Liver anatomy function tests

Question 1

4 functions of the liver

Answer 1

• delivers bile to duodenum
• carbs -> glycogen
• lipids?
• makes albumin/clotting factors

Question 2

2 vessels supplying blood to liver

Answer 2

• portal vein

- hepatic artery

Question 3

which zone has most rich blood supply in liver lobule

Answer 3

• zone 1 near the portal triad

Question 4

what is the direction of flow in the liver (vessels?)

Answer 4

• from portal vein and artery to central vein

Question 5

when do you start experiencing symptoms from liver disease

Answer 5

liver at 25% of function

platelets have dropped and INR elevated

Question 6

severe hepatitis when ALT/AST is

Answer 6

> 15x ULN or > 600

Question 7

Ddx for severe hepatitis with AST, ALT elevations higher than ALP GGT

Answer 7

• Viral
• Autoimmune
• cocaine
• acute obstruction

Question 8

Diffuse nodular transformations with fibrosis suggests

Answer 8

CIRRHOSIS

Question 9

In acute viral (a/e) hepatitis, which enzyme goes up first

Answer 9

ALT

Question 10

Incubation period of HEV

Answer 10

• ~ 1 mo

Question 11

causes of chronic hepatitis

Answer 11

• viral B(D), C
• Drug-induced
• Autoimmune

Question 12

Classic histology of chronic hepatitis

Answer 12

• portal inflammation
• parenchynal inflammation, necrosis
• fibrosis

Question 13

progression of fibrotic changes

Answer 13

• first portal-portal
• portal- central
• severe necroinflammatory activity

Question 14

who is most at risk of chronic hepatitis due to viral infection

Answer 14

• neonate

Question 15

If HBeAg is present in blood, it indicates

Answer 15

person is infectious

Question 16

how can you treat a HepB infection

Answer 16

• Immune modulation - interferon alpha

- nucleoside analogs

Question 17

3 things to order if suspect Hep B infection

Answer 17

• HBsAg - infected
• Anti-HBs - immune -
• Anti- HBc - core - resolved infection

Question 18

If you’re HBs Ag positive then what is the work up

Answer 18

• rest of HEP B antibodies

- Check LFTs - INR, Bili, Alb, Plt, CBC

Question 19

In the setting of inactive hep B, and active hepatitis think about

Answer 19

Hep D

Question 20

how do you screen for a Hep C infection

Answer 20

• Anti-HCV (pos -> PCR, check RNA)
• ALT
• AST

Question 21

Diagnosing alcoholic hepatitis

Answer 21

• AST>ALT

- management: no alcohol, withdrawal, give steroids if acute

Question 22

Chronic alcoholic hepatitis lab restults

Answer 22

effects on platelets
INR
elevated MCV

Question 23

Histological features of alcoholic hepatitis

Answer 23

• fat droplets in hepatocytes
• mallory bodies
  ballooning

Question 24

Differences between steatosis and steatohepatitis

Answer 24

steatosis can resolve -

steatohepatitis - with fibrosis chronic damage

Question 25

where does fibrosis form in the context of steatohepatitis

Answer 25

• Zone 3 - around central vein

Question 26

Who is at risk for non alcoholic fatty liver disease - NAFLD

Answer 26

• Metabolic syndrome

Question 27

Contrary to AFLD, NASH lab tests look like

Answer 27

ALT> AST rather than the opposite
- HIGH ferritin (inflammation)
-

Question 28

Pathogenesis of NASH

Answer 28

2 hit process

1) inflammation hepatic steatosis
2) oxidative stress - steatohepatitis
- extra FFAs