Liver / Gall Bladder Pathophysiology

Question 1

The hepatic portal vein delivers ____% of the oxygen to the liver, and comprises ___ % of total liver blood flow

Answer 1

60-70%

75%

Question 2

Superior and inferior mesenteric veins join splenic vein to form the ______. This then splits to form ________, each supplying about half of the liver. On entering the liver, the blood drains into the _______, where it is screened by specialised macrophages (________) to remove ___________ The plasma is filtered through the endothelial lining of the sinusoids and bathes the ____________

Answer 2

hepatic portal vein

the right and left branches

hepatic sinusoids

Kupffer cells

any pathogens that manage to get past the GI defences

hepatocytes

Question 3

The portal venous blood contains __________ absorbed from the GI tract, so all useful and non-useful products are processed in the liver before being either released back into the _______ which join the _______ just inferior to the diaphragm, or stored in _______ for later use

Answer 3

all of the products of digestion

hepatic veins

inferior vena cava

liver

Question 4

Hepatic encephalopathy is confusion and mental deterioration due to _________ build up in blood when ____ is injured

Answer 4

bilirubin, ammonia

liver

Question 5

Liver pathology leads to skin symptoms such as _________ because ______ is not recycled causing _______

Answer 5

spider vessels on the face and chest, palmar erythema, pruritus, bright red complexion

estrogen

dilation of blood vessels

Question 6

List top three most injurious factors for liver damage

Answer 6

1) alcohol
2) drugs - aspirin in pediatrics, corticosteriods, tamoxifen, tetracycline
3) infections - viral, parasitic

Question 7

What are liver function tests? What is being tested to identify possible liver injury? Which liver enzyme is the most specific index of the liver injury?

Answer 7

• group of blood tests that detect inflammation and damage to the liver
• levels of liver enzymes, bilirubin, fetoprotein, albumin, blood clotting factors
• ALT (Alanine aminotransferase)

Question 8

What are the three stages of alcoholic liver disease? Which are reversible and which are not?

Answer 8

Steatosis (Fatty Liver) - reversible
Alcoholic Hepatitis - partially reversible
LV Cirrhosis - irreversible

Question 9

Describe chain of events regarding origination and conversion of indirect (unconjugated or unbound) bilirubin into direct (conjugated, bound) bilirubin. What organ is involved in this conversion? What enzyme is necessary?

Answer 9

Heme group of RBC -> biliverdin -> unconjugated bilirubin -> conjugated bilirubin

Liver

glucuronyltransferase

Question 10

What is the most possible cause of pre-hepatic jaundice? Intra-hepatic jaundice? Post-hepatic jaundice? What fractions of bilirubin will be most prevalent in blood plasma with each type of jaundice?

Answer 10

• excessive hemolysis (e.g. hemolytic anemia, malaria); unconjugated bilirubin most prevalent
• injured/diseased liver (e.g. virus, alcoholic hepatitis); conjugated and unconjugated bilirubin present
• obstruction of common bile duct (e.g. gallstones, pancreatic cancer mass); conjugated bilirubin most prevalent

Question 11

List major risk factors and associated patient profile for development of cholelithiasis and cholecystitis:

Answer 11

• Four F profile (fat, fertile, over forty, female), people over 60, American Indians, Mexcian Americans, obesity, drastic weight loss, family history of gallstones, diabetics, cholesterol lowering drugs, oral contraceptive, Western high fat diet

Question 12

List major causes of acute pancreatitis and describe in brief clinical presentations of acute hemorrhagic pancreatitis:

Answer 12

• chronic alcoholism, gallstone in common bile duct, hypercalcemia, elevated triglycerides in blood, anatomic strictures within pancreas, prolonged ischemia, virus (mumps), heredity (cystic fibrosis)
• severe upper abdominal pain radiating to back, nausea, vomiting, peri-umbilical bruising (McCullen’s sign), flanks hematoma (Grey-Turner’s sign), hypocalcemia, unable to assume supine position

Question 13

Most common causes of liver cirrhosis are _________

Answer 13

alcoholism, HBV, HCV

Question 14

Hepatitis B virus may lead to development of what cancer?

Answer 14

hepato-cellular carcinoma

Question 15

HBsAg is ________. Presence of HBsAg in serum indicates _________.

Answer 15

the surface antigen of the hepatitis B virus

either acute infection or chronic carrier state

Question 16

HBcAg is __________. Presence of anti-HBc antibodies in serum indicates ____________

Answer 16

Hepatitis B core antigen.

acute infection

Question 17

HBeAg is _____________. Presence of HBeAg in serum indicates ____________

Answer 17

Hepatitis B envelope antigen

high transmissibility / infectivity

Question 18

HBsAb is ________. Presence of HBsAb in serum indicates ______________

Answer 18

Hepatitis B surface antibody

successful recovery or successful immunization

Question 19

What is the pathogenesis of acute pancreatitis?

Answer 19

premature activation of pancreatic enzymes and autodigestion of the pancreas with possible hemmorhage and necrosis

Question 20

Which type of hepatitis is regarded as a sexually transmitted disease?

Answer 20

HBV

Question 21

Which type of hepatitis is a cause of higher mortality rate in pregnant females?

Answer 21

HEV

Question 22

Which of the hepatitis viruses have vaccines?

Answer 22

A,B,D

Question 23

Which of the hepatitis viruses have DNA?

Answer 23

HBV

Question 24

Which of the hepatitis virus is mostly asymptomatic until later?

Answer 24

HCV

Question 25

Which of the hepatitis viruses are associated with aversion to smoking?

Answer 25

HAV and HEV

Question 26

List the routes of transmission of each hepatitis viruses:

Answer 26

A,E - are fecal/oral (poor sanitation)
B - blood and body fluids (STD)
C - blood to blood (IV, drug use)
D - can only acquire if you have B or simultaneously