Liver non-neoplastic

Question 1

Vitamin A is stored in what cell of the liver?

Answer 1

Hepatic stellate cell

Question 2

Percentage of functional capacity lost before hepatic failure ensues?

Answer 2

80 - 90%

Question 3

What is the incubation period of Hep A, B, C, D and E?

Answer 3

Hepa A - 2 to 6 weeks
B - 2 to 26 weeks
C - 4 to 26 weeks 
D - same as B
E - 4 to 5 weeks

Question 4

What can be detected in the window period of Hepatitis B infection?

Answer 4

IgM- HbcAg

Question 5

What is the best predictor of chronicity in hepatitis B infection?

Answer 5

Age at the time of infection

Remarks: the younger the age, the higher probability of chronicity.

Question 6

What is the second most common cause of hepatitis C?

Answer 6

Multiple sex partners
Remarks: Intravenous drug abuse - number one cause
Unknown cause - number three cause

Question 7

This hepatitis is known as quasispecies?

Answer 7

Hepatitis C

Remarks: it has low fidelity and closely related genetic variants exists within any given individual (quasispecies).

Question 8

How many percent does hepatitis C transform into chronic disease? and to cirrhosis?

Answer 8

Chronic disease occurs in 80 to 90% of hepatitis C and 20% will become cirrhotic.

Question 9

In symptomatic individuals of chronic hepatitis, what is the most common clinical finding?

Answer 9

Fatigue

Question 10

Hepatitis that has a high mortality rate in pregnant women.

Answer 10

Hepatitis E

Question 11

Hepatitis that may be especially rich in plasma cell infiltrates?

Answer 11

Hepatitis A.

Question 12

Hepatitis that is associated with metabolic syndrome?

Answer 12

Hepatitis C

Remarks: particularly the genotype 3

Question 13

Which type of autoimmune hepatitis is more common in children?

Answer 13

Type 2 - autoantibodies include Anti-LKM (liver-kidney), anti-ACL1
Remarks: Type 1 is more common in adults - Autoantibodies are ANA, ASMA, LKM, SLA/LP (liver-pancreas)

Question 14

Mallory-Denk bodies are seen in alcoholic hepatitis, these structures are made up of what?

Answer 14

Intermediate filaments such as keratins 8 and 18 and ubiquitin
Remarks: also seen in Wilson disease and chronic biliary tract disease.

Question 15

What is the threshold (mg/day) for the development of alcohol liver disease?

Answer 15

80 mg/day of alcohol

Question 16

True or false. Nonalcoholic fatty liver disease show central fibrosis and neutrophilic infiltrates?

Answer 16

False
Remarks: NAFLD - portal fibrosis and mononuclear cell infiltrates vs Alcoholic liver disease - central fibrosis with neutrophilic cell infiltrates.

Question 17

What is the most common mutation in hemochromatosis?

Answer 17

HFE mutation is most common in adults

Remarks: HFE on chr. 6 at 6p21.3, a cysteine-to-tyrosine substitution at amino acid 282 (C282Y)

Question 18

What is the mutation in Wilson disease?

Answer 18

ATP7B gene mutation on chr. 13

Mnemonics: Wilson ate 7 Bananas = Energy (ATP)

Question 19

What is the most specific screening test for Wilson disease?

Answer 19

Most specific screening test: Increased urinary excretion of copper.
Most sensitive and accurate test: Decrease in serum ceruloplasmin and increase hepatic copper content.

Question 20

Most common mutation in Alpha-1 antitrypsin deficiency?

Answer 20

Piz mutation

Remarks: Alpha-1 antitrypsin def. is the most commonly diagnosed inherited hepatic disorder in infants and children.

Question 21

True or false. Primary biliary cirrhosis is more common in males and is associated with inflammatory bowel disease?

Answer 21

False.
Remarks: Primary Biliary Cirrhosis: associated with Sjogren syndrome and is more common in females. Primary Sclerosing Cholangitis: associated with ulcerative colitis and is more common in males.

Question 22

What part of the bile duct is involved in Primary Sclerosing Cholangitis?

Answer 22

PSC: inflammation and obliterative fibrosis of LARGE INTRAHEPATIC and EXTRAHEPATIC bile ducts.
Remarks: PBC: nonsuppurative, inflammatory destruction of SMALL and MEDIUM INTRAHEPATIC bile ducts.

Question 23

What syndrome constitutes the obstruction of two or more major hepatic veins producing liver enlargement, pain, and ascites?

Answer 23

Budd-Chiari syndrome

Question 24

Sinusoidal obstruction syndrome is originally described in Jamaican drinkers of what beverage?

Answer 24

Bush tea containing pyrrolizidine alkaloid

Remarks: Causing toxic injury to the sinusoidal endothelium.

Question 25

This variant of aldehyde dehydrogenase is common in 50% of Asians leading to alcohol intolerance.

Answer 25

ALDH*2

Question 26

True or False. NAFLD is found to have increase risk for hepatocellular carcinoma.

Answer 26

True.

Remarks: Even in the absence of significant scarring.

Question 27

Pathologic hepatosteatosis is defined as involving more than __% of hepatocytes?

Answer 27

more than 5%

Question 28

True or False. Pediatric autoimmune hepatitis has a better prognosis than adult autoimmune hepatitis.

Answer 28

False! Adults have a better prognosis.