Robbin's Tables

Question 1

Normal values of bilirubin: conjugated and unconjugated

Answer 1

conjugated - .1 - .3

unconjugated - .2 - 9

Question 2

Dasabuvir

Answer 2

NS5B
CYP3A4
N, pruritus, insomnia

Question 3

Preeclampsia

Answer 3

maternal HTN
proteinuria
peripheral edema
coag abnormalities

+ hyperreflexia and convulsions = eclampsia

Question 4

HNF1-alpha hepatocellular adenoma

Answer 4

inactivating HNF1alpha mutation
fatty and devoid of cellular architectural atypic
LFABP is NOT expressed (typically always is)

Question 5

What levels are elevated in:
a. Steatosis
b. Steatohepatitis
c, Steatofibrosis/cirrhosis

Answer 5

a. alk phos, ggt
b. AST, ALT, alk phos, bilirubin
c. coag probs hypoprotein

Question 6

Elbasvir

Answer 6

fatigue, HA, N when combined with Grazoprevir

Question 7

When is infarct of hepatic artery a problem?

Answer 7

in liver transplantation –> leads to infarction of major ducts of biliary tree

Question 8

Simeprevir

Answer 8

NS 3/4 protease inhibitor

must be taken with food

Question 9

Ledipasvir

Answer 9

fatigue, HA, asthenia when combined with sofobuvir

Question 10

Pattern of Injury: Cholestatic Hepatitis

Answer 10

antibiotics

statins

Question 11

Glasgow alcoholic hepatits score

Answer 11

predicts mortality based on

1. age
2. serum bilirubin
3. BUN
4. PT time
5. peripheral WBC count

greater than/equal to 9 –> better survival is received glucocorticoids

Question 12

What is cholestasis?

Answer 12

impaired bile formation and bile flow that leads to bile pigmentation in the haptic parenchyma

Question 13

Grazoprevir

Answer 13

NS 3/4 protease inhibitor

fatigue, HA, N

Question 14

Classic Tetrad of Hemochromatosis

Answer 14

1. Cirrhosis with hepatoemegaly
2. Abnormal skin pigmentation
3. DM
4. Cardiac dysfunction

Question 15

Mallor Denk bodies

Answer 15

accumulations of intermediate filaments found within hepatocytes

1. Alc Liver disease (main one)
2. NAFLD
3. Wilson Disease
4. Chronic biliary obstruction
5. PBC

Question 16

Pattern of Injury: Hepatocellualr necrosis

Answer 16

acetaminophen

Question 17

PBC Morphology Highlights

Answer 17

1. patchy distribution
2. bile accumulation is periportal
3. feathery degeneration and ballooned, bile-stained hepatocytes
4. Mallory Denk Bodies
5. Marked hepatomegaly

End stage livers have a green pigmentation!!

some pts develop portal HTN rather than severe cholestasis

Question 18

Pattern of Injury: Fatty liver disease

Answer 18

ethanol
aspirin (reye)
corticosteroids

Question 19

Dagnosis for

1. HNF1-alpha hepatocellular adenoma
2. Beta catenin hepatocellular adenoma
3. Inflammatory hepatocellular adenoma

Answer 19

1. stain for LFABP –> will be absent
2. beta catenin nuclear translocation; glutamine synthetase is positive
3. inc CRP and serum amyloid in serum; areas of fibrotic storm, mononuclear inflammation, ductular reactions, dilated sinusoids, telangiectatic vessels

Question 20

Pattern of Injury: Neoplasms

Answer 20

vinyl chloride
alcohol
oral contraceptives
thorotrast

Question 21

Velpatasvir

Answer 21

with sofosbuvir = first once daily single tablet regime

HA, fatigue

Question 22

Pattern of Injury: Fibrosis and cirrhosis

Answer 22

alcohol

vitamin A

Question 23

Pattern of Injury: Granulomas

Answer 23

amiodarone

allopurinol

Question 24

Sofosbuvir

Answer 24

NS5B

prodrug, nucleotide analog

Question 25

What cytokines activate stellate cells?

Answer 25

proliferation - PDGF, TNF contraction - ET-1 chemotaxis - MCP-1, PDGF 422,

Question 26

Ombitasvir

Answer 26

nausea, purities, insomnia | CYP3A4

Question 27

Why are women more susceptible to alc liver disease?

Answer 27

estrogen increases gut permeability to endotoxins --> increases expression of LPS receptor CD14 in Kupffer cells --> increased production of pro inflammatory cytokines and chemokine

Question 28

What can a PPI due in hemochromatosis?

Answer 28

reduces intestinal iron absorption and decreases maintenance phlebotomy blood volume requirement

Question 29

Paritaprevir

Answer 29

NS 3/4 protease inhibitor CYP3A4 N, pruritus, insomnia

Question 30

What levels are raised in hepatic steatosis? alcoholic hepatitis?

Answer 30

a. serum bilirubin, alk phos | b. AST > ALT, hyperbilirubinemia, alk phos

Question 31

Mxns of liver injury due to iron

Answer 31

1. lipid per oxidation via iron catalyzed free radicals 2. stimulations of collagen formation by activation of hepatic stellate cells 3. Interaction of reactive oxygen species and iron with DNA leading to cell death and possibly HCC

Question 32

Three ways Cu is toxic to liver

Answer 32

1. promotes formation of free radicals 2. binds to sulfhydryl groups of cellular proteins 3. displaces other metals from hepatic metal-enzymes

Question 33

What is unique about aflatoxin in HCC?

Answer 33

leaves molecular signature - mutation in codon 249 of p53 gene

Question 34

Criteria for Metabolic Syndrome

Answer 34

1. DM or insulin resistance or impaired glucose tolerance or impaired fasting glucose 2. BP (140/90), microalbuminuria, central obesity, dyslipidemia

Question 35

Stupid high liver enzyme levels

Answer 35

ischemic hepatitis acetaminophen OD acute viral hep

Question 36

Pattern of Injury: Cholestatic

Answer 36

contraceptives | anabolic steroids

Question 37

What are the three types of hepatic adenomas?

Answer 37

1. HNF1-alpha: no risk of malignant transformation 2. Beta catenin Activated: very high risk (cut out even if asx); associated with OCs and anabolic steroids 3. Inflammatory: small, but definite risk (cut out even if asx)

Question 38

Pattern of Injury: Vascular lesions

Answer 38

oral contraceptives high dose chemo anabolic steroids

Question 39

Maddrey Discriminant Function

Answer 39

if at or above 32, have high risk of mortality and may benefit from glucocorticoids *alcoholic hepatitis

Question 40

Associated Conditions with Wilson Disease

Answer 40

``` renal calculi infertility hemolytic anemia subQ lipomas RTA ```

Question 41

What is the histo hallmark of ascending cholangitis?

Answer 41

influx of periductular neutrophils directly into bile duct epithelium and lumen