Liver

Question 0

Three categories of jaundice:

Answer 0

Prehepatic, hepatic, posthepatic

Question 1

Reference values for bilirubin in blood (total/conjugated)
Infants:
Adults:

Answer 1

Infants - total: 4-8 mg/dL, conjugated: 0-2 mg/dL
Adults - total: 0,2-1 mg/dL, conjugated: 0-0,2 mg/dL

> 2mg/dL –> jaundice

Question 2

Jaundice due to unconjugated bilirubin.

Three reasons:

Answer 2

• Overproduction
• Decreased hepatic uptake
• Impaired conjugation

Question 3

Reasons for prehepatic jaundice:

Answer 3

Hemolysis
Ineffective erythropoiesis
Increased turnover of non-hemoglobin heme
Extravasation (hematoma)

Question 4

In which type of jaundice is alkaline phosphatase >3x upper limit of reference range?

Answer 4

Post hepatic (cholestatic)

Question 5

In which type of jaundice is AST and ALT levels raised a lot?

Answer 5

Hepatocellular

Question 6

Which form of bilirubin is soluble in water and can therefore be excreted in urine? (Conjugated or unconjugated?)

Answer 6

Conjugated

Question 7

Which hepatitis viruses can cause chronic hepatitis?

Answer 7

HBV
HCV
HDV

Question 8

Lab findings in viral hepatitis:

Answer 8

• Increased AST and ALT(>1000U/L)
• Increased bilirubin (>5-20mg/dL) - first conjugated, later unconjugated
• Slightly elevated alkaline phosphatase and serum globulins
• Decreased albumin and coagulation factors
• Neutropenia with relative lymphocytosis

Question 9

Outcomes of acute HCV infection:

Answer 9

• 15% recover spontaneously
• 85% develop chronic hepatitis (of these: 20% cirrhosis, 80% stable disease)
• Fulminant hepatitis and death = rare