HPB

Question 1

ALT/ALP ratio of less than 2 suggests what pattern of liver injury?

Answer 1

Cholestatic

Question 1

ALT/ALP ratio of more than 5 suggests what pattern of liver injury?

Answer 1

Hepatocellular

Question 2

Bile is produced by which cells?

Answer 2

Hepatocytes

Question 3

What cells are responsible for recycling haemoglobin?

Answer 3

Kupffer cells

Question 4

What cells store vitamin A?

Answer 4

Stellate cells

Question 5

What is the function of GGT?

Answer 5

Transport of amino acids and peptides to the liver

Question 6

ALP is found mainly in the cells lining what structure?

Answer 6

Bile duct

Question 7

What are the four most common causes of liver cirrhosis?

Answer 7

Alcohol related liver disease- non-alcoholic fatty liver, hepatitis B, hepatitis C

Question 8

High levels of ammonia can cause what serious condition?

Answer 8

Hepatic encephalopathy

Question 9

Why is the RAAS system activated in liver failure?

Answer 9

Cirrhosis causes resistance in blood flow of the liver. Increased portal hypertension. Arterial vasodilation to compensate for poor perfusion, triggering the RAAS system.

Question 10

Deficiency in what ion can increase the risk of decompensation in liver failure and why?

Answer 10

Sodium, it’s how the astrocytes compensate for excess glutamine.

Question 11

Where is IgA mainly found?

Answer 11

Mucosal cells lining the lungs and GI tract

Question 12

Which hepatitis viruses are transmitted via faecal-oral route?

Answer 12

A and E

Question 13

Which hepatitis viruses are transmitted via blood and semen?

Answer 13

B and C

Question 14

Which hepatitis virus is most concerning for a mother-baby transmission during childbirth?

Answer 14

B

Question 15

Which hepatitis virus can be transmitted through undercooked pork meat?

Answer 15

E

Question 16

Reduced plasma protein binding, caused by hypalbuminaemia, has what effect on drug pharmacokinetics?

Answer 16

Increased gradient, free-drug movement into tissues, increased Vd, reduced plasma concentration.

Question 17

First pass metabolism may be decreased in liver cirrhosis, what affect does this have?

Answer 17

Bypasses functional liver cells, less first-pass effect on oral drugs, increased bioavailability.

Question 18

What mainly affects the clearance rate of drugs with a high extraction ratio, such as propranolol?

Answer 18

Blood flow

Question 19

Morphine is a flow limited drug. Decreased hepatic blood flow, caused by cirrhosis, results in what bioavailability of this drug?

Answer 19

Increased bioavailability due to reduced hepatic clearance.

Question 20

Drugs with a low extraction ratio are also called what? What limits the metabolism in these drugs?

Answer 20

Capacity limited drugs.

Protein binding and intrinsic clearance.

Question 21

Hepatobiliary cycling may be reduced in what pathology?

Answer 21

Biliary obstruction

Question 22

How does N-acetylcysteine prevent liver damage in paracetamol overdose?

Answer 22

Replenishes availability of glutathione which reacts with reactive metabolite of paracetamol to form an inactive metabolite that can be excreted in the urine.

Question 23

Describe the structure of haem

Answer 23

Molecule consisting of single inorganic Fe ion bound to by 4 pyrrole rings.

Question 24

Haem has what four chains?

Answer 24

2 alpha and 2 beta chains