Week 4: Liver

Question 1

Definition of

• hyper acute LF
• acute liver failure
• subacute LF
• fulminant

Answer 1

ALF (pocket medicine):

acute hepatic disease + coagulopathy + encephatlopahty w/o pre-existing liver disease

Applies to pts with no previous liver disease
• Hyperacute: within 2 wks
• Acute: within 8 wks
• subacute: within 24 wks
• fulminant: severe enough to produce encephalopathy

Question 2

what is it that destroys in the liver in viral hepatitis?

Answer 2

the immune response

Question 3

What is it that destroys the liver in acetaminophen toxicity?

Answer 3

NAPQI toxic intermediate

Question 4

Pathogenesis of cirrhosis (general)

Answer 4

• Inflammation activates Ito cells (AKA: hepatic stellate cells…lipocytes in space of disse…Vit A storage)
• Release factors that lead to collagen deposition

Question 5

Survival of end-stage decompensated cirrhosis

Answer 5

1 yr: 26-35%

Question 6

Features of hepatic encephalopathy

Mechanism/pathogenesis of hepatic encephalopathy

Precipitants

Answer 6

varies from subtle to overt

• decreased LOC
• slurred speech
• coma
• asterixis **

mechanism: increased GABA activity from ?hyperammonemia from gut
precipitants: high protein diet, sepsis, hypokalemia, sedatives

Question 7

chronic hepatitis progression to cirrhosis

Answer 7

Question 8

what kind of cells do you expect to see on a liver biopsy with viral hepatitis vs. alcoholic liver disease vs. autoimmune hepatitis vs. PBC?

Answer 8

Viral: lymphocytes

Alcoholic: PMNs

autoimmune: plasma cells present

PBC: granulomas (have giant cells)

Question 9

Autoimmune hepatitis

• gender preference?
• age preference?

Answer 9

Women under 40

Question 10

primary biliary cirrhosis

• gender preference
• age preference

Answer 10

Women 40-50