Liver cont cont.

Question 1

This is a condition of iron overload

Answer 1

Hemochromatosis

Question 2

What absorbs and what stores iron?

Answer 2

The intestine absorbs iron and the liver stores iron

Question 3

When iron levels are increased, what is the first thing to be damaged?

Answer 3

The liver (bc it stores it all)
-The heart and pancreas are also involved

Question 4

Is primary hemochromatosis more common in males or females?

Answer 4

-Autosomal recessive
Males- because women lose blood during their period
-Lose blood= lose iron

Question 5

What can hemochromatosis lead to?

Answer 5

Cirrhosis

Question 6

What is a treatment for hemochromatosis

Answer 6

Phlebotomy

Question 7

Describe Wilsons disease

Answer 7

A genetic defiency of ceruloplasmin (a copper binding protein)

Question 8

Pathogenesis of Wilsons disease

Answer 8

• Decrease in ceruloplasmin
• Copper cant be excreted in bile
• Copper accumulates in the liver and brain
• Neurological problems and cirrhosis
• Kayser-Fleischer rings (increase in copper where the cornea meets the sclera)

Question 9

Pathogenesis of hereditary alpha-1-antitrypsin deficiency

Answer 9

• Abnormal protein is nonfunctional
• Tyrpsin is released by neutrophils
• Damages lung tissue
• Leads to emphysema
• Mutant protein accumulates in the liver
• Damages hepatocytes
• Causes cirrhosis

Question 10

Pathogenesis of hepatic vein occlusion

Answer 10

• Due to Budd-Chiari syndrome
• Hepatic vein thrombosis
• secondary to hypercoaguable states (pregnancy, Oral contraceptive us, polycythemia vera)
• Get severe PASSIVE congestion and hepatocyte necrosis

Question 11

What is the most common circulatory problem?

Answer 11

Hepatic vein occlusion- secondary to right heart failure

-blood actually pools due to increased pressure when trying to return to the RA from the IVC

Question 12

Are liver infarcts common or rare?

Answer 12

Rare- because of the dual blood supply of the liver

Question 13

Describe hepatocellular carcinoma

Answer 13

• Primary tumor is large single mass
• can invade an intrahepatic branch of the hepatic vein
• liver is cirrhotic

Question 14

What is a major cause of hepatocellular carcinoma?

Answer 14

• Cirrhosis

- Chronic hepatitis (B or C) or the carrier state

Question 15

How do tumors of the liver tend to metastasize?

Answer 15

• Locally through hepatic veins and IVC/SVC

- THOUGH BLOOD (bc duel blood supply)

Question 16

Where does liver cancer spread?

Answer 16

• Colon
• Lung
• Breast

Question 17

What color is normal gallbladder mucosa?

Answer 17

-Green due to staining of the normal bile

Question 18

What color is gallbladder mucosa in patients with gallstone?

Answer 18

-Bright yellow

Question 19

Choledocholithiasis=

Answer 19

stones in the bile duct

Question 20

What are the 2 categories of gallstones?

Answer 20

• Cholesterol stones (most common)

- Bile pigment stones

Question 21

What are factors that contribute to gallstones?

Answer 21

1. Age
2. Weight
3. Race
4. Pregnancy/rapid weight loss
5. Estrogen replacement/oral contraceptive use

Question 22

What is the major cause of pigment stones?

Answer 22

Hemolysis

Question 23

What causes inflammation of the gallbladder?

Answer 23

Obstruction–> chemical irritation from bile–> mucosal swelling–> luminal distension–> venous congestion–> ischemia and secondary bacterial infection –> necrosis

Question 24

What is the number one cause of extrahepatic biliary obstruction

Answer 24

Gallstones

Question 25

What are other causes of gallstones?

Answer 25

• Biliary atresia in newborns
• Cancer of pancreatic head
• Pancreatitis
• Inflammatory duct disease
• Post-op scarring

Question 26

What is a serious complication of biliary obstruction

Answer 26

• Ascending cholangitis
• Bacterial infection
• Septicemia