Liver And Gallbladder Disease

Front 1

a. How is Hep A transmitted? Who most commonly contracts it?

Back 1

i. Fecal-oral
ii. Travelers

Front 2

b. What is the disease state of Hep A?

Back 2

i. Acute only

Front 3

c. What markers signal an active Hep A and Hep E infection?

Back 3

i. Anti-virus IgM

Front 4

d. What does anti-virus IgG indicate in a Hep A and Hep E infection?

Back 4

i. Protection
ii. Presence indicates prior infection or immunization

Front 5

e. What does a Hep E infection in a pregnant woman indicate?

Back 5

i. Fulminant hepatitis→ liver failure with massive liver necrosis

Front 6

a. How is Hep B transmitted?

Back 6

i. Parenteral transmission
ii. Childbirth, unprotected intercourse, IV drug abuse, needle stick

Front 7

b. What is the disease state of Hep B?

Back 7

i. Acute
ii. Rarely goes chronic

Front 8

a. How is Hep C transmitted?

Back 8

i. IVDA
ii. Unprotected intercourse

Front 9

b. What is the disease state of Hep C?

Back 9

i. Acute
ii. Chronic in most cases

Front 10

c. What test confirms a Hep C infection?

Back 10

i. HCV-RNA test

Front 11

a. What does Hep D depend upon for infection?

Back 11

i. Hep B

Front 12

a. What is the first serologic marker to rise in Hep B?

Back 12

i. HBsAG

Front 13

b. What indicates chronic Hep B?

Back 13

i. HBsAG for more than 6 months

Front 14

c. What indicates that a chronic Hep B infection is contagious?

Back 14

i. HBeAg or HBV DNA

Front 15

d. What immunoglobulin is present in the acute phase of HBV infection?

Back 15

i. IgM

Front 16

e. What immunoglobulin is present in the window phase of HBV infection?

Back 16

i. IgM

Front 17

f. What immunoglobulin is present in a resolved HBV infection?

Back 17

i. IgG

Front 18

g. What immunoglobulin is present in a chronic HBV infection?

Back 18

i. IgG

Front 19

a. What is viral hepatitis?

Back 19

i. Inflammation of liver parenchyma

Front 20

b. How does viral hepatitis present?

Back 20

i. Jaundice
ii. Dark urine→ CB
iii. Fever
iv. Malaise
v. Nausea
vi. Elevated liver enzymes

Front 21

c. What is histological evidence of viral hepatitis?

Back 21

i. Apoptosis of hepatocytes in lobules of liver

Front 22

d. How long does acute viral hepatitis last?

Back 22

i. < 6 mos.

Front 23

e. How long does chronic viral hepatitis last?

Back 23

i. > 6 mos.

Front 24

f. Where is the inflammation generally found in chronic viral hepatitis?

Back 24

i. Portal tract

Front 25

g. What are some histological hallmarks of acute hepatitis?

Back 25

i. Ballooning degeneration
ii. Cholestasis
iii. Macrophage aggregates
iv. Apoptosis
v. Kupffer cell hyperplasia

Front 26

h. How do you dx acute viral hepatitis?

Back 26

i. Serological markers
ii. No need for bx

Front 27

a. What is the serological indicator for a dx of viral hepatitis?

Back 27

i. Serological markers are negative
ii. Highs serum titers of autoantibodies→
iii. ANA
iv. SMA
v. Anti-LKM1

Front 28

a. What is cirrhosis?

Back 28

i. End-stage liver damage characterized by disruption of the normal hepatic parenchyma

Front 29

b. What is the histological hallmark of cirrhosis?

Back 29

i. Bands of fibrosis
ii. Regenerative nodules of hepatocytes

Front 30

c. What is the key mediator of fibrosis in cirrhosis?

Back 30

i. TGF-β from stellate cells

Front 31

d. How will a patient with cirrhosis present?

Back 31

i. Portal hypertension (principal symptoms, causes all others)
ii. Ascites
iii. Congestive splenomegaly
iv. Portosystemic shunts
v. Decreased liver function

Front 32

e. How will decreased hepatic detoxification due to cirrhosis present?

Back 32

i. Mental status changes
ii. Asterixis
iii. Eventual coma
iv. Hyperesterinism
v. Jaundice

Front 33

f. What will decreased protein synthesis due to cirrhosis lead to?

Back 33

i. Hypoalbuminemia
ii. Coagulopathy

Front 34

a. What is fatty liver?

Back 34

i. Accumulation of fat in hepatocytes
ii. Results in heavy, greasy liver

Front 35

b. How can you cure alcoholic fatty liver?

Back 35

i. Abstinence from alcohol

Front 36

c. What is alcoholic hepatitis?

Back 36

i. Chemical injury to hepatocytes

Front 37

d. What mediates the damage in alcoholic hepatitis?

Back 37

i. Acetaldehyde

Front 38

e. What are the histological signs of alcoholic hepatitis?

Back 38

i. Swelling of hepatocytes
ii. Formation of Mallory bodies

Front 39

f. What are found within Mallory bodies?

Back 39

i. Damaged intermediate filaments

Front 40

g. What are the symptoms of alcoholic hepatitis?

Back 40

i. Painful hepatomegaly
ii. Elevated liver enzymes

Front 41

a. What is nonalcoholic fatty liver disease?

Back 41

i. Fatty change, hepatitis, and/or cirrhosis that develop without exposure to alcohol

Front 42

b. What condition is associated with nonalcoholic fatty liver disease?

Back 42

i. Obesity

Front 43

c. How can you dx nonalcoholic fatty liver disease?

Back 43

i. Dx of exclusion
ii. Elevated liver enzymes

Front 44

a. What is hemochromatosis

Back 44

i. Excess body iron leading to deposition in tissues and organ damage

Front 45

b. What mediates tissue damage in hemochromatosis?

Back 45

i. Free radicals

Front 46

c. What causes primary hemochromatosis?

Back 46

i. Defect in iron absorption in hepatocytes

Front 47

d. What causes secondary hemochromatosis?

Back 47

i. Chronic blood transfusions

Front 48

e. What is the classic triad of presentation for hemochromatosis?

Back 48

i. Cirrhosis
ii. Secondary diabetes mellitus
iii. Bronze skin

Front 49

f. What will a liver biopsy of hemochromatosis show?

Back 49

i. Prussian blue positive for iron

Front 50

a. What causes Wilson disease?

Back 50

i. Lack of copper transport into bile
ii. Lack of copper incorporation into ceruloplasmin

Front 51

b. What causes tissue damage in Wilson disease?

Back 51

i. Hydroxyl free radicals

Front 52

c. When does Wilson disease present? How?

Back 52

i. Cirrhosis
ii. Neurologic manifestations
iii. Kayser-Fleisher rings in cornea

Front 53

a. What is primary biliary cirrhosis?

Back 53

i. Autoimmune granulomatous destruction of intrahepatic bile ducts

Front 54

b. What antibody is present in primary biliary cirrhosis?

Back 54

i. Antimitochondrial antibody

Front 55

c. What is the presentation of primary biliary cirrhosis?

Back 55

i. Obstructive jaundice

Front 56

a. What is primary sclerosing cholangitis?

Back 56

i. Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

Front 57

b. What is the histological appearance of primary sclerosing cholangitis?

Back 57

i. Periductal fibrosis with an onion-skin appearance
ii. Uninvolved regions are dilated resulting in a bedaded appearance on contrast imaging

Front 58

c. With what disorders is primary sclerosing cholangitis associated?

Back 58

i. UC
ii. p-ANCA positive

Front 59

d. How does primary sclerosing cholangitis present?

Back 59

i. Obstructive jaundice

Front 60

a. What is secondary biliary cirrhosis?

Back 60

i. Prolonged obstruction of the extrahepatic bile duct from biliary atresia, gallstones, carcinoma, and strictures

Front 61

b. What can cause ascending cholangitis in secondary biliary cirrhosis?

Back 61

i. Enteric bacilli and enterococci

Front 62

c. What are the symptoms of secondary biliary cirrhosis?

Back 62

i. Pruritis
ii. Jaundice
iii. Malaise
iv. Dark stools
v. Hepatosplenomegaly

Front 63

d. What is the histologic appearance of secondary biliary cirrhosis?

Back 63

i. Liver is hard with a finely granular appearance
ii. Hepatic fibrous septa in jigsaw pattern

Front 64

a. What is acute cholecystitis?

Back 64

i. Inflammation of the gallbladder wall

Front 65

b. What are some complications associated with acute cholecystitis?

Back 65

i. Impacted stone in cystic duct results in dilatation with pressure ischemia, bacterial overgrowth and inflammation

Front 66

c. What are the signs of acute cholecystitis?

Back 66

i. RUQ pain radiating to right scapula
ii. Fever
iii. Elevated WBC count
iv. Nausea, vomiting
v. Increased serum alkaline phosphatase

Front 67

a. What is chronic cholecystitis?

Back 67

i. Chronic inflammation of the gallbladder
ii. Due to chemical irritation from longstanding cholelithiasis

Front 68

b. What are the signs of chronic cholecystitis?

Back 68

i. Herniation of gallbladder mucosa into muscular wall
ii. Vague RUQ pain
iii. Porcelain gallbladder

Front 69

c. What is the histological presentation of cholesterolosis?

Back 69

i. Yellow streaks on gross examination
ii. Lipid-laden macrophages in lamina propria
iii. May occasionally form cholesterol polyps

Front 70

a. What is α1 antitrypsin deficiency?

Back 70

i. Autosomal recessive disorder involving chromosome 14
ii. α1-antitrypsin inhibits proteases

Front 71

b. What are the symptoms of α1 antitrypsin deficiency?

Back 71

i. Emphysema
ii. Chronic liver disease