Liver

Question 1

• ALT/ AST tell what type of damage? Alk Phos? Billi? Alb/PT?
• PT/INR: All liver except? Could also be?
• AST: Located in? What cells?
• ALT: Located in? What cells?
• AST:ALT = 2 (why?); >1
• Alk phos present in? (4) Where in liver?
• GGT increases with?
• Increased unconjugated in? (3)
• Increased conjugated? (4)

Answer 1

• Hepatocyte; Cholestasis/obstruction/infiltrate; Chol./ob/impaired conj.; Synthetic dysfx
• 8; K defic
• Cyto and mito; liver, heart, muscle, blood
• Cyto of liver only
• Normal; alcohol (mito injury, B6 defic lowers ALT); cirhossis
• Liver (microvilli of bile canal); bone, placenta, intestine
• Alcohol
• Gilberts/Crigler Nejar; Hemolysis
• Dubin Johnson, obstruction, cholestasis, Hep, cirrhosis

Question 2

1. ) HBV: HBVDNA says? Seroconversion? 3 things to treat? Treatment? (2)
2. ) HCV: Goal? SVR = ?
3. ) Hemachromatosis: Treatment? (2) Anemic?
4. ) Autoimmune: Treatment? (2) Helpful markers? (2)
5. ) PBC: Autoimmune of? Ab marker? Treatment? DXA?
6. ) PSC: Destruction of? Increased risk of? Treatment?
7. ) Wilson’s: AR? Problem? Treatment? Maintenence?
8. ) NASH: Injury of? Treatment? (3)

Answer 2

1. ) Active rep; HBeAG –> HBeAB; HbSag > 6 mo, HBVDNA > 10^5 copies; High ALT/AST; Interferon 1 yr, Nucleoside
2. ) HCV RNA (-) 12 wks; Cure
3. ) Letting/stop vit c; Chelation
4. ) Cortico/azathriopine; AsmAB, ANA
5. ) Small ducts; anti-mito; UDCA; yes
6. ) LArge bile ducts; Cholangiocarcinoma; NONE
7. ) Yes; No copper excretion; Chelation; Zinc
8. ) Hepatocytes; Obesity, T2DM, Dyslipidemia

Question 3

• Liver failure common complications? (2)
• Top 4 chronic liver disease in US?
• Hepatitis: Lymphos? Neutros? Eisinos? Plasma?
• Grade? Stage?
• Progression of fibrosis? (4)
  1. ) HAV: Acute? Trans? Antibodies?
  2. ) HBV: DNA? Transmission? Problem where?
  3. ) HCV: Major where? Chronic?
  4. ) HDV: Replication? Dependent on? increase risk of?
  5. ) HEV: Acute? High mortality in?

Answer 3

• jaundice, cholestasis
• HCV>Alcohol>Fatty Liver>HBV
• Viral; Steato; Drug; Auto immune
• Inflammation; Fibrous tissue
• Portal –> periorbital –> Bridging –> cirrhosis
  1. ) Yes; F-O; IgM
  2. ) Yes; Vertical; World
  3. ) US; 85%
  4. ) No; HBV; Fulminant hep
  5. ) Yes; pregos

Question 4

• 3 autoimmune of liver?
• Drug induced: 2 types? Location?
  4. ) Metabolic Hep: a.) Alcohol due to? 2 histo findings?
  b. ) Met. Syndrome: Due to?
• 3 other metabolics?
• Blood flow causes issues?
• Liver masses: Metastasis? Malignant types? 3 benign? Most common?

Answer 4

• Autoimmune, PBC, PSC
• Idiosyncratic/intrinsic; zone 3
• Decreased beta ox/ neutro/mallory; Increased lipolysis
• Hema, Wilsons, a-1
• Yes
• Most common; HC Carcinoma, Cholangio; Hemangioma, Focular nodular, HC Adenoma; hemangioma

Question 5

• Cirhosis: 2 things with portal htx? 2 with LI?
• 4 keys signs?
• Labs with portal htx?
• Biopsy necessary?
• Child score includes? (5)
• MELD Includes? (3)
• Trasplant ranking? (2)
  1. ) Portal Htx: Based on what equation? 5 sites or resistance and example?
• Wedged, free and total for all 5 spots?

Answer 5

• Varices/Ascites; Enceph/Jaundice
• Jaundice, spider angioma, ascites, palmar ethyma
• Low plts
• No
• Enceph, Ascites, Bili, Alb, INR
• INR, Bili, Cr
• Fulminant > MELD
• P = Flow x R; Prehep (Portal/splenic thromb; presinusoidal (Schistosomiasis); Sinusoidal (Cirrhosis); post sinusoidal (veno-occllusive); post hep (CHF, Budd Chiari
• Prehep/presinus = Normal all; sinusoidal/postsinus = High wedge and Total; post hep = Normal but high both

Question 6

a. ) Varices due to 3 things? 4 treatments and effects?
b. ) Ascites: 80% due to? Etiology? (4)
- Serum ascites - ascites albumin: Bad = ? Cirrhotic? Cardiac? Malignant?
- Treatment with no ascites? uncompensated? (2) Refractory? (3)
- 2 types of refractory? More common?
c. ) Hepatorenal: 2 types? Na retention? Renal vasoconstriction? H2O retention?
- Can lead to? Treat with? (2) Not? Also add? To decrease recurrence?
d. ) Hepatic Enceph: Due to? Treatment?

Answer 6

a. ) Increased splanchnic flow, incr. intra hep, increase portal pressure; 1.) ER octreotide VC 2.) Venodilator 3.) Both 4.) Tips
b. ) Cirrhosis; Portal htx –> uncom. –> Refrac. –> HRS
- >1.1; High but low protein; cardiac high both; high protein
- None; Diuretics, LVP; TIPS, Albumin, LVP
- Diuretic intractable > Diuretic resistant
c. ) Type 1 rapid regress, type 2; Ascites; HRS; Hypnat.
- SBP; Augmentin/Ceftriaxone; Aminoglycosides; Albumin; Norfloxacin
- Ammonia; Lactulose

Question 7

Pediatric:

1. ) Physio Jaunduce: Occurs when? Not? Treat? Why? Does what?
2. ) Hered. Hyper: 2 unconj.? 2 Conj?
3. ) Choledochal Cyst: Triad? Increased risk of?
4. ) Biliary atresia: 2 types? Assoc? Treatment?
5. ) Idiopathic nen hep: Cells seen?
6. ) Hepatoblastoma: Presents when? High serum what? Pathway? 3 types? Important prognostic factor?

Answer 7

1. ) After 24 hrs/before 2 wks; outside this; Slow liver enzymes and RBC turnover; Photo; No kernicturus; kidney
2. ) Crigler Nijar (1=AR worse, 2 = AD), Gilberts; Dubin johnson, Rotor
3. ) RUQ mass, pain, direct bili; Cholangio/pancreo/cholan
4. ) Fetal (35%) other abn.; Perinatal no other ab; Kasai
5. ) Giant cells
6. )

Question 8

• Macs of liver? Hepatic vein drains where?
• Bile transporter protein? Messed up in? Exocrine fxn?
  1. ) Classic lobule shape? Shows?
  2. ) Triangle connects? Around? Called? Shows?
  3. ) Acinus splits into? Shows?
• Viruses? Toxins? Ischemia?
• Hepatocytes have apical face? Space of disse b/n? Stellate cell where? 2 jobs?

Answer 8

• Kuppfer; IVC
• MRP2; Dub Johnson; bile production
  1. ) Hexagon; anatomical flow/drainage of blood
  2. ) 3 central veins; 1 portal triad; portal lobe; Bile
  3. ) Eliptical zone 1,2,3; blood flow/metab
• Zone 1; zone 3, zone 3
• Bile; hepato and sinusoidal endo; space of disse; store fat/vit A; produce Type 1 collagen with damage