PAS 535 Hepatobiliary Patho Exam | Questions with 100% Correct Answers

PAS 535 Hepatobiliary Patho Exam | Questions with 100% Correct Answers What does Hgb break down into? unconjugated (indirect) bilirubin Heme breaks down into: biliverdin -- bilirubin What type of bilirubin is toxic and lipid soluble? unconjugated (indirect) bilirubin What does unconjugated (indirect) bilirubin bind to? Albumbin Where does UCB bound to albumin travel? Liver Where is bilirubin conjugated? Liver What is bilirubin conjugated with? glucuronic acid via the enzyme UDP glucuronyl transferase What type of bilirubin is water soluble? conjugated (direct) bilirubin What type of bilirubin is excreted in urine and secreted into bile? conjugated (direct) bilirubin What is conjugated (direct) bilirubin converted to in the intestines? Urobilinogen Urobilinogen eventually becomes: Feces What is the result of hyperbilirubinemia? Jaundice Why does jaundice occur in the sclera first? bilirubin has affinity for elastin Jaundice typically occurs with a serum bili: 4-5 mg/dL What are the four major causes of jaundice? - excessive RBC destruction - impaired uptake of bilirubin by hepatocytes - decreased conjugation of bilirubin - bile flow obstruction What is the mechanism of prehepatic jaundice? excessive RBC destruction (increased hemolysis) What is the result of prehepatic jaundice? increased unconjugated (indirect) bilirubin What is an example of prehepatic jaundice? hemolytic anemia What is the mechanism of intrahepatic jaundice? impaired bilirubin uptake or decreased conjugation What is the result of intrahepatic jaundice? increased unconjugated and conjugated bilirubin What are examples of intrahepatic jaundice? - hepatitis - cirrhosis - Dubin-Johnson syndrome What is the mechanism of posthepatic jaundice? bile flow obstruction What is the result of posthepatic jaundice? increased conjugated (direct) bilirubin What are examples of posthepatic jaundice? - gallstone - malignancy - inflammation ↓ bilirubin elimination via biliary tract posthepatic jaundice What is inflammation of the liver? Hepatitis What is viral hepatitis? Inflammation of the liver 2/2 viral infection What are the hepatotropic viruses? Hepatitis A-E What are the mechanisms of hepatic injury in viral hepatitis? direct cellular injury & immune response What are the phases of viral hepatitis? - prodromal (preicteric) - icteric phase - convalescent phase What occurs during the prodromal phase of acute hepatitis? constitutional sxs The icteric phase follows the prodrome by: 5-10 days What occurs during the icteric phase of acute hepatitis? - jaundice - pruritis - RUQ abd pain What occurs during the convalescent phase of acute hepatitis? improvement (cessation of symptoms) What accounts for the majority of chronic HBV? carrier state What hepatitis viruses can have carrier state? - HBV - HCV Patients in carrier state of hepatitis are: infectious but asymptomatic What zone is affected first by viral hepatitis? zone 1 What is seen in hepatocyte injury in viral hepatitis? - councilman body - ballooning degeneration - bridging necrosis Why is zone 1 affected first by viral hepatitis? high O2 content is good environment for virus What is hepatitis A (HAV)? Single-stranded RNA virus What family is hepatitis A (HAV)? Picornaviridae How is HAV transmitted? fecal-oral What is the pathway of viral shedding in HAV? Replicates in liver (hepatotropic) -- transported through bile -- excreted in stool When is HAV infectious? 2 weeks before and 1 week after symptom onset What is the disease spectrum of HAV? usually benign, self limited Who is the primary reservoir and source of transmission of HAV? Children 75% of adults with HAV are __________ and 70% of children are ___________ symptomatic; asymptomatic Which type of viral hepatitis can only be acute? Hepatitis A What is hepatitis B (HBV)? double-stranded DNA virus What family is hepatitis B (HBV)? Hepadnaviridae Which type of hepatitis relies on reverse transcriptase for replication? hepatitis B (HBV) What is the pathogenesis of hepatitis B (HBV)? - Targets liver (hepatotropic) & taken up by hepatocytes -- replicates w/in hepatocytes - HBV genome undergoes reverse transcription How is hepatitis B (HBV) transmitted? body fluids What is the major body fluid that transmits hepatitis B (HBV)? Blood Which hepatitis virus can be transmitted from mother to baby leading to a lifelong carrier? hepatitis B (HBV) What are the RF for hepatitis B (HBV) transmission? - homosexual men - blood product recipients - IVDU - healthcare workers - multiple sexual partners What is hepatitis C (HCV)? enveloped RNA virus What family is hepatitis C (HCV)? Flaviviridae How is hepatitis C (HCV) transmitted? Blood What is the most important cause of transfusion associated hepatitis? hepatitis C (HCV) What type of hepatitis is primary transmitted by IVDU? hepatitis C (HCV) What hepatitis C (HCV) the most common cause of? - chronic hepatitis - cirrhosis - hepatocellular CA Which hepatitis virus has the highest rate of chronic infection and/or cirrhosis? hepatitis C (HCV) What hepatitis virus has the mildest sxs? hepatitis C (HCV) What is the most likely disease course of an acute hepatitis C (HCV) infection? chronic hepatitis Which hepatitis virus is dependent on the presence of hep B? hepatitis D (HDV) What is the result of a coinfection of HBV and HDV? acute hepatitis What is the result of a superinfection of HBV and HDV? fulminant hepatitis How is HDV transmitted? body fluids How is HEV MC transmitted? fecal-oral What hepatitis virus has a risk of fulminant hepatitis in pregnant patients? hepatitis E (HEV) Chronic hepatitis is chronic liver inflammation: 6 months What is the most common etiology of chronic viral hepatitis? hepatitis C (HCV) How does chronic viral hepatitis persist? failure of immune clearance What is the principal cause of cirrhosis and HCC? chronic viral hepatitis What are the sxs of chronic viral hepatitis? Asymptomatic When is linking necrosis seen? chronic viral hepatitis When are ballooning degeneration and councilman bodies seen? acute viral hepatitis What is autoimmune chronic hepatitis? immune-mediated attack on hepatocytes What is the result of autoimmune hepatitis? necrotizing inflammatory response What tests are positive in pts with autoimmune hepatitis? ANA, ASMA, AMA antibodies What is the spectrum of alcoholic liver disease? fatty liver disease -- EtOH hepatitis -- cirrhosis Why is there relative hypoxia in alcoholic liver disease? EtOH metabolism -- acetaldehyde Where is there relative hypoxia in alcoholic liver disease? zone III (central veins) Where does fatty infiltration begin in alcoholic liver disease? zone III (central veins) What zone has the lowest O2 concentration? zone III (central veins) What is fatty liver disease? hepatocyte fat accumulation (steatosis) & deposition Which alcoholic liver disease involves fat deposits with no inflammation? fatty liver disease What causes fat deposits in fatty liver disease? impaired lipolysis and increased lipogenesis What is the pathogenesis of fatty liver disease? unclear; likely due to NADH production Fatty liver disease is: reversible Fatty liver disease stage can develop within _________ of excess ethanol consumption 2 days What alcoholic liver disease is characterized by inflammation/necrosis? alcoholic hepatitis What is the intermediate stage of alcoholic liver disease? alcoholic hepatitis What are seen in alcoholic hepatitis? - Mallory-Denk bodies - ballooning degeneration What are the manifestations of alcoholic hepatitis? - fever - RUQ pain - fatigue