Lecture 7.2 MJ slides

Question 1

List the 3 manifestations of alcoholic liver disease, and how common each is

Answer 1

1) Hepatic steatohepatitis (90-100%)
2) Alcoholic hepatitis (10-35%)
3) Cirrhosis (8-20%)

Question 2

Hepatic steatohepatitis (90-100%) (Alcoholic Liver Disease):
1) What increases?
2) What decreases?
3) What is the net effect?

Answer 2

1) ↑ lipid biosynthesis
2) ↓ the assembly and secretions of lipoproteins
3) Accumulation of intracellular lipids

Question 3

Alcoholic hepatitis (10-35%; Alcoholic Liver Disease)
1) Acetaldehyde (metabolite of ETOH) disrupts _____________ and _____________ function.
2) ETOH affects what two things?
3) What damages membranes and proteins?

Answer 3

1) cytoskeleton and membrane function
2) Mitochondrial function + membrane fluidity
3) ROS (generated during oxidation of ETOH)

Question 4

Cirrhosis (Alcoholic Liver Disease) (8-20%):
1) When does it typically occur?
2) What can make it happen faster?
3) What % of alcoholics have this factor that accelerates towards cirrhosis?

Answer 4

1) Usually after 10 years
2) Can be expedited w/ concurrent Hep C infection
3) 30% of alcoholics have Hep C

Question 5

Nonalcoholic Fatty Liver Disease (NAFLD) is associated with what 4 things?

Answer 5

1) Metabolic syndrome
2) Obesity
3) Type 2 diabetes
4) Dyslipidemia and/or hypertension

Question 6

Nonalcoholic Fatty Liver Disease (NAFLD)
1) NAFLD may show all the changes associated with alcoholic liver disease, including what?
2) The features of _____________ often are less prominent than they are in alcohol-related injury.
-Give some examples

Answer 6

1) Steatosis, nonalcoholic steatohepatitis (NASH), and cirrhosis
2) steatohepatitis
-hepatocyte ballooning, Mallory-Denk bodies, and neutrophilic infiltration

Question 7

What pediatric condition is increasingly being recognized as the obesity epidemic spreads to pediatric age groups, but its histologic pattern differs somewhat from that seen in adults?

Answer 7

Pediatric NAFLD (Nonalcoholic Fatty Liver Disease)

Question 8

1) What lab is decreased with Wilson disease?
2) What 2 labs are increased? Include sensitivity/ specificity

Answer 8

1) ↓ serum ceruloplasmin
2) ↑ hepatic copper content (most sensitive)
↑ urinary excretion of copper (most specific)

Question 9

1) Normal α1AT inhibits what?
2) Describe the pathogenesis & inheritance of α1-Anti-Trypsin Disease
3) How can it cause lung injury?
4) How can it cause liver injury?

not sure how much of this slide we need to know

Answer 9

1) Proteases released by neutrophils
2) Autosomal recessive caused by mutations that lead to misfolding of α1AT > ↓ levels of circulating α1-anti-trypsin
2) Pulmonary emphysema b/c destructive protease not inhibited
3) Hepatocellular build up of misfolded α1AT

Question 10

1) What is Charcot’s Triad?
2) What condition is it indicative of?

Answer 10

1) RUQ pain + Jaundice + Fever
2) Cholangitis

Question 11

α1-Anti-Trypsin Disease:
What are the 3 clinical manifestations?

not sure how much of this slide we need to know

Answer 11

1) Newborns: neonatal hepatitis w/ cholestatic jaundice
2) Adolescents: attacks of hepatitis w/ apparent recovery, which may lead to failure or cirrhosis
3) Adults: may be “silent” until cirrhosis is discovered

Question 12

Neonatal Cholestasis:
1) What is it?
2) What are the 2 major causative conditions?

Answer 12

1) Prolonged conjugated hyperbilirubinemia [in neonates]
2) Biliary atresia + Neonatal hepatitis

Question 13

1) “Complete of partial obstruction of the extrahepatic biliary tree (occurs in first 3 months)” describes what?
2) What is Neonatal hepatitis a cluster of?

Answer 13

1) Biliary atresia
2) Disorders that could be toxic, metabolic, or infectious

Question 14

________________ carcinoma has the highest mortality rate secondary to diagnosis at advance stage

Answer 14

Pancreatic

Question 15

Cirrhosis Causes: What is the mnemonic to remember these? What are they?

Answer 15

VW’s Happen
Virus (hepatitis)
Wilson’s
Hemochromatosis
Alpha-1
PSC
PBC
Etoh
NASH

Question 16

Cholesterol stones: List at least 4 groups who are at risk for these

Answer 16

1) Advancing age (>40)
2) Female
3) Pregnancy
4) Obesity
5) Gallbladder stasis
6) Dyslipidemia syndromes
7) Rapid WL

Question 17

Besides cholesterol stones, what’s another type of stone that’s found in different conditions & in a different demographic?

Answer 17

Pigment stones (biliary infection, GI disorders, asian more than western and more rural)

Question 18

What are 2 things to remember for Cholangitis? Describe/ define each

Answer 18

1) Charcot’s Triad: RUQ pain, Jaundice, Fever
2) Reynold’s Pentad (even worse): Hypotension + AMS

Question 19

Acute pancreatitis:
1) What are the Sx like?
2) What are 5 causes/ risk factors?

Answer 19

1) Symptoms range: focal edema → widespread hemorrhagic necrosis
2) Alcoholism, hyperlipoproteinemia, gallstones, iatrogenic surgery, or endoscopic problems w. dye injection

Question 20

What is the pathogenesis of acute pancreatitis? (i.e. what causes it after the initial factors are in place?)

Answer 20

Autodigestion of the pancreas by inappropriately activated pancreatic enzymes

Question 21

Alcoholism, hyperlipoproteinemia, gallstones, iatrogenic surgery, and endoscopic problems w. dye injection can all cause what?

Answer 21

Acute pancreatitis

Question 22

1) 3rd leading cause of cancer deaths in US is what?
2) What are the first 2 causes of cancer deaths?

Answer 22

1) Pancreatic carcinoma
-(aka infiltrating ductal carcinoma)
2) Lung & colon

Question 23

What is the pathogenesis of pancreatic carcinoma?

Answer 23

1) Probably arise from pre-cursor lesions (Pancreatic intraepithelial neoplasia (PanINs))
2) Developed by mutation of 1 oncogene and 3 tumor suppressor genes