question

Acetaminophen toxicity results in extensive zone ____ hepatocellular necrosis because the hepatocytes in zone ___ contain enzymes that convert acetaminophen into a cytotoxic metabolite.

answer

Zone 3

question

What is the purpose of stellate cells in normal and injury?

answer

Vit A storage, fibroblasts to heal injury; this is also a cause of damge since most viruses have no cytopathic effect

question

The findings for drug induced and viral hepatitis are similar histologically, so then how are they deduced?

answer

Serology; autoimmune hep can have plasma cells in greater numbers

question

In addition it hep viruses, others cause acute mild hepatitis, which ones?

answer

HSV, CMV, rubells, EBV

question

Acute hepatitis is characterized by active hepatocellular damage and necrosis in the form of _______ or ________. There is no fibrosis or injury longer than 6 months.

answer

Ballooning degen, apop

question

The inflammation in acute hepatitis is primarily in the _________, and is composed primarily of ________. There are fewer neutrophils, eosinophils or plasma cells. There are relatively few inflammatory cells in the portal tracts. __________ ________ hypertrophy results.

answer

Lobule, lymphocytes, kupfer cell

question

Hepatocellular regeneration occurs and one sees mitotic figures, binucleate cells and focally thickened hepatocellular plates. There may or may not be fatty change and there may or may not be canalicular cholestasis (bile within canaliculi). This is seen in what type of hepatits?

answer

Acute

question

persistent, often progressive inflammatory process characterized by lymphocytic inflammation in the portal tracts with varying degrees of parenchymal inflammation, hepatocellular injury and fibrosis.

answer

Chronic hep

question

Acitivty of infiltrate and fibrosis are two criteria for staging chronic hep. How are they evaluated?

answer

Based on there distance from the portal tract; activity is infiltrate distance from the tract and crossing the limiting plate, and fibrosis is between the tracts

question

Gournd glass hepatocytes are seen in Hep B. Immunoperoxidase stains also let you see what 2 antigens?

answer

Surface, core; HBV, HCV, and cirrhosis can all cause hepatocellular carcinoma

question

The standard liver test for hepatocyte damage is AST, and ALT leakage from the cell. What are they from and which is greater in viral/alcohol induced hep?

answer

They are cytosolic and mitochondrial enzymes; viral ALT>AST, alcohol opposite

question

There are 3 tests for cholestasis. One is alk phos. What other two and describe where else alk phos comes from.

answer

GGT is microsomoal enzyme, Bilirubin; alk phos comes from bone, placenta, intestine, and small bile ducts

question

What are two standard tests for liver synthetic function?

answer

PT, albumin

question

__________ is an autoimmune disease that results in destruction of small bile ducts. Biopsy specimens demonstrate mononuclear inflammatory lesions centered on the small bile ducts. Granulomas are often present. Portal tract scarring leads to bridging fibrosis and ultimately cirrhosis

answer

primary biliary cirrhosis

question

____________ is progressive inflammatory disease that results in fibrosis of large intra and extrahepatic large bile ducts. Assoc with UC. cholangiogram shows strictures in the large duct(s). concentric fibrosis and ultimately fibrous obliteration of the bile duct. increased risk of developing cholangiocarcinoma.

answer

Primary sclerosing cholangitis

question

Other causes of large duct cholestasis include ________________(congenital cystic dilation of bile ducts), parasitic infestation and tumors. ___________ and _____________, (particularly tumors arising in the head of the pancreas) are the most common malignancies presenting with obstructive cholestasis.

answer

Caroli

question

The major components of bile are bile salts, phospholipids (lecithin), and cholesterol. Gallstones are composed primarily of cholesterol, bilirubin, and calcium salts (bile salts). What are the two types of stones?

answer

>50% cholesterol is cholesterol stones, less than is pigment stones of black and brown

question

Excessive secretion of cholesterol into bile is the most common cause of cholesterol supersaturation. Why?

answer

High cholesterol concentration is toxic to the gall bladder decreasing motility and causing mucous hypersecretion. Decreased wall motility promotes crystal formation and thereby nucleation, or the formation of cholesterol aggregates.

question

Women in particular have an increased risk of gallstone formation. Why?

answer

Estrogen increases LDL uptake, ups HMB-CoA reductase which makes cholesterol, progesterone downs gall bladder motility

question

What is the pathophysiology of cholesterol stone formation in non-obese, Caucasian males with gallstones?

answer

Inadequate bile salt reduction results in lower concentrations of bile salts in bile and therefore elevated concentrations of cholesterol, i.e., supersaturation.

question

Pigment stones: Both black and brown pigment stones are due to an increased level of __________- bilirubin in bile.

answer

Unconjuagated

question

Brown pigment stones are from infection, black are from RBC breakdown. What is pathophys and which one does Crohn

answer

Infection, RBC breakdown interfere with conjugation in the liver; Crohn

question

__________ _________ results from occlusion of the neck of the neck of the gallbladder or the cystic duct by a gallstone. The subsequent increased intraluminal pressure causes dilation of the gallbladder. Histologically one sees edema and varying amounts of neutrophilic infiltration.

answer

Acute cholecystitis; acalculous chole is due post-surgical/trauma/infectious causes inducing ischemia; chronic is associated with repeated gall stones causing fiber depot

question

Both _________ steatohepatitis and NASH (caused by _________) are characterized by the presence of varying degrees of steatosis, inflammation, ballooning change, Mallory bodies and pericellular, lobular fibrosis.

answer

alcoholic ; T2DM, obesity, hyperlipid,

question

Two forms of steatosis are recognized, __________- in which the droplets of fat are generally larger than the nucleus and deform the cells, and __________ in which the cytoplasm appears foamy, having been replaced by a tiny vacuoles barely visible by light microscopy. Steatosis is thought to be a, non-progessive, reversible form of injury.

answer

macrovesicular , microvesicular

question

The inflammation in steatohepatitis is predominantly ______, with proportionally _____ inflammation in the portal tracts than is would be seen in chronic viral hepatitis.

answer

Lobular, less

question

________ increases the ratio of NADH: NAD, and NADPH: NADP which results in decreased fatty acid oxidation and increased lipid production. In _____ high insulin levels decrease fatty acid oxidation. Patients with ______- do not make adequate amounts apoproteins for the generation of VLDL, thereby decreasing export of fat form hepatocytes.

answer

Ethanol, T2dm, abetalipoproteinemia

question

pure macrovesicular steatosis is less frequently associated with other findings of ____________ than when there is a mixture of macro and micro vesicular steatosis.

answer

steatohepatitis

question

_________ __________results from impairment of mitochondrial beta-oxidation which results in decreased lipid oxidation (back up of the lipid breakdown pathway). Furthermore, the decreased availability of ATP causes a drop in gluconeogenesis. Both result in the accumulation of fatty acids and triglycerides.

answer

Microvesicular steatosis, which is rare to be pure and not include macro

question

______________ is an enzyme deficiency, and a storage disorder depending upon the genotype. The clinical presentation is quite variable, and can result in neonatal cholestasis with progressive liver disease, or as cryptogenic cirrhosis in the adult.

answer

Alpha 1 antitrypsin disease

question

Liver disease from alpha 1 antitrypsin abnormalities is therefore a ______ disease, not an enzyme deficiency. In patients with

answer

storage

question

The most characteristic finding of alpha 1 antitrypsin disorder is the presence of __________ cytoplasmic globules within the hepatocytes. These globules represent accumulated abnormal protein in the heptaocelluer ________.

answer

Esosinophilic, ER

question

Hemochromatosis is the pathologic accumulation of iron in parenchymal cells of the liver and in other organs. What is diff btw primary and secondary? Men or women greater?

answer

Primary is hereditry, secondary is simple excess iron accum; men greater due to women mensing

question

Hemosiderin is an insoluble endstage product of ferritin degradation. _________ hemosiderin is derived primarily via hepatocellular receptor-mediated uptake from circulating transferrin and ferritin. This is the __________ form of hemosiderin deposition in genetic hemochromatosis. ___________ (Kupffer cell) hemosiderin is derived primarily from phagocytosis of senescent red blood cells. This is the primary form of hemosiderin in _________- hemochromatosis.

answer

Parenchymal , primary, Reticuloendothelial , secondary

question

Therefore in later stages of hemochromotosis the pattern of iron distribution does not necessarily indicate primary or secondary disease. What is the inheritance of primary?

answer

Auto rec; A mutant gene on chromosome 6 (HFE) results in increased iron absorption from the gastrointestinal tract.

question

What is the key diff btw phase one and two metabolismin liver?

answer

Phase one is to take lipophlic substance and introduce polar function via oxidation, hydrolysis, etc; P two is to coupl polar sub with polar compound like glucorinc acid, glycine, sulfate.

question

CYP

answer

CYP3A4; alcholo uses non-CYP

question

Rifampin, carbama, phenobarbit, pheny, st johns wort, and ethanol are all CYP __________.

answer

Inducers

question

Cyclophosphamide and ifosfamide are CYP _____ ________.

answer

Auto inducers

question

T or F, The majority of acetmino metab is glucorindation, then CYP.

answer

True

question

T or F, Chronic alcholo use can stim use of secondary metab via MEOS system and results in possible malnutrion vi amodified metabolism.

answer

True

question

How does alcholo protect against NAPQI formation?

answer

Stims CYP2E but occupies it; but once alcholo is gone the stimed CYP make more NAPQI

question

There are two theories of pruritis from jaundice what are they?

answer

Bile acids cause itchy, use bile acid meds; bile increases endogenous opiods, op antags work too

question

This disease is the most common liver disorder, source of up LFT, women=men, 5th and 6th decade, associated with obesity, t2dm (which can lead to HCC), hyperlipid, metabolic syndrome (due to up ROS) and anything else.

answer

NAFLD

question

To diagnose NAFLD you determine fatty infiltration and establish non-alcholic. What are the pros and cons of liver biopsy?

answer

Pro is histo staging is best prognostic indicator, PPV of noninvasive test is poor; con is findings don

question

30% of people with NAFLD progress to HCC, what are management recommendations?

answer

Exercise, weight loss, diet, dontrol DM, hyperlipid, Vit E, thiazolidiones in DM patients, Bariatric surgery in those who fial the above

question

Acute pancreatitis is from autodigestino of the pancreas by enzymes. GET SMASHeD is the acronym for causes. Go.

answer

Gallstones, Etoh, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypercalcemia/lipid, Drugs(sulfa)

question

The signs of acute pancreatitis are ab pain rad to the back, Nausea, vomit, eccymoses at flanks or peri-unbilicus. Sever cases can cause shock and organ failure. What are the tests and treatment?

answer

Elevated serum amylase, lipase, then ultrasound for gallstones or CT for fluid/calcifications; supportive care (bowel rest, hydration, electrolyt), antibiotics and drainage and debridement if infection (psuedocysts) or necrosis.

question

What are a few complications of acute pancreatitis?

answer

DIC, necrosis, infection, hypocalcemia/kalemia, ARDS, hemorrhage

question

The causes of chronic pancreatitis can be alchol, autoimmune, obstruction, CF, hyper triglyc, recurrent acute pancreatitis. What are the clinical findings?

answer

Patients present with persistent or intermittent abdominal pain similar to acute pancreatitis with or without changes in serum amylase/lipase. Steatorrhea, fat vitamin deficient, diabetes.

question

Testing for chronic panceratits, is CT and ultrasound as well as secretin/CCK secretion tests. What is the treat?

answer

Nutrional mange for exocrine insuffic - like modiefied fats, vitamins, enzxymes, calcium, b12; analgesia, drainage of cysts, endoscopy to dilate strictures; surgery reserved for complication because of high mobidity and mortality

question

What are the top causes for cirrhosis and portal hypertension?

answer

HBV/HCV, alcohol, NAFL

question

The most common cause of portal hypertesntion is up vascular resistance from cirrhosis and obstruction (budd-chiari). What are the complications?

answer

GI bleeding with esophogastric varices most important, ascites, hepatic encephalopathy, hepatorenal syndrome

question

T or f, Band ligation and TIPS are surgical techiniques to control esophogastric varices.

answer

True

question

What is mech of ascites?

answer

Peripheral vasodilation via NO and other mediators, reduced volume, reinin system, Na and water retention.

question

The treatment for hepatic encephalopathy is treat cuases, protect air, no sedation, and remove nitrogenous waste from gut via antibacterials and laxatives. What is cause?

answer

Disturbances in CNS functions due to hepatic insufficiency

question

T or f, The indications for orthotopic livert transplant are ESLD with hepatic encephalo, hyper bili, portal hyper, synthetic dysfunction.

answer

True

question

Name this - disease induced by cirhhotic liver probs that causes constricted renal vessels due dilation of splachnic vessels, rennin system activated but doesn

answer

Hepatorenal syndrome

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