Liver disease

Question 1

virtually all known acute/chronic hepatic injury patterns can results from drugs/toxins

Answer 1

yep

Question 2

NAFLD may be morphologically indistinguishable from ALD

Answer 2

yep

Question 3

histologic spectrum of NAFLD (3)

Answer 3

1. simple steatosis
2. steatohepatitis
3. NASH and progressive fibrosis

Question 4

mutations of genes encoding HFE

Answer 4

hereditary hemochromatosis

Question 5

hereditary hemochromatosis

Answer 5

reduced synthesis/activity of hepcidin which results in uncontrolled small bowel Fe absorption

• increased serum trnasferrin saturation
• increased serum ferritin

Question 6

hereditary hemochromatosis:

1. symptoms appear in
   ____ decade
2. classic triad

Answer 6

1. 5th- 6th decade

2. classic triad: cirrhosis, diabetes, skin pigmentation

Question 7

Wilsons

1. inheritance pattern
2. what is it
3. mutation
4. accumulation is
5. increased/decreased serum ceruloplasmin
6. complication
7. treatment

Answer 7

1. autosomal recessive
2. deposition of copper
3. encodes a transmembrane Cu-transporting ATPase on canalicular membrane
4. it is toxic due to oxidative injury from free radicals formation
5. decreased
6. fulminant liver
7. chelation

Question 8

kayser-fleischer ring

Answer 8

wilson’s disease

Question 9

chronic biliary diseases can progress to

Answer 9

cirrhosis

Question 10

biliary tract diseases

1. secondary
2. primary

Answer 10

1. secondary: extrahepatic biliary obstruction with gallstones, tumors or biliary atresia
2. primary: autoimmune cholcangiopathies like PBC and PSC

Question 11

primary biliary cholangitis/cirrhosis involves what part of the liver

Answer 11

intrahepatic bile ducts (autoimmune)

Question 12

primary sclerosing cholangitis involves what part of the liver and is associated with

Answer 12

both intra and extra-hepatic bile ducts

• IBD associated

Question 13

non- suppurative granulomas cholangitis that results in florid duct lesion

Answer 13

primary bile cholangitis

Question 14

primary bile cholangitis

1. occurs in
2. onset
3. autoantibodies
4. LFT
5. treatment
6. serology

Answer 14

1. occurs in middle aged women
2. insidious onset
3. AMA ab (antimitochondrial)
4. increased alk. phos
5. UDCA
6. positive AMA

Question 15

localized aggregate of epithelioid macrophages that is either necrotizing or non-nectrotizing that is due to either an infectious cause such as mycobacteria or non-infectious causes like sarcoidosis

Answer 15

granulomatous hepatitis

Question 16

primary sclerosing cholangitis:

1. what is it
2. occurs in
3. association with
4. diagnosis from
5. increased risk of
6. radiology
7. serology

Answer 16

1. autoimmune dysregulation of T-lymphocytes
2. occurs in middle aged males
3. association with IBD
4. diagnosis from ERCP and MRCP
5. increased risk of bile duct cholangiocarcinoma and GB and colon cancers
6. strictures and beading of large bile ducts; pruning of smaller ducts
7. positive ANCA

Question 17

benign neoplasm of hepatocytes that results in non-cirrhotic liver but may rupture and bleed. there is rare malignant transformation from a beta-catenin mutation

Answer 17

hepatocellular adenoma

Question 18

hyperplastic tumor-like growth of hepatocytes with nodular regenerative response to localized vascular perfusion abn.

Answer 18

focal nodular hyperplasia

Question 19

central stellate scar

Answer 19

focal nodular hyperplasia

Question 20

hepatic mass lesion resulting in a cirrhosis liver results in

Answer 20

HCC

Question 21

hepatic mass lesion resulting in a non- cirrhosis liver

1. age<50
2. age>50

Answer 21

1. age<50: hepatocellular adenoma

2. age>50: metastases