GNUR 293 Patho Final UPDATED ACTUAL
Exam Questions and CORRECT Answers
The blood supply is delivered to the liver by way of - CORRECT ANSWER - dual arterial
sources (25% arterial flow from the aorta & 75% hepatic artery)
The liver has a dual blood supply, delivering a blood supply (25%) from arterial inflow from the
aorta via the celiac trunk and hepatic artery (75%) and from the portal vein via the capillary bed
of the alimentary canal and pancreas.
Esophageal varices are a complication of liver disease and are a result of - CORRECT
ANSWER - elevated portal pressure/portal HT
Esophageal varices result mainly from impaired blood flow through the liver. Increased pressure
in the portal system leads to portal hypertension and congestion of the esophageal vessels
resulting in varices.
Biliary obstruction could result in - CORRECT ANSWER - Jaundice
& more specifically increased level of conjugated bilirubin
What term is used to describe the process of converting bilirubin from its freely lipid-soluble
form to the form that is tightly bound to the plasma protein albumin? - CORRECT
ANSWER - Conjugation
Damaged or destroyed red blood cells are lysed and the oxygen-carrying hemoglobin molecule is
recycled. Separation of heme from globin yields biliverdin, which is converted to bilirubin and
released into plasma and transported to the liver. Free unconjugated bilirubin is lipid-soluble and
crosses easily into the brain of the neonate. Conjugation by the liver tightly binds bilirubin to the
plasma protein albumin.
,What condition occurs when a form of bilirubin diffuses into the brain and causes a type of
encephalopathy? - CORRECT ANSWER - in babies: kernicterus
Kernicterus refers to brain injury as a result of hyperbilirubinemia. The immature blood-brain
barrier allows free unconjugated bilirubin to enter the brain, which causes encephalopathy
through unknown mechanisms
The development of hepatocellular carcinoma is - CORRECT ANSWER - Usually
associated with chronic viral hepatitis
Hepatocellular carcinoma is often the result of years of injury from chronic alcohol abuse,
chronic viral hepatitis, or injury and is therefore more often seen in older individuals.
Portal hypertension occurs as a result of - CORRECT ANSWER - -Obstruction of blood
flow in the liver's venous sinusoids
-Impaired drainage into the central veins
-A buildup of venous pressure
characterizes the nature and capabilities of the liver - CORRECT ANSWER - -Blood
detoxification is a function of the liver.
-The liver plays a role in the digestion of fats (bile)
-The liver is vulnerable to illness, but has considerable repair abilities
Which manifestation is typical of hepatocellular failure? - CORRECT ANSWER --
hypoalbuminemia
-glucose imbalance
-osteomalacia
Appropriate early treatment for infants with jaundice-related encephalopathy may include which
of the following? - CORRECT ANSWER - -Phenobarbital to increase the levels of
UDPGT
,-Phenobarbital to increase the levels of UDPGT
-Exchange transfusions
Universal vaccination against hepatitis of child is recommended for which Hep classes? -
CORRECT ANSWER - Hep A & B
What is ascites related to? - CORRECT ANSWER - portal hypertnsion &
hypoalbuminemia
What role does the liver play in nutrient metabolism, bile synthesis, storage of vitamins and
minerals, urea synthesis, clotting factor synthesis, and detoxification? - CORRECT
ANSWER - (notice the wide array of roles)
The liver functions as a digestive organ (bile salt secretion for fat digestion; processing and
storage of fats, carbohydrates, and proteins absorbed by the intestines; processing and storage of
vitamins and minerals); as an endocrine organ (metabolism of glucocorticoids,
mineralocorticoids, and sex hormones; regulation of carbohydrate, fat and protein metabolism), a
hematologic organ (temporary storage of blood, removal of bilirubin from bloodstream,
hematopoiesis, synthesis of blood clotting factors), and an excretory organ (excretion of bile
pigment and cholesterol via bile, urea synthesis, detoxification of drugs and other foreign
substances).
Manifestations of liver disease due to hepatocelleular failure - CORRECT ANSWER -
Jaundice, decreased clotting factors, hypoalbuminemia, decreased vitamins D and K, and
feminization (gynocomastia & female hair distributionb) are attributed to hepatocellular failure.
Manifestations of liver disease due to portal HT - CORRECT ANSWER - Portal
hypertension may result in GI congestion with the development of esophageal or gastric varices,
hemorrhoids, splenomegaly, and ascites.
hat clinical and laboratory findings would lead to a diagnosis of liver cirrhosis? - CORRECT
ANSWER - Clinical and laboratory findings that would lead to a diagnosis of liver
cirrhosis include palpation of an enlarged, nodular liver, jaundice, gastric varices, hemorrhoids,
, splenomegaly, ascites, decreased clotting factors, hypoalbuminemia, decreased vitamins D and
K, and elevated AST/ALT (more than 40 units)
s/s of alcoholic cirrhosis - CORRECT ANSWER - -weakness
-fatigue
-muscle wasting
-anorexia
-ascites *
-abnormal blood glucose levels
-elevated serum lipids
-feminization
-palmar erythema *
spider telangiectasia *
^ all are primarily due to hepato cellular failure
s/s of portal hypertension - CORRECT ANSWER - varices (enlarged veins including
hemorrhoids and gastroesophageal)
splenomegaly (enlarged spleen)
Everything enlarged. Why? Pressure pushing out on veins + arteries.
Why is a patient with alcoholic cirrhosis at risk for GI bleeding? - CORRECT ANSWER -
The liver is needed in synthesis of clotting factors; with heptacellular filkure, severe
hypoprothrombinemia can develop
Upper GI bleeding may result from varices, portal HT, or gastroduodenal ulcer (all of which are
manifestations of cirrhosis)
Exam Questions and CORRECT Answers
The blood supply is delivered to the liver by way of - CORRECT ANSWER - dual arterial
sources (25% arterial flow from the aorta & 75% hepatic artery)
The liver has a dual blood supply, delivering a blood supply (25%) from arterial inflow from the
aorta via the celiac trunk and hepatic artery (75%) and from the portal vein via the capillary bed
of the alimentary canal and pancreas.
Esophageal varices are a complication of liver disease and are a result of - CORRECT
ANSWER - elevated portal pressure/portal HT
Esophageal varices result mainly from impaired blood flow through the liver. Increased pressure
in the portal system leads to portal hypertension and congestion of the esophageal vessels
resulting in varices.
Biliary obstruction could result in - CORRECT ANSWER - Jaundice
& more specifically increased level of conjugated bilirubin
What term is used to describe the process of converting bilirubin from its freely lipid-soluble
form to the form that is tightly bound to the plasma protein albumin? - CORRECT
ANSWER - Conjugation
Damaged or destroyed red blood cells are lysed and the oxygen-carrying hemoglobin molecule is
recycled. Separation of heme from globin yields biliverdin, which is converted to bilirubin and
released into plasma and transported to the liver. Free unconjugated bilirubin is lipid-soluble and
crosses easily into the brain of the neonate. Conjugation by the liver tightly binds bilirubin to the
plasma protein albumin.
,What condition occurs when a form of bilirubin diffuses into the brain and causes a type of
encephalopathy? - CORRECT ANSWER - in babies: kernicterus
Kernicterus refers to brain injury as a result of hyperbilirubinemia. The immature blood-brain
barrier allows free unconjugated bilirubin to enter the brain, which causes encephalopathy
through unknown mechanisms
The development of hepatocellular carcinoma is - CORRECT ANSWER - Usually
associated with chronic viral hepatitis
Hepatocellular carcinoma is often the result of years of injury from chronic alcohol abuse,
chronic viral hepatitis, or injury and is therefore more often seen in older individuals.
Portal hypertension occurs as a result of - CORRECT ANSWER - -Obstruction of blood
flow in the liver's venous sinusoids
-Impaired drainage into the central veins
-A buildup of venous pressure
characterizes the nature and capabilities of the liver - CORRECT ANSWER - -Blood
detoxification is a function of the liver.
-The liver plays a role in the digestion of fats (bile)
-The liver is vulnerable to illness, but has considerable repair abilities
Which manifestation is typical of hepatocellular failure? - CORRECT ANSWER --
hypoalbuminemia
-glucose imbalance
-osteomalacia
Appropriate early treatment for infants with jaundice-related encephalopathy may include which
of the following? - CORRECT ANSWER - -Phenobarbital to increase the levels of
UDPGT
,-Phenobarbital to increase the levels of UDPGT
-Exchange transfusions
Universal vaccination against hepatitis of child is recommended for which Hep classes? -
CORRECT ANSWER - Hep A & B
What is ascites related to? - CORRECT ANSWER - portal hypertnsion &
hypoalbuminemia
What role does the liver play in nutrient metabolism, bile synthesis, storage of vitamins and
minerals, urea synthesis, clotting factor synthesis, and detoxification? - CORRECT
ANSWER - (notice the wide array of roles)
The liver functions as a digestive organ (bile salt secretion for fat digestion; processing and
storage of fats, carbohydrates, and proteins absorbed by the intestines; processing and storage of
vitamins and minerals); as an endocrine organ (metabolism of glucocorticoids,
mineralocorticoids, and sex hormones; regulation of carbohydrate, fat and protein metabolism), a
hematologic organ (temporary storage of blood, removal of bilirubin from bloodstream,
hematopoiesis, synthesis of blood clotting factors), and an excretory organ (excretion of bile
pigment and cholesterol via bile, urea synthesis, detoxification of drugs and other foreign
substances).
Manifestations of liver disease due to hepatocelleular failure - CORRECT ANSWER -
Jaundice, decreased clotting factors, hypoalbuminemia, decreased vitamins D and K, and
feminization (gynocomastia & female hair distributionb) are attributed to hepatocellular failure.
Manifestations of liver disease due to portal HT - CORRECT ANSWER - Portal
hypertension may result in GI congestion with the development of esophageal or gastric varices,
hemorrhoids, splenomegaly, and ascites.
hat clinical and laboratory findings would lead to a diagnosis of liver cirrhosis? - CORRECT
ANSWER - Clinical and laboratory findings that would lead to a diagnosis of liver
cirrhosis include palpation of an enlarged, nodular liver, jaundice, gastric varices, hemorrhoids,
, splenomegaly, ascites, decreased clotting factors, hypoalbuminemia, decreased vitamins D and
K, and elevated AST/ALT (more than 40 units)
s/s of alcoholic cirrhosis - CORRECT ANSWER - -weakness
-fatigue
-muscle wasting
-anorexia
-ascites *
-abnormal blood glucose levels
-elevated serum lipids
-feminization
-palmar erythema *
spider telangiectasia *
^ all are primarily due to hepato cellular failure
s/s of portal hypertension - CORRECT ANSWER - varices (enlarged veins including
hemorrhoids and gastroesophageal)
splenomegaly (enlarged spleen)
Everything enlarged. Why? Pressure pushing out on veins + arteries.
Why is a patient with alcoholic cirrhosis at risk for GI bleeding? - CORRECT ANSWER -
The liver is needed in synthesis of clotting factors; with heptacellular filkure, severe
hypoprothrombinemia can develop
Upper GI bleeding may result from varices, portal HT, or gastroduodenal ulcer (all of which are
manifestations of cirrhosis)
