Liver I

Question 1

What transports unconjugated bilirubin?

Answer 1

Albumin

Question 2

What is added to make bilirubin “conjugated”?

Answer 2

Glucuronic acid

Question 3

Which bilirubin is toxic to tissues?

Answer 3

Unconjugated bilirubin

Question 4

What types of processes lead to high levels of unconjugated bilirubin?

Answer 4

Increased bilirubin production
Impaired bilirubin uptake (heart failure, shunts, some drugs)
Impaired conjugation (Gilbert’s, Hyperthyroidism, liver diseases)

Question 5

What processes lead to increased conjugated bilirubin?

Answer 5

Extrahepatic cholestasis

Intrahepatic cholestasis

Question 6

What is Gilbert’s syndrome?

Answer 6

Decreased glucuronyltransferase activity, leading to increased unconjugated bilirubin

Question 7

What is the inheritance pattern of Gilbert’s syndrome?

Answer 7

Autosomal recessive

Question 8

What is the difference between hepatocellular cholestasis, canalicular cholestasis, and acute cholangitis?

Answer 8

Hepatocellular: Bile stasis in hepatocytes
Canalicular: Bile plugged within bile ducts
Acute cholangitis: Inflammation of bile ducts with neutrophils in ducts

Question 9

What is chronic passive congestion?

Answer 9

Centrilobular circulation congestion

Question 10

What is defined as centrilobular congestion with centrilobular necrosis?

Answer 10

Centrilobular hemorrhagic necrosis

Question 11

What is defined as a fibrosing reaction of pericardium following longstanding CPC and/or centrilobular necrosis?

Answer 11

Cardiac sclerosis

Question 12

What is described as a “nutmeg” liver?

Answer 12

Centrilobular hemorrhagic necrosis

Question 13

What areas are spared in centrilobular hemorrhagic necrosis?

Answer 13

periportal areas

Question 14

What is defined as a thrombosis of two or more hepatic vein branches?

Answer 14

Budd chiari syndrome

Question 15

What does Budd-Chiari syndrome often present as?

Answer 15

Triad: Hepatomegaly, ascites, abdominal pain

Question 16

What is the pathology of Budd-Chiari syndrome?

Answer 16

Centrilobular hemorrhagic necrosis

Cardiac sclerosis

Question 17

What is defined as an obstructive, nonthrombotic lesion of central hepatic veins?

Answer 17

Sinusoidal obstruction syndrome

Question 18

What is the main problem with sinusoidal obstruction syndrome?

Answer 18

Increased exposure to hepatotoxins

Question 19

What are acute symptoms of Sinusoidal obstruction syndrome? Chronic?

Answer 19

Acute: Hepatomegaly, weight gain, jaundice
Chronic: Pyrrolizidine alkaloids causing toxic effects, leading to Budd Chiari symptoms

Question 20

Which vessels are affected in Sinusoidal obstruction syndrome?

Answer 20

central veins

Question 21

What is defined as sinusoidal dilatation with rupture, leading to blood filled spaces?

Answer 21

Peliosis hepatis

Question 22

What causes peliosis hepatis?

Answer 22

Anabolic steroids, contraceptives, danazol, AIDS infection, malignancy

Question 23

What is done to prevent perinatal HBV?

Answer 23

treat with HepB immune globulin and HepB vaccine. Prevents chronic carrier state when administered 2-12 hours after birth

Question 24

What are the phases of acute viral hepatitis?

Answer 24

Incubation
Preicteric (symptoms)
Icteric
Convalescence/liver failure/chronic hep

Question 25

What is the pathology of acute hepatitis?

Answer 25

Diffuse liver cell degenration with focal hepatocellular necrosis and apoptosis

Question 26

What liver cells are proliferated in acute hepatitis?

Answer 26

Kupffer cells

Question 27

Do you biopsy acute hepatitis?

Answer 27

Seldom.