Unit 1 Finals PPP/Clin Med

Question 1

What impact do cytokines have on appetite in response to chronic LPS elevation?

Answer 1

Negative impact on appetite

Question 2

What effect does increased leptin levels have on appetite?

Answer 2

Decreased appetite

Question 3

What leads to fibrosis of the liver?

Answer 3

Chronic inflammation along with stellate cell collagen and scar tissue

Question 4

What does fibrosis lead to?
Which is reversable?

Answer 4

Fibrosis leads to cirrhosis.
Fibrosis can be reversed while cirrhosis cannot.

Question 5

High NADH levels inhibit breakdown of fatty acid to acetyl-CoA and TG break down to fatty acids. What is the result?

Answer 5

Hypertriglyceridemia and Steatosis

Question 6

Chronic liver disease leads to functional loss of gluconeogenesis and glycogenolysis. What is the result?

Answer 6

Increased production of triglycerides and suppressed glucose regulation

Question 7

What are the consequences of prolonged chronic alcohol use? (6)

Answer 7

1. prolonged satiety
2. poor appetite
3. hypoglycemia
4. weight loss
5. nutritional deficiencies
6. cachexia, muscle wasting

Question 8

How much ethanol is processed by CYP (%) and what are the products?

Answer 8

25%
Reactive O2 species and DNA adducts (cancerous)

Question 9

Thiamine deficiency can lead to what 3 diseases?

Answer 9

1. Wernicke Encephalopathy
2. Beriberi
3. Korsakoff syndrome

Question 10

What is cirrhosis?

Answer 10

Fibrosis and conversion of normal liver architecture into abnormal nodules. – late stage fibrosis

Question 11

What happens to the liver in cirrhosis size wise?

Answer 11

It shrinks

Question 12

What are the top 2 causes of cirrhosis in the USA?

Answer 12

HepC (26%)
Alcoholic liver disease (21%)

Question 13

What ratio of AST to ALT is suggestive of alcoholic liver disease? What other lab value would be elevated?

Answer 13

AST:ALT 2:1
GGT would also be high

Question 14

Gold standard for confirmation of cirrhosis?

Answer 14

Liver biopsy
–NOT FIRST LINE

Question 15

All blood from the pancreas, stomach, spleen, gallbladder, small and large intestine is sent to where?

Answer 15

to the liver via portal vein

Question 16

Fibrosis/Cirrhosis can lead to what in the portal vein?

Answer 16

Portal hypertension

Question 17

What are the 5 varices sites?

Answer 17

1. esophageal
2. paraumbilical
3. superior mesenteric veins
4. inferior mesenteric veins
5. Rectal veins

Question 18

Varices can lead to what signs? (4)

Answer 18

1. coffee ground emesis
2. melena
3. anemia
4. positive hemoccult blood test

Question 19

What 3 effects does accumulation of blood in the liver/portal system/splenomegaly have on the CBC?

Answer 19

1. thrombocytopenia due to less thrombopoietin
2. Anemia (blood loss, malnutrition)
3. Leukopenia (more prone to infection)

Question 20

What is ammonia converted to normally?

Answer 20

Urea

Question 21

What is a common sign of hepatic encephalopathy?

Answer 21

Asterixis

Question 22

What is asterixis?

Answer 22

flapping of wrist and fingers due to rapid relaxation of wrist dorsiflexion

Question 23

What is a classic EEG finding for a patient with encephalopathy?

Answer 23

triphasic waves over the frontal lobes at oscillate at 5Hz and in stage 4 show slow delta waves

Question 24

Hepatorenal syndrome can be diagnosed by what 3 signs?

Answer 24

1. renal failure
2. degreased GFR
3. increased BUN/CRE

Question 25

What is itching caused by in liver damage?

Answer 25

High levels of uric acid in the skin - hyperuricemia

Question 26

What 4 vitamin levels are low in liver disease?

Answer 26

Vitamin A, D, K and Zinc

Question 27

What is the result of zinc deficiency?

Answer 27

Altered taste

Question 28

What is the first line test for cirrhosis?

Answer 28

Sonography

Question 29

What is the purpose of lactulose?

Answer 29

It traps ammonia and reduces the concentration.
-Helps prevent hepatic encephalopathy