Inflammatory Diseases Of The Liver

Question 1

Three characteristics of NASH on biopsy?

Answer 1

hepatic steatosis, lobular inflammation and ballooned hepatocytes

Question 2

Role of vitamin E in NASH?

Answer 2

improves steatosis and inflammation but was not associated with improvements in hepatic fibrosis

Question 3

Skin condition associated with NAFLD?

Answer 3

Psoriasis

Question 4

UGT1A1 gene?

Answer 4

Gilbert

Question 5

Progressive familial intrahepatic cholestasis (PFIC):

Which are characterized by normal GGT levels?

Which is associated with an increased risk for hepatocellular carcinoma?

Answer 5

PFIC type1 and PFIC type 2

PFIC type 2

Question 6

Hemachromatosis: symptoms that are not improved with chelation therapy?

Answer 6

arthropathy, hypogonadism, cirrhosis

Question 7

Function of Hepcidin?

Impact on identifying the etiology of the hemachromatosis?

Answer 7

Secreted by the liver and decreases iron release from macrophages and duodenal enterocytes by interacting with ferroportin

Normal to elevated in ferroportin disease. Low in HFE, TfR2 and Hemojuvulin.

Question 8

PBC - type of portal hypertension? Significance?

Answer 8

pre-sinusoidal portal hypertension in the absence of cirrhosis (varices without cirrhosis)

Question 9

Ursodeoxycholic acid in the management of PBC - beneficial for?

Does not help with?

Answer 9

reduce LDL levels, variceal bleeding, slow the progression and reduce the risk of needing a liver transplant

Fatigue, osteoporosis

Question 10

Hepatocyte rosettes with plasma cell infiltrate - suggestive of?

Answer 10

autoimmune hepatitis

Question 11

Annual screenings for PSC patients?

Answer 11

-colonoscopy
-GB ultrasound

Question 12

IgG-4 sclerosing cholangitis (vs PSC) - treatment, serology, demographic

Answer 12

Steroid responsive, P-ANCA negative, older men

Question 13

When should Hepatic sarcoid be treated with steroids?

Answer 13

Mainly if symptomatic

Question 14

Liver bx: ductulitis and endotheliitis - suggestive of?

Answer 14

Acute cellular rejection

Question 15

Liver bx: ductopenia and cholestasis suggestive of?

Answer 15

Chronic rejection

Question 16

Post transplant patient presenting with: fevers, leukopenia, anemia, secretory diarrhea and maculopapular rash - likely dx?

Answer 16

Liver GVHD

Question 17

the wedged hepatic venous pressure (WHVP), the free hepatic venous pressure (FHVP) and the hepatic venous pressure gradient (HVPG) measurements in
1) pre-sinusoidal disease
2) sinusoidal disease (cirrhosis)
3) cardiac cirrhosis

Answer 17

1) normal WHVP, normal FHVP and normal HVPG
2) elevated WHVP, normal FHVP and elevated HVPG
3) elevated WHVP, elevated FHVP and resultant normal HVPG

Question 18

Caudate lobe hypertrophy - suggestive of?

Mechanism?

Contrast CT finding?

Answer 18

Budd Chiari syndrome, and is due to the separate venous drainage of the caudate into the inferior vena cava allowing for sparing of the outflow, resulting in compensatory hypertrophy

early homogeneous central enhancement with delayed patchy enhancement of the peripheral liver and prolonged retention of contrast in the hepatic periphery, resulting in inhomogeneous portal perfusion

Question 19

macrovesicular steatosis, a neutrophilic lobulitis, the presence of Mallory-Denk bodies, and pericellular fibrosis - diagnosis?

Mallory-Denk bodies?

Answer 19

Alcoholic hepatitis or NASH

cytoplasmic hyaline inclusions of hepatocytes