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2012-10-11 06:51:07

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  1. Pathogenesis of ascites in liver disease. (sm)
    decreased albumin production > decreased osmotic pressure/increased hydrostatic pressure > formation of abdominal fluid > decreased intravacular volume > increased aldosterone (kidney) and increaesd Na+ reabsorption > increased intravascular volume > more abdominal fluid > ascites
  2. Which type of hepatitis requires HBV for replication and why? (sm)
    • Hep D
    • RNA-virus that cannot exist independently
  3. List the organs in which haemosiderin is deposited in haemochromotosis (and the order of most common > least common). (sm)
    Liver > pancreas > myocardium > pituitary gland > adrenal gland > thyroid and parathyroid > joints > skin
  4. Describe the pathogenesis of Hepatitis B. (sm)
    Ingestion/inoculation > replication in the liver and viraemia > cellular immune response > apoptosis, necrosis of hepatocytes > inflammation (hepatitis) > bridging hepatocyte necrosis > fibrosis > cirrhosis > liver failure, carcinoma
  5. Interpret these blood test results:
    HBsAg - negative
    anti-HBcAg - negative
    anti-HBsAg - positive
    The patient is immune because of vaccination against HBV
  6. What are some less common causes of viral hepatitis?
    • Less common - EBV, CMV
    • Rare - Herpes simplex, yellow fever
  7. Morphological features of chronic hepatitis? (sm)
    • Lymphoid aggregates
    • Macrovesicular steatosis
    • Bridging necrosis
    • Fibrous tissue deposition
  8. Which HepB serological marker reflects viral replication? (sm)
    • E antigen
    • HBeAg
  9. List 5 stigmata of chronic liver disease that you will see on physical examination
    • Abnormal skin pigmentation
    • Erythema
    • Hepatic flap
    • Spider naevi
    • Gynaecomastia
    • Clubbing
    • Jaundice
  10. The persistence of which serological marker is associated with chronic HepB infection?
  11. What is the enzyme required for Hep B virus replication? (sm)
    DNA polymerase
  12. Morphological features of acute hepatitis? (sm)
    • Diffuse swelling
    • Cholestasis
    • Macrophage aggregates
    • Bridging necrosis
    • Inflammatory cells
    • Kupffer cells
  13. Interpret these blood test results: (sm)
    HBsAg - positive
    anti-HBcAg - positive
    anti-HBcAg IgM - positive
    anti-HBsAg - negative
    The patient has an acute HBV infection.
  14. Pathogenesis of haemochromotosis. (sm)
    Recessive mutation > upregulation of iron-specific transporters > excessive iron absorption
  15. You suspect alcoholic liver disease in a patient. What Ix? (sm)
    • FBC - macrocytosis in absence of anaemia
    • LFTs (GGT)
    • PT 
    • Bilirubin
    • Albumin
    • USS/CT
    • Viral hepatitis serologies
    • Liver biopsy - to determine extent of liver damage
  16. What percentage (~) of cirrhosis patients go on to develop hepatocellular carcinoma? (sm)
  17. List 4 drugs that can cause drug-induced hepatitis.
    • Chlorpromazine
    • Oetrogens
    • NSAIDs
    • Statins
    • Rifampicin
    • Isoniazid
    • Amiodarone
    • Azathioprine
    • Methotrexate
  18. Interpret these blood test results:
    HBsAg - positive
    anti-HBcAg - positive
    anti-HBcAg IgM - negative
    anti-HBsAg - negative
    The patient has a chronic HBV iunfection. The IgM anti-HBc has waned
  19. What are the 3 patterns of alcoholic liver disease?
    • 1. Fatty change - reverisble
    • 2. Alcoholic hepatitis - irreversible but progression may be arrested
    • 3. Cirrhosis - irrversible
  20. Primary biliary cirrhosis most commonly affects elderly men. True or false?
    False. Most commonly affects middle-aged women
  21. Aetiology (s) of haemochromotosis. (sm)
    • Hereditary
    • Excess blood transfusions
    • Iron loading anaemias (thalassemia, sideroblastic anaemia)
    • Liver disease
    • Alcoholic liver disease
  22. Which HepB serological marker is not found in the blood? (sm)
    • core antigen
    • HBcAg
  23. How to improve rates of HepA transmission? (sm)
    • Improve social conditions - overcrowding, poor sanitation etc
    • Inactivated virus vaccine
  24. What is the most common cause of transmission of Hep B worldwide? (sm)
    Tranmission from mother to child - most common cause and carries the highest transmission risk
  25. What are some treatment options for Hep B? (sm)
    Interferon alphaLamivudineAdefovir (any of the -virs)Liver transplantation
  26. List 5 clinical manifestations (signs or symptoms) of haemohchromotosis. (sm)
    • Fatigue
    • Arthropathy
    • Skin pigmentation
    • Impotence
    • Loss of libido, testicular atrophy
    • Cardiac failure/dysrhythmia (due to iron deposition in the heart)
  27. List the steps of ethanol metabolism (with enzymes)
    Ethanol ---(ADH)---> Acetaldehyde ---(ALDH)---> Acetate ---> Carbon dioxide + water
  28. List 4 risk factors for Hep C. (sm)
    • IVDU
    • Unscreened blood products
    • Vertical transmission
    • Needle stick injury
  29. What is the characteristic morphological finding in primary biliary cirrhosis?
    Non-caseating granulomatous inflammation
  30. What is the major risk factor for Hepatocellular carcinoma? What are some other risk factors? sm
    • Chronic Hep B infection (also Hep C)
    • Alcoholism, aflatoxins, cirrhosis, haemochromotosis, obesity/type 2 diabetes
  31. What protein can be found in the blood to diagnose hepatocellular carcinoma? sm
    • Alpha fetoprotein (AFP) 
    • (foetal form of serum albumin, produced by the liver)
  32. List 4 diseases that can cause childhood cirrhosis. sm
    • Hep B & C
    • Autoimmune hepatitis
    • Wilsons disease
    • Alpha 1 anti-trypsin deficiency
    • Cystic fibrosis
  33. What is Wilson's disease? sm
    Autosomal recessive condition in which copper accumulates in the tissues. Causes neurological/psychological issues and liver disease
  34. What does HELLP syndrome stand for and in what patient group would you see it? sm
    • Haemolysis, elevated liver enzymes, low platelet count
    • Can occur in pre-eclamptic pregnant women
  35. What is the drug thought to be implicated in Reye syndrome?
  36. How much functional capacity of the liver must be lost before hepatic failure ensues? sm
  37. What is the pathogenesis of peripheral oedema in hypoalbuminaemia (liver failure)? sm
    decreased production of albumin > decreased proteins in the blood > decreased osmotic pressure > hydrostatic pressure is greater than osmotic pressure > fluid extravasates into the tissues