Liver

Question 1

damage/blockage of either intra-hepatic or extra-hepatic bile ducts

Answer 1

cholestasis

Question 2

systemic retention of not only bilirubin, but also other elimination products (bile salts, cholesterol)

Answer 2

cholestasis

Question 3

characterized by conjugated bilirubin

Answer 3

cholestasis

Question 4

Two types of cholestasis:

Answer 4

intra-hepatic or extra-hepatic

Question 5

Intra-hepatic or extra-hepatic cholestasis? decrease in bile secretion within the liver

Answer 5

intra-hepatic

Question 6

Intra-hepatic or extra-hepatic cholestasis? blockage of the main bile duct

Answer 6

extra-hepatic

Question 7

Intra-hepatic cholestais is due to 2 things:

Answer 7

• abnormalities in hepatocytes

- disease of intra-hepatic bile ducts

Question 8

Causes of intra-hepatic cholestasis:

Answer 8

viral hepatitis, drugs, alcoholic liver disease, pregnancy-related cholestasis, septicemia

Question 9

Causes of extra-hepatic cholestasis:

Answer 9

primary biliary cirrhosis, sclerosing cholangitis, tumor within the liver

Question 10

yellow discoloration of the sclera and skin

Answer 10

jaundice

Question 11

the result of abnormalities in bilirubin metabolism and excretion (what is the serum bilirubin levels?)

Answer 11

jaundice (levels above 2.0 mg/dL)

Question 12

2 most common causes of jaundice:

Answer 12

• hepatitis
• obstruction of bile flow

*specifically the accumulation of conjugated bilirubin

Question 13

the amount of bilirubin present has exceeded the liver’s capacity to conjugate and secrete

Answer 13

unconjugated hyperbilirubinemia (jaundice)

Question 14

Gilbert syndrome

Answer 14

unconjugated hyperbilirubinemia (jaundice)

Question 15

neonatal jaundice

Answer 15

unconjugated hyperbilirubinemia (jaundice)

Question 16

80-90% of liver function is lost

Answer 16

acute liver failure

Question 17

Clinical signs:
o Jaundice
o Coma
o Bleeding tendency

Answer 17

acute liver failure

Question 18

3 main etiologies:
o Severe hepatocyte damage (drug induced toxicity—acetaminophen)
o Systemic shock (multiorgan system failure)
o Acute decline in slowly progressing but relatively stable chronic liver disease (chronic hepatitis or cirrhosis)

Answer 18

acute liver failure

Question 19

treatment for acute liver failure

Answer 19

transplant

Question 20

two groups of fatty liver disease

Answer 20

alcoholic and non-alcoholic

Question 21

stats for alcoholic fatty liver disease

Answer 21

• 90-100% of heavy drinkers with develop a fatty liver
• 10-35% develop alcoholic hepatitis
• 8-20% develop cirrhosis

*each condition may develop independently, thus not representing a continuum

Question 22

commonly associated with insulin resistance and metabolic syndrome (obesity, insulin resistance, dyslipidemia, and hypertension)

Answer 22

non-alcoholic fatty liver disease (NAFLD)

Question 23

chronic, progressive, sometimes fat cholestatic liver disease

Answer 23

primary biliary cirrhosis

Question 24

due to the destruction of intra-hepatic bile ducts, portal inflammation, and scarring, and the development of cirrhosis and liver failure over years to decades

Answer 24

primary biliary cirrhosis

Question 25

more than 90% of sufferers have high titers of autoantibodies directed against several mitochondrial dehydrogenases

Answer 25

primary biliary cirrhosis

Question 26

symptomatic patients present with pruritus and advanced disease

Answer 26

primary biliary cirrhosis

Question 27

untreated leads to hepatic decomposition with portal hypertension, variceal bleeding, and hepatic encephalopathy

Answer 27

primary biliary cirrhosis

Question 28

early treatment with oral ursodeoxycholic acid dramatically improves outcome

Answer 28

primary biliary cirrhosis

Question 29

hyperbilirubinemia is a late feature, usually signifying incipient hepatic decompensation

Answer 29

primary biliary cirrhosis

Question 30

associated extra-hepatic conditions include Sjogren syndrome, scleroderma, thyroiditis, rheumatoid arthritis, Raynaud phenomenon, and celiac disease

Answer 30

primary biliary cirrhosis

Question 31

results in liver congestion due to back-up of blood in central veins

Answer 31

right-sided heart failure

Question 32

typically caused by left-sided heart failure

Answer 32

right-sided heart failure

Question 33

congestion causes mottled, red appearance of liver sections known as “nutmeg liver”

Answer 33

right-sided heart failure

Question 34

increase in portal venous pressure due to blood flow resistance or obstruction, responsible for carrying blood from digestive organs to liver

Answer 34

portal HTN

Question 35

results in ascites (fluid accumulation in abdomen) and esophageal and stomach varices, attempts to bypass obstruction

Answer 35

portal HTN

Question 36

Causes of portal HTN can depend on where obstruction occurs in portal system:

Answer 36

presinusoidal, sinusoidal, postsinusoidal

Question 37

postsinusoidal obstruction in hepatic veins delivering blood to inferior vena cava of heart

Answer 37

Budd-Chiari syndrome

Question 38

Name the benign tumor: usually seen in women of child-bearing age who have used oral contraceptives, regression with discontinuation of hormone use has been seen

Answer 38

hepatic adenoma

Question 39

Name the benign tumor: lesions are usually well-demarcated, unencapsulated, and may be yellow/tam or bile stained, and up to 30 cm in diameter

Answer 39

hepatic adenoma

Question 40

Name the benign tumor: histology composed of sheets and cords of cells that may resemble normal hepatocytes or have minimal variation in cell and nuclear size

Answer 40

hepatic adenoma

Question 41

Name the benign tumor: portal tracts are absent and prominent arterial and draining vessels are distributed

Answer 41

hepatic adenoma

Question 42

Name the benign tumor: not a true neoplasm, but a hamartoma of peribiliary gland vs ductular proliferation following injury

Answer 42

bile duct adenoma

Question 43

Name the benign tumor: characterized grossly by unencapsulated, firm, tan/white nodules

Answer 43

bile duct adenoma

Question 44

Name the benign tumor: composed of networks of ducts among fibrous stroma

Answer 44

bile duct adenoma

Question 45

Name the benign tumor: often misdiagnosed as adenocarcinoma (malignant mimicker)

Answer 45

bile duct adenoma)

Question 46

Name the malignant tumor: common precursors such as cellular changes and nodular lesions are seen in chronic viral hepatitis, alcoholic liver disease, and other diseases

Answer 46

hepatocellular carcinoma

Question 47

Name the malignant tumor: more than 85% of cases occur in countries with high rates of chronic HBV infection

Answer 47

hepatocellular carcinoma

Question 48

Name the malignant tumor: incidence is rapidly increasing in western countries due to HepC epidemic, has tripled in the US in recent decades

Answer 48

hepatocellular carcinoma

Question 49

Name the malignant tumor: rarely seen before age 60 in Western countries, and in 90% of cases the tumor develops in the presence of cirrhosis

Answer 49

hepatocellular carcinoma

Question 50

Name the malignant tumor: can manifest with silent hepatomegaly

Answer 50

hepatocellular carcinoma

Question 51

Name the malignant tumor: often encountered in persons with symptomatic cirrhosis

Answer 51

hepatocellular carcinoma

Question 52

Name the malignant tumor: progressive enlargement of the primary mass until it seriously disturbs hepatic function, or metastasizes (typically to lungs)

Answer 52

hepatocellular carcinoma

Question 53

Name the malignant tumor: the 5-year survival of large tumors is dismal, with most patients dying within the first 2 years

Answer 53

hepatocellular carcinoma

Question 54

Name the malignant tumor: rare malignancy arising from the epithelial cells of the bile ducts

Answer 54

cholangiocarcinoma

Question 55

Name the malignant tumor: chronic inflammation of biliary duct system predisposes individuals to disease (cholangitis, irritable bowel disease)

Answer 55

cholangiocarcinoma

Question 56

Name the malignant tumor: highly lethal as disease is typically advanced when detected

Answer 56

cholangiocarcinoma

Question 57

Two forms of cholangiocarcinoma:

Answer 57

extrahepatic and intrahepatic malignancy

Question 58

Which is more common? metastatic tumors to the liver or primary hepatic neoplasms

Answer 58

metastatic tumors to the liver *common: colon, breast, lung, pancreas