological fibrosis marker?

A

Fibroscan(Transient elastography)

47
Q

Scoring system for fibrosis?

A

NAFLD FIBROSIS SCORE
FIB-4

48
Q

Conditions causing both acute and chronic liver injury?

A

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

49
Q

Virus causing both Acute and chronic liver injury?

A

Hep-B

50
Q

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

A

Wilsons
NASH
autoimmune

এর বাইরে ক্রোনিক কজ গুলা

51
Q

Causes of major elevation of ALT? >300

A

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

52
Q

what are the late features of cholestasis?

A

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

53
Q

Unconjugated hyper bilirubinemia+neonatal death..Dx?

A

Absent Glucoronyl transferase
(Type 1 crigler najar)

54
Q

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

A

Dubin johnson

Pigmented DJ 😎

55
Q

Alternate to PT to assess degree of liver damage?

A

Factor 5 levels

56
Q

When Acute liver failure is considered severe?

A

In presence of jaundice and coagulopathy

57
Q

Causes of static jaundice?

A

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

58
Q

Acute liver failure without jaundice?

A

1.paracetamol toxicity
2.Reyes syndrome etc

59
Q

T2 HRS is clinically characterised by?

A

Diuretic resistant ascities

60
Q

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

A

IV albumin+terlipressin

61
Q

High Na and Na retaining drugs?

A

High Na হলো PANCa
-paracetamol, phenytoin
-aspirin,alginate,antacids,antibiotica
-Na valporate
-Ca

Na রিটেইনিং গুলা আলাদা মনে রাখব

NSAID
OCP
STEROID
METOCLOPRAMIDE
CARBENOXOLONE

62
Q

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

A

Portal HTN
Cirrhosis

63
Q

Which hepatitis spread through saliva?

A

ABC

64
Q

Cholestatic hepatitis is caused by?

A

A

65
Q

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

A

PNPLA-3/ ADIPONUTRIN

66
Q

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

A

F..Not predictive

67
Q

Rapid onset of jaundice with recent heavy drinking with tender hepatomeghaly..

Diet after 2 days of admission.Cause lf death?

A

Sepsis/Renal failure

68
Q

Macrocytosis without Anemia!
Next history you Will take?

A

Alcohol

69
Q

Most important prognostic factor for ALD?

A

Alcohol cessation..Best advice is life time abstinence

70
Q

Best determinant of outcome in NAFLD

A

Fibrosis

71
Q

Which vitamin &Mineral is associated with prostate cancer?

A

Vit E
Cadmium

72
Q

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?

A

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

73
Q

What is portal Lymphoplasmacytic hepatitis?

A

Abundant lymphocyte and plasma cell around portal tracts in autoimmume hepatitis

74
Q

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

A

1.glucocorticoids
2.Azathioprine
3.Tacrolimus

75
Q

A1 Anti trypsin deficiency.

1.system affected?
2.Gene and chromosome?
3.Homozygous?

A

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

76
Q

Brown crumbly pigment stone in GB?

A

Almost always due to bacterial or parasitic biliary infection

77
Q

Which infection carries risk of Ca GB?

A

Chronic salmonella

78
Q

How you confirm ampulla of vater ca?

A

Duodenal endoscopy with biopsy

Imaging shows - Double duct sign
Staging:EUS

79
Q

Triad of Budd chiari syn?

A

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

My Notes (3 decks)

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