Viral and Non-viral Liver Disease

Question 1

what are the signs of liver failure

Answer 1

Jaundice
Icterous
Acities: Hypoalbuminemia
Estrogen problem
Spyder angiometa
Pulmar Arrythema
Gynocomastia
 Coagulopathy

Question 2

what is cirrhosis

Answer 2

Scarred liver

End point to many chronic liver diseases

Question 3

what is compensated vs decompensated liver cirrhosis

Answer 3

Compensated  = Functional
Decompensated = Failing functions

Question 4

what are the gross characteristic of liver cirrhosis

Answer 4

Characterized by diffuse fibrous septation that divides the liver parenchyma into nodules

Result of chronic recurring death of hepatocytes, deposition of extracellular matrix, and architectural and vascular reorganization

Question 5

what is portal hypertension?

Answer 5

A consequence of cirrhosis
Increase blood pressure in portal system
Result of vascular reorganization in liver
Increase in sinusoidal pressure

Question 6

what is the most common cause of Chronic Liver Disease in U.S. Adults

Answer 6

HCV

Question 7

Inflammation in Hepatitis
types characteristic but not pathognomonic 
Lymphocytes – many \_\_\_\_\_\_
Neutrophils – common in \_\_\_\_\_\_\_
Eosinophils – common in \_\_\_\_\_\_\_\_
Plasma cells – common in  \_\_\_\_\_\_

Answer 7

hepatitides; common in viral,
steatohepatitis,
drug injury,
autoimmune hepatitis

Question 8

list the microscopic findings in acute hepatitis

Answer 8

lobular disarray, marked inflammation throughout, widespread hepatocyte injury, no fibrosis

Question 9

cytoplasmic accumulation  of:
Fat = \_\_\_\_\_
Bile = \_\_\_\_ 
Iron = \_\_\_\_\_
Copper =\_\_\_\_\_\_\_
Viral particles = \_\_\_\_\_\_\_

Answer 9

Steatosis,
Cholestasis,
Hemosiderosis/ genetic hemochromatosis,
Wilson Disease / chronic cholestasis,
Viral hepatitis

Question 10

Serial liver biopsies track liver disease progress
“Grade” = amount of _______
“Stage” = amount of _______

Answer 10

inflammation and injury,

fibrous tissue deposition

Question 11

Major cause of chronic liver disease worldwide

is ______

Answer 11

Hep B

Question 12

which hepatitides never become chronic liver disease

Answer 12

A & E

Question 13

which hepatitides have fecal - oral route of transmission

Answer 13

A&E

Question 14

the hep D virus is Replication incompetent, completely dependent on _______

Answer 14

HBV coinfection

Question 15

what is the Clinical Presentation of Primary Biliary Cirrhosis

Answer 15

Insidious onset with pruritus often appearing before jaundice.
Middle aged women most commonly affected.
Cholestatic liver function testing (elevated ALP, GGT, bilirubin)

Question 16

what is common serology finding (90%) for Primary Biliary Cirrhosis

Answer 16

Anti-mitochondrial antibody

Question 17

Clinical Presentation of primary sclerosing cholangitis
Men > women; 70% of patients have _______
Asymptomatic with persistent ________ elevation.
Progressive fatigue, pruritus, and jaundice

Answer 17

ulcerative colitis,

alkaline phosphatase

Question 18

what is seen on cholangiography in primary sclerosing cholangitis

Answer 18

alternating biliary strictures and dilation

Question 19

pts with Primary Sclerosing Cholangitis have an incresaed risk of ______

Answer 19

cholangiocarcinoma

Question 20

Periductal “onion-skin” fibrosis on histology probably means ______

Answer 20

Primary Sclerosing Cholangitis

Question 21

which drug is a Major cause of acute liver failure that leads to liver transplant in United States?

Answer 21

Acetaminophen

Question 22

Acetaminophen is an Intrinsic hepatotoxin that can cause ________

Answer 22

Centrilobular necrosis (zone 3)

Question 23

what is steatosis?

Answer 23

Accumulation of fat in hepatocytes due to Metabolic derangement of hepatocytes

Question 24

what is the pathogenesis of Alcohol Steatosis/Steatohepatitis

Answer 24

alcohol blocks beta oxidation within the hepatocyte

which usually converts lipids to CO2 and ketones

Question 25

name a histiologic finding associated with Alcohol Steatosis/Steatohepatitis

Answer 25

Mallory bodies

Question 26

what is a Fatty liver disease associated with:

Obesity, diabetes type II, hypertriglyceridemia

Answer 26

Non-alcoholic steatosis/steatohepatitis

Question 27

what is Alpha-1-Antitrypsin Deficiency

Answer 27

Genetic decreased production of alpha-1-antitrypsin (protease inhibitor)

Question 28

PASD stain in Alpha-1-Antitrypsin Deficiency histology will reveal _______

Answer 28

pink globules

Question 29

what is the Most common 1° malignant liver tumor

Answer 29

Hepatocellular Carcinoma

Question 30

hepatocellular adenoma is a Benign neoplasm of hepatocytes. Occurs mostly in ______
Associated with _______ use
Usually no underlying ________

Answer 30

women of child-bearing age,
oral contraceptive,
chronic liver disease