Liver and Gallbladder Pathology

Question 1

what is ammonia

Answer 1

nitrogen waste (primarily from protein break down)

Question 2

what is the pH of ammonia

Answer 2

11

Question 3

what makes aspartate aminotransferase (AST) increase

Answer 3

damage to hepatocytes

Question 4

where is AST located

Answer 4

mitochondria of liver + other metabolically active tissues

Question 5

where is ALT located

Answer 5

within the cytosol of the hepatocytes
more specific to liver - longer half life

Question 6

when does ALt increase

Answer 6

damage/necrosis to hepatocytes

Question 7

What is a AST/ALT ration > 1 mean

Answer 7

alcoholic cirrhosis

Question 8

what is AST/ALT ration < 1 mean

Answer 8

acute hepatitis (viral, mono..)

Question 9

when does alk phos increase

Answer 9

obstruction of biliary tree, cholestatis hepatitis
increased in pregnancy and kids

Question 10

when does LDH increase

Answer 10

hypoxic and primary liver damage

Question 11

what is LDH

Answer 11

lactate dehydrogenase

Question 12

what indicates hyperbilirubinemia

Answer 12

jaundice

Question 13

what is increased lipid deposition wtihin the liver

Answer 13

steatosis

Question 14

where does steatosis begin

Answer 14

central vein and spread out

Question 15

what is steatohepatitis

Answer 15

alcoholic hepatitis: next stage in advancing ETOH induced liver disease

Question 16

what is inflamation and fibrosis of the liver

Answer 16

cirrhosis
irreversible

Question 17

what is non-alcoholic fatty liver disease

Answer 17

triglyceride infiltration into hepatocytes

Question 18

what are risk factors for non-alcoholic fatty liver disease

Answer 18

genetic predisposition, obesity, hypercholesterolemia, hypertriglyceridemia, change in gut microbiome

Question 19

what is portal hypertension

Answer 19

downstream effect of hepatocyte scaring and inflammation
-intrahepatic, posthepatic, prehepatic

Question 20

what is prehepatic portal hypertension

Answer 20

thrombosis of portal vein
causes: malignancy, hyper-coagulable state, septicemia, decreased flow 9cirrhosis), trauma/inflammation (pancreatitis, hepatitis)

Question 21

what are cause of intrahepatic portal hypertension

Answer 21

thrombosis
inflammation
fibrosis (cirrhosis)
infectious hepatitis
schistosomaiasis

Question 22

what is schistomaisis

Answer 22

parasite the lives in liver and causes intrahepatic portal HTN

Question 23

what is excess fluid within the peritoneal cavity

Answer 23

ascites
-increased portal pressure
- decreased albumin

Question 24

what is the presentation ascites

Answer 24

distended abdomen
weight gain
SOB b/c decreased diaphragmatic excursion
peripheral edema
hypoatremia

Question 25

what is the incubation period of hepatitis A

Answer 25

28 days

Question 26

what is the presentaiton of hepatitis A

Answer 26

fever/chills N/V clay-colored stools arthralgias abdominal discomfrot jaundice dark urine hepatomegaly

Question 27

what is hepatitis B

Answer 27

double stranded DNA virus transmitted via mucosal contact or blood born can survive 7 days on fomites

Question 28

what is the presentation of hepatitis B

Answer 28

ascites, fatigue, anemia, encephalopathy rarely cause fulminant hepatic failure m/c subclinical infection

Question 29

what is hepatitis C

Answer 29

enveloped ssRNA virus flavivirus high rate of chronic liver disease bloodborn transmission 4-12 week incubation period

Question 30

what is the presentation of Hep C

Answer 30

abdominal discomfort, N/V, jaundice, fatigue may develop chronic infection

Question 31

what is Hepatitis D

Answer 31

must have concomintant Hep B increases pts risk of HCC

Question 32

what is the causes of hepatic failure

Answer 32

infectious (hepatitis) toxins (meds, tylenol, ETOH) ischemic

Question 33

what is the presentation of liver failure

Answer 33

jaundice hepatomegaly/splenomegaly encephalopathy increased bleeding asterixis

Question 34

what are liver abscess

Answer 34

m/c visceral abscess associated with DM, transplant pts, on PPIs, hepatobiliary disease, pancreatic diease

Question 35

what is the cause of liver abscess

Answer 35

typically polymicrobial - anaerobic organisms, streptococci, staphylococcus

Question 36

what is the presentation of liver abscess

Answer 36

abdominal pain, fever, N/V, weight loss, transaminitis consider in febrile neurtropenia