Liver

Question 1

What is ammonia

Answer 1

Nitrogen waste (primarily from protein deamination)

Question 2

What is ammonia converted to

Answer 2

urea via glucose/alanine cycle in the liver

*urea secreted in urine

Question 3

Where is AST found

Answer 3

within the mitochondria of the liver
*ETOH more commonly effect mitochondria

Question 4

Where is ALT found

Answer 4

within the cytosol of hepatocytes
*more specific to the liver

Question 5

Where is ALT found

Answer 5

within the cytosol of hepatocytes
*more specific to the liver

Question 6

What causes AST to elevate

Answer 6

when there is damage to hepatocytes

Question 7

How much with AST elevate with viral hepatitis?

how about obstruction?

Answer 7

20x
10x

Question 8

When is the AST/ALT ratio elevated

Answer 8

with alcoholic cirrhosis or Rhabdo

Question 9

What do you think of if the AST/ALT ratio <1

Answer 9

acute hepatitis

Question 10

When will Alk Phos be elevated

Answer 10

this will increase with an obstruction of the biliary tree and cholestatic hepatitis

Question 11

When does LDH increase

Answer 11

with hypoxic damage and primary liver damage

Question 12

When does unconjugated bili increase

Answer 12

with hemolysis
*70% of T-bili

Question 13

When will conjugated bili increase

Answer 13

when there is damage to hepatocytes or with obstruction

Question 14

What physically indicates hyperbilirubinemia

Answer 14

jaundice

Question 15

What is the cause of conjugated hyperbilirubinemia

Answer 15

defect in bilirubin transport
biliary obstruction
intrahepatic cholestasis

Question 16

What are the causes of unconjugated hyperbilirubinemia

Answer 16

increased bili production
increased breakdown of hgb
impaired bili uptake
decreased conjugation

Question 17

What is the spectrum of disease caused by chronic ETOH

Answer 17

steatosis
steatohepatitis
fibrosis
cirrhosis
increased risk of HCC

Question 18

What in ETOH damages hepatocytes

Answer 18

acetaldehyde

Question 19

What is steatosis

Answer 19

reversible increased lipid deposition within the liver that begins in the central vein

Question 20

What is occurring in the liver with cirrhosis

Answer 20

inflammation cause an activation of Kupffer cells and this releases inflammatory mediators and ultimately activation of fibrogenic hepatic stellate cells

Question 21

What does the fibrosis in the liver cause with cirrhosis

Answer 21

it will change/block the flow of bile or blood within the liver lobule

Question 22

What causes the liver to be nodular with cirrhosis

Answer 22

fibrotic bands

Question 23

What are the common causes of intrahepatic portal hypertension

Answer 23

thrombosis
inflammation
fibrosis
infectious hepatitis
schistosomiasis

Question 24

What are the causes of post hepatic portal hypertension

Answer 24

prosthetic thrombosis
RV failure

Question 25

What are the main causes of ascites

Answer 25

portal HTN
malignancy
nephrotic syndrome
malnutrition
right heart failure

Question 26

What is ascites

Answer 26

transudative effusion associated with change in hydrostatic pressure that outweighs capillary osmotic pressure

Question 27

What is the physiologic cause of ascites

Answer 27

increased HTN + low albumin causes water to be forced into the peritoneal cavity

Question 28

What is Hep A most commonly associated with

Answer 28

travel to endemic areas
*fecal-oral route

Question 29

What type of virus is hep A

Answer 29

nonenvelgped RNA picornavirus

Question 30

What type of virus is Hep B

Answer 30

double stranded DNA

Question 31

What type of hepatitis is linked with HCC

Answer 31

Hep B
*blood borne

Question 32

What type of virus is Hep C

Answer 32

Enveloped ssRNA

Question 33

What is the most common cause of fulminant liver failure

Answer 33

acetaminophen