Liver II Flashcards

1
Q

What serological markers are found in autoimmune hepatitis?

A

Anti-nuclear antibodies and anti-smooth muscle actin and elevated IgG

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2
Q

What is seen on biopsy of autoimmune hepatitis?

A

Plasma cells and inflammation

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3
Q

How do you treat AIH?

A

Corticosteroids

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4
Q

What causes most cases of cirrhosis?

A

Alcoholic liver disease

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5
Q

What are the three main causes of death associated with cirrhosis?

A

Progressive liver failure
Complications of portal hypertension
Hepatocellular carcinoma

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6
Q

What is the most common cause of acute liver failure?

A

Acetaminophen overdose

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7
Q

What is the most common cause of chronic liver failure?

A

Cirrhosis

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8
Q

What is the clinical manifestation of liver failure?

A
Jaundice
Hypoalbumin
Coagulopathy
Hyperammonemia
Fetor hepaticus
AST/ALT
Hypoglycemia
Endocrine changes
Decreased drug metabolism
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9
Q

What is the most common cause of portal hypertension?

A

Cirrhosis

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10
Q

What are the main complications of portal hypertension?

A

Splenomegaly
Hepatic Encephelopathy
Esophageal Varices
Ascites

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11
Q

What cells are often seen on liver biopsy for alcoholic hepatitis?

A

Swelling liver cells
Mallory bodies
Neutrophils

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12
Q

What can steatofibrosis oftentimes lead to?

A

cirrhosis

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13
Q

What are the major causes of death for alcoholic cirrhosis?

A
Encephalopathy, coma
Esophageal varices
Infection
Hepatorenal syndrome
Hepatocellular carcinoma
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14
Q

What is the gross appearance of alcoholic cirrhosis?

A

Early: Enlarged, fatty, micronodular
Late: Shrunken, nonfatty, nodules varying in size, cholestasis

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15
Q

What oftentimes leads to non-alcoholic liver disease?

A

Insulin resistance

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16
Q

What is defined as an autoimmune cholangiopathy characterized by porgressive inflammatory destruction of small and medium sized intrahepatic bile ducts?

A

Primary biliary cirrhosis

17
Q

How does primary biliary cirrhosis present?

A

Anicteric pruritis
Xanthomas
Bile stuff

18
Q

What serological marker is common in primary biliary cirrhosis?

A

Antimitochondrial antibodies

19
Q

What are the four stages for PBC?

A

1: Lymphocytic/granulomatous cholangitis in portal tracts
2: Periportal hepatitis with periportal fibrosis
3: Bridging necrosis with bridging fibrosis
4: Cirrhosis

20
Q

What causes secondary biliary cirrhosis?

A

Anything causing prolonged bile duct obstruction

21
Q

What is defined as an autoimmune cholangiopathy with progressive, random, uneven fibroinflammatory destruction of extrahepatic and intrahepatic bile ducts?

A

Primary sclerosing cholangitis

22
Q

Who usually gets PSC?

A

People with IBD
Male
40 years

23
Q

What gene is oftentimes mutated in hereditary hemochromatosis? What is the change?

A

HFE, regulates hepcidin synthesis

C282Y

24
Q

What is the clinical triad of Hereditary hemochromatosis?

A

Cirrhosis, diabetes, skin pigmentation

25
What is the best screening test for Hereditary Hemochromatosis?
Fasting transferrin saturation
26
What is different on liver biopsy for primary and secondary hemochromatosis?
In secondary, iron initially accumulates in the Kupffer cells, not hepatocytes
27
What is the inheritance pattern of Wilson's disease and what is mutated?
Autosomal recessive | ATP7B is mutated
28
What serum levels are low in Wilson's disease?
Ceruloplasmin
29
What causes liver disease with A1AT deficiency?
Accumulation of A1AT in hepatocytes
30
What is direct hepatotoxicity in terms of drug induced liver damage?
Toxic in a predictable, dose dependent manner.
31
What is unpredictable hepatotoxicity (with drugs)?
Idiosyncratic liver injury from drugs. Not all exposed will develop injury
32
What causes Reye's syndrome?
Aspirin after acute viral illness
33
What are the symptoms for Reye's syndrome?
Liver injury and encephalopathy
34
What is seen on liver biopsy for Reye's syndrome?
Small lipid vacuoles in hepatocytes | Microvesicular steatosis
35
What is neonatal cholestasis?
Diseases caused by Prolonged conjugated hyperbilirubinemia in theanemia
36
What is defined as a complete or partial obstruction of the biliary tree in the first three months of life?
Biliary atresia
37
What are the most common causes of neonatal hepatitis?
Biliary atresia Metabolic disorders (A1AT deficiency, CF) Infections Idopathic
38
What causes granulomatous hepatitis?
Idiopathic (50%) Sarcoidosis (22%) Drug related (6%) Tuberculosis (3%)