path: liver 2

Question 1

Wilson disease is an autosomal recessive disorder caused by ____________ gene mutation

Answer 1

ATP7B

Question 2

Wilson disease gene mutation leads to impaired ___________ excretion into bile

Answer 2

Copper

Question 3

Wilson disease results in toxic copper accumulation in what areas?

Answer 3

Liver
Brain
Eyes
Kidneys
Bones
Joints

Question 4

Function of ATP7B

Answer 4

Incorporates copper into ceruloplasmin
Excretes copper into bile

Question 5

How is urinary excretion of copper in Wilson disease?

Answer 5

Increased

Question 6

Diagnosis of Wilson disease

Answer 6

Decreased ceruloplasmin
Increased hepatic copper content - most sensitive
Increased urinary copper excretion - most specific
Kayser-Fleischer rings on slit lamp exam
Green to brown deposits of copper in Descemet membrane in the limbus of the cornea.

Question 7

Damage to hepatic parenchyma due to consumption of alcohol

Answer 7

Alcohol-associated liver disease

Question 8

Alcohol-Associated Liver Disease (ALD) manifests histologically in what 3 ways?

Answer 8

Hepatic steatosis
Steatohepatitis
Alcoholic cirrhosis

Question 9

Microvascular fatty change, may be reversible with alcohol cessation

Answer 9

Hepatic steatosis

Question 10

steatohepatitis

Answer 10

inflammation of the liver associated with excess fat

Question 11

steatohepatitis damage is mediated by what?

Answer 11

Acetaldehyde

Question 12

Histological changes in steatohepatitis

Answer 12

Necrotic hepatocytes with Neutrophilic infiltration
Mallory bodies

Question 13

How does steatohepatitis present? How are liver enzymes?

Answer 13

Painful hepatomegaly

Elevated liver enzymes (AST>ALT)

Question 14

Complication of long-term, chronic alcohol induced liver damage

Answer 14

Alcoholic cirrhosis

Question 15

What may be seen in early alcoholic cirrhosis?

Answer 15

Sclerosis around central vein

Question 16

Alcoholic cirrhosis leads to ____________ and ____________________

Answer 16

Portal hypertension and end-stage liver disease

Question 17

Hepatocellular carcinoma is also known as ______________

Answer 17

hepatoma

Question 18

Malignant tumor of hepatocytes

Answer 18

Hepatocellular carcinoma

Question 19

Risk factors for Hepatocellular carcinoma

Answer 19

• chronic hepatitis B/C
• hemochromatosis
• Wilson disease
• cirrhosis
• aflatoxins derived from aspergillus

Question 20

4 findings with Hepatocellular carcinoma

Answer 20

Anorexia
Jaundice
Tender hepatomegaly
Weight loss

Question 21

What helps confirm diagnosis of Hepatocellular carcinoma?

Answer 21

Unifocal/multifocal mass on ultrasound or contrast CT/MRI

Serum tumor marker - AFP

Question 22

Gallstones are caused by what 3 things?

Answer 22

Imbalance of cholesterol and/or bilirubin
Reduced bile salts
Gallbladder stasis

Question 23

Classic 4 risk factors of gallstones

Answer 23

Female
Fat (obesity)
Fertile (multiparity)
Forty (middle-aged)

Question 24

Most common complication of gallstones

Answer 24

cholecystitis

Question 25

Types of gallstones

Answer 25

cholesterol and pigment

Question 26

Cholesterol stones are associated with what?

Answer 26

obesity advanced age estrogen therapy multiparity rapid weight loss

Question 27

Pigment stones: Black stones are composed of what? And associated with what?

Answer 27

Ca2+ bilirubinate Chronic hemolysis Crohns disease Alcoholic cirrhosis Advanced age

Question 28

Brown pigment stones are associated with _____________ infection and ___________

Answer 28

Biliary Parasites

Question 29

A 16-year-old boy presents with behavioral changes, difficulty in school, and new-onset tremors. Physical examination reveals yellowish-brown rings at the corneal margin. Laboratory studies show low serum ceruloplasmin, elevated urinary copper, and abnormal liver function tests. Which of the following is the most likely diagnosis?

Answer 29

B. Wilson disease

Question 30

A 58-year-old man with chronic alcoholism presents with fever, jaundice, tender hepatomegaly, and abdominal pain. Labs show AST: 230 U/L(Normal range - 10-40 U/L), ALT :95 U/L (normal range - 7-56 U/L), and elevated bilirubin. Liver biopsy reveals Mallory-Denk bodies and neutrophilic infiltration. Which of the following is the most likely diagnosis?

Answer 30

B. Alcoholic hepatitis

Question 31

A 62-year-old man with a history of chronic hepatitis B infection presents with unintentional weight loss, right upper-quadrant discomfort, and progressive abdominal swelling. Laboratory tests reveal elevated α-fetoprotein (AFP) levels. Ultrasound shows a heterogeneous mass in the right lobe of the liver. Which of the following is the most likely diagnosis?

Answer 31

B. Hepatocellular carcinoma