liver disease

Question 1

where is AST vs ALT found originally ?

Answer 1

AST - located in the mitochondria
ALT located in the cytoplasm

Question 2

which liver enzyme is mostly elevated in alcoholic hepatitis ?

Answer 2

AST

Question 3

which liver enzyme is associated with hepatocellular damage ?

Answer 3

ALT

Question 4

what are the different sources of ALP ?

Answer 4

liver
bones
GIt

Question 5

when is ALP increased ( lover associated)?

Answer 5

in cholestasis - any obstruction of bile flow

Question 6

what are the non liver conditions where ALP is elevated ?

Answer 6

pregnancy
thyroid disease
bone disease

Question 7

how can we determine the source of rised ALP ?

Answer 7

by measuring the GGT
elevated in cholestatic pattern but not elevated in bone disease

Question 8

what are the conditions associated with increased GGT levels ?

Answer 8

cholestatic disease
heavy alcohol consumption

Question 9

what other enzyme can be used to determine the source of elevated ALP ?

Answer 9

5 nucleotidase

Question 10

what are the liver function tests ?

Answer 10

albumin ( decrease in dysfunction)
PT /PTT ( increase)
glucose ( decrease )

Question 11

what are the different problems that alcohol can cause in the liver ?

Answer 11

alcoholic fatty liver disease
acute hepatitis
cirrhosis

Question 12

what is the cause of alcoholic fatty disease ?

Answer 12

accumulation of fatty acids
asymptomatic conditions
may be enlarged in an alcholic

Question 13

what kind of toxin is alcohol ?

Answer 13

mitochondrial toxin

Question 14

which zone of the liver lobule is highly affected by alcohol ?

Answer 14

zone 3
where fatty infiltration is first affected

Question 15

what is NAFLD ?

Answer 15

non alcoholic fatty liver disease
often asymptomatic
associated with obesity
may progress to cirrohsis

Question 16

when does alcoholic hepatitis classically happen ?

Answer 16

classically occurs after heavy binge drinking on top of long history of alcohol consumption
present with jaundice and RUQ pain

Question 17

what is alcoholic hepatitis a toxic effect from ?

Answer 17

due to the formation of acetaldehyde

Question 18

what is found on biopsy of people with alcoholic hepatitis ?

Answer 18

mallory bodies
caused due to the damaged intermediate filaments in hepatocytes

Question 19

what is budd chiari syndrome ?

Answer 19

thrombosis of hepatic veins

Question 20

what is the presentation of budd chiari syndrome ?

Answer 20

ascites
abdominal pain
hepatomegaly

Question 21

which zone of the liver lobule is first affected by budd chiari ?

Answer 21

zone 3

Question 22

what are the common causes of budd chiari syndrome ?

Answer 22

myeloproliferative disorders
hepatocellular carcinoma
OCP/pregnancy
hypercoaguable state

Question 23

how does right heart failure cause cirrhosis ?

Answer 23

also called cardiac cirrohsis
rare cause of liver failure
chronic liver edema causes cirrhosis

Question 24

what is distinctively seen in cardiac cirrohsis ?

Answer 24

nutmeg liver
mottled like a nutmeg

Question 25

what is reyes syndrome ?

Answer 25

rare cause of liver failure with encephalopathy associated with children who have a virus infection and are then treated with aspirin classically chicken pox and influenza B

Question 26

how does aspirin cause the liver failure in reyes syndrome ?

Answer 26

aspirin inhibits beta oxidation

Question 27

what is the only condition where aspirin should not be avoided in children ?

Answer 27

kawasaki disease

Question 28

what is the mode of inheritance of alpha 1 anti trypsin deficiency ?

Answer 28

autosomal co-dominant

Question 29

what is the presentation of children with alpha 1 anti trypsin deficiency ?

Answer 29

has emphysema - no smoke exposure liver cirrhosis - pathologic polymerization of AAT, occurs in endoplasmic reticulum

Question 30

what are the histological findings associated with alpha 1 anti trypsin deficiency in the liver ?

Answer 30

AAT polymers stain purple with PAS resist digestion by diastase ( unlike glycogen)

Question 31

what are the causes of liver abscess in the US vs developing countries ?

Answer 31

US - bacteremia , cholangitis (GN rods, klebsiella ) entamoeba histolytica and echinococcus in developing countries

Question 32

what is the most common vs most specific antibody abnotrmality with autoimmune hepatitis ?

Answer 32

ANA - most common Ansti smooth muscle antibody - more specific

Question 33

what is the maximum dose for tylenol ?

Answer 33

4 grams every 24 hours

Question 34

what is the danger of tylenol overdose ?

Answer 34

acute liver failure

Question 35

what is the treatment for acetomeniphone overdose ?

Answer 35

activated charcoal n-acetylcysteine

Question 36

which of the metabolites of acetaminophen is toxic to the liver ?

Answer 36

NAPQI

Question 37

what is shock liver ?

Answer 37

also called ischemic hepatitis due to hypo perfusion - hypotension or shock

Question 38

which zone is associated with shock liver ?

Answer 38

zone 3 near the central vein