Liver

Question 1

Cause of Hepatitis A

Answer 1

Fecal oral, contaminated food or water

Question 2

Patho of Hepatitis A

Answer 2

HAV enters GI tract, travels to livers replicates in hepatocytes

Question 3

Symptoms of Hepatitis A

Answer 3

Fever
Nausea
Vomiting
Fatigue
RUQ pain
Jaundice
Pale stools
Dark urine
Pruritus

Question 4

Cause of Hepatitis B

Answer 4

Blood, sexual contact, perinatal transmission

Question 5

Patho of Hepatitis B

Answer 5

Immune system attacks infected hepatocytes —> liver injury
STAGES:
incubation
symptomatic inflammatory
immune clearance
recovery or chronic

Question 6

Symptoms of Hepatitis B

Answer 6

Incubation 2-6 moths, flu symptoms
D pain
Jaundice
Pruritus
Dark urine
Asymptomatic

Question 7

Causes of Hepatitis C

Answer 7

Blood from IV drug use, needles, sexually

Question 8

Patho of Hepatitis C

Answer 8

High mutation rate –> genotypes + quasispecies
Chronic infection (70%) –> cirrhosis, heptaocellular carcinoma

Question 9

Symptoms of Hepatitis C

Answer 9

Fatigue
Anorexia
Jaundice
RUQ discomfort

Question 10

Patho + Causes of Chronic Hepatitis

Answer 10

Hepatic inflammation + necrosis for 6 mths
Causes: Cirrhosis, liver failure, hepatocellular carcinoma

Question 11

Causes of Non-Alcohol Related Fatty Liver Disease

Answer 11

Liver manifestation of metabolic syndrome
Fat accumulation in hepatocytes, 5-10% liver weight is fat

Question 12

Patho of Non-Alcohol Related Fatty Liver Disease

Answer 12

Insulin promoted fat storage in adipose tissue –> directs fat to the liver
First: fat accumulation disrupts hepatocyte metabolism
Second: oxidative stree + free radical generation –> fibrosis –> cytokines increase firbrosis + acc

Question 13

Risks of Non-Alcohol Related Fatty Liver Disease

Answer 13

Metabolic syndrome (hyperlipemia, insulin resistance, obesity)
Diabetes mellitus
HTN

Question 14

Symptoms of Non-Alcohol Related Fatty Liver

Answer 14

Asymptomatic, seen on labs

Question 15

Patho of Alcohol-Related Liver Disease

Answer 15

Chronic excessive alcohol use –> hepatocyte damage
Alcohol impairs fatty acid oxidation –> steatosis
Chronic ingestion –> hepatocyte organelle disruption –> necrosis –> fibrosis –> cirrhosis

Question 16

Symptoms of Alcohol-Related Liver Disease

Answer 16

RUQ pain
Malaise
Fever
Jaundice
Dark urine
Encephalopathy
Coagulopathy
GI bleeding
Ascites
Esophageal varices
Splenomegaly

Question 17

Cause of Cirrhosis + End-Stage Liver Disease

Answer 17

Chronic liver injury –> fibrosis
HCV
Alcohol-related liver disease
NAFLF/NASH
Drug induced

Question 18

Patho of Cirrhosis + End-stage Liver Disease

Answer 18

Repeated hepatocyte injury –> activation of stellate cells –> collagen disposition –> fibrosis –> cirrhosis
Portal HTN –> splenomegaly –> esophageal/rectal varice, ascites
Decreased detoxification –> ammonia accumulation –> hepatic encephalopathy
Reduces bile synthesis –> fat malabsorption –> steatorrhea, via A,D, E, K deficiency
Decreased albumin synthesis –> hyponcotic pressure –> peripheral edema, ascites
Hyperbilirubinemia –> jaundice, kerincterus
Impaired clotting factor –> coagulopathy –> bleeding tendency
HCC risk

Question 19

Symptoms of Cirrhosis + End Stage Liver Disease

Answer 19

Ascites –> caput –> splenomegaly (portal HTN)
Esophageal varices –> hematemesis
Jaundice, pruritus, dark urine, pale stools
Spider angiomas –> palmar erythema –> gynecomastia –> testicu;ar atrophy
Musle wasting –> dupuytren contracture
Hepatic encephalopathy: confusion, asterisks (liver flap), coma