G and E EXAM 4

spontaneous bacterial peritonitis

life-threatening consequence of cirrhosis and associated ascites

HBsAG negative, AntiHBs IgG positive

dental student immunized for Hep B, would have what serology

IgM Anti-HBc positive, HBsAg positive, HBV DNA positive

serology of acute Hep B infection

IgG Anti-HBc positive, HBsAg positive, HBV DNA positive

serology of chronic Hep B infection

IgG anti-HBs positive and IgG anti-HBc positive

serology of immunity due to natural infection

HBsAg

surface antigen from the hepatitis B virus that indicates ACTIVE infection

Anti-HBs

antibody to hepatitis B surface antigen; indicates IMMUNITY after infection or vaccination

Anti-HBc igG

antibody to core of hep b virus indicated past or chronic infection

acetaminophen toxicity

most common cause of ACUTE liver failure in USA

glutathione

antioxidant vital in detoxifying acetaminophen and other toxins in the liver

Drug induced liver injury

patient on 2-week course of antibiotics (augmentin) reports jaundice and dark urine. likely diagnosis?

augmentin (amoxicillin-clavulanate)

most common cause of drug induced liver injury (DILI) worldwide

hemochromatosis

disorder of iron metabolism, commonly due to HFE gene defect

hemochromatosis

excess iron deposited in liver, pancreas (diabetes) , heart, and skin (bronze appearance)

common bile duct at sphincter of oddi (below pancreatic duct)

patient with elevated conjugated bilirubin and elevated amylase diagnosed with obstructing gallstone. The gallstone is likely lodged in the:

cholelithiasis

gallstones in gall bladder

choledocholithiasis

gallstones in common bile duct

cholecystitis

inflammation of the gallbladder, often due to gallstones in gallbladder (cholethiasis)

cholangitis

inflammation of the bile ducts, due to gallstones in common bile duct (choledocholithiasis)

long chain fatty acids

cause damage to stellate cells through TNFa

stellate cell

promote fibrosis and scar tissue formation in response to liver injury

MASLD

buildup of fat in the liver not due to alcohol consumption, potentially leading to inflammation and liver damage

hepatic encephalopathy, coagulopathy, hepatocellular carcinoma, portal hypertension

complications of cirrhosis

varices, ascites, hepatorenal syndrome

complications of portal hypertension

cirrhotic ascites

ALWAYS associated with portal hypertension

intra-hepatic portal hypertension

due to nodular compression and fibrosis of sinusoids

hemochromatosis

patient with bronzing skin, fibrotic liver, and diabetes. likely diagnosis?

wilson’s disease

which disease presents with greenish golden crescents on the cornea (kayser-fleischer rings)

wilson’s disease

disorder that results in copper accumulation in the liver, brain, and eyes

alpha-1-antitrypsin deficiency

EMPHYSEMA due to reduction of serum A1AT levels

albumin and INR

test to determine ability of LIVER to SYNTHESIZE compounds (function)

ALT/AST

test to assess active hepatic cellular disease

alkaline phosphatase fractionated

test to determine biliary obstruction

reactive quinone metabolite (of acetaminophen) toxic to hepatocyte

acetaminophen toxicity is due to:

maternal/fetal, blood, sexual contact

transmission routes of hep B

absorbed by the ileum and returned to the portal vein for reuse

after secretion into the duodenum the majority of bile salts are:

bile

fluid produced by the liver that aids in digestion and fat absorption

bile salts

allow digestion of lipids by creating micelles

micelles

small aggregates of fatty acids, bile salts, and other lipids that facilitate lipid digestion and absorption in the intestine

bilirubin

metabolic waste of hemoglobin brreakdown

cholelithiasis (gallstone of gallbladder)

best diagnosis based on the findings

most likely to progress to end stage liver disease

compared with other forms of hepatitis acquired in adulthood, untreated HEP C:

gilberts disease

presents with icteric sclera (yellow eyes) and UNCONJUGATED hyperbilirubinemia after STAYING UP LATE, but otherwise normal

increased bleeding

from a dentist's POV pts with advanced chronic liver disease are most at risk for infection, poor medication metabolism, and:

ammonia

advanced chronic liver disease causes asterixis and cognitive changes due this factor that affects the brain:

Hep C

most likely cause of chronic liver disease in patient with history of IV drug use

recovered hepatitis B infection

what does the follwoing hepatitis panel indicate:

HBsAg : -

Anti-HBs IgG: +

Anti-HBc IgM: -

Anti-HBc IgG: +

Anti-HAV (antibody to Hep A )

patient present with nausea, anorexia, malaise, fever, and abdominal pain. develops dark urine, jaundice, and pruritus. He denied needle use or sexual contact and just came back from traveling. which lab test is likely positive?

fecal/oral

hepatitis A transmission

hepatic encephalopathy

Medications that suppress the central nervous system (CNS) should be used with caution in patients with chronic liver disease because they can cause:

decrease acetaminophen dose

patient with severe chronic liver disease requires pain medication after dental procedure, you should:

use universal precautions (as you would for all patients)

if a patient informs you they are a chronic carrier of hepatitis C you should

elevated estrogen

cause of palmar erythema and spider angiomata in patient with chronic liver dysfunction

hepatocellular carcinoma

recent increase in alpha fetoprotein is associated with

duodenum

where is iron absorbed

Ileum

where is vitamin B12 absorbed

ileum

where are most bile salts absorbed

small chain fatty acids

what are carbohydrates absorbed as in the COLON

celiac sprue

destruction of intestinal villi caused by gluten intolerance

autoimmune T cell attack

how are intestinal villi destroyed in celiac sprue

irritable bowel syndrome

chronic abdominal pain and altered bowel habits (constipation or diarrhea) of unknown cause

celiac

can cause nutritional deficiency in healthy person due to malabsorption

gliadin

a gluten protein that triggers intestinal damage in celiac disease

transglutaminase

marker for celiac disease

celiac

causes iron deficiency anemia from malabsorption

steatorrhea

fat in stool, often symptom of celiac disease

colon

does most of Na+ and water absorption

crohns, ulcerative colitis, carcinoma, pseudomembranous colitis

main diseases of the colon

crohns disease

inflammatory bowel disease anywhere in GI tract, characterized by transmural inflammation and skip lesions.

ulcerative colitis

continuous ulceration of colon that starts at rectum and moves proximally

pseudomembranous colitis

antibiotic-associated colitis due to C. diff

colon carcinoma

2nd most common cancer death in the US

ulcerative colitis

greatly increases risk of carcinoma

ulcerative colitis

patient presents with bloody stool, chronic diarrhea and rectal tenderness. likely diagnosis?

blood loss

cause of iron deficiency anemia in ulcerative colitis and Crohn's patients

ulcerative colitis

ALWAYS involves RECTUM and continuous colon inflammation with ulcers

albumin, coagulation factors, urea, bile salts

molecules synthesized by liver

conjugated

type of hyperbilirubinemia associated with acute hepatic necrosis (ex: hepatitis or DILI)

conjugated

bilirubin that is excreted in urine

elevated conjugated bilirubin

bilirubinuria indicates

unconjugated

hyperbilirubinemia that occurs in Gilbert’s disease

central vein

hepatic artery and portal vein drain into?

Portal vein and hepatic artery

What vessels deliver blood to the liver?

Portal vein, hepatic artery, bile duct

components of portal triad

Space of disse

where exchange of substances occurs between the blood in sinusoids and hepatocytes

Vitamin A

Stored by stellate cells

Kupffer cell

type of macrophage found in the liver that plays a role in immune response and the breakdown of old red blood cells

liver acinus

Functional unit of the liver, where blood flows from portal triad through sinusoids to central venule

Low oxygen

Why is zone 3 of liver acinus susceptible to hypoxic damage?

Zone I

What liver acinus zone does viral hepatitis damage?

albumin

What does unconjugated bilirubin complex with in the blood to make it more water soluble?

Conjugated

water-soluble bilirubin

conjugated

all bilirubin leaving the liver cell is ____

Conjugated bilirubin converted by glucuronidases 

Where does unconjugated bilirubin come from in the bile duct?

Bilirubin (mesobilifusions) not present to color stool

Why does stool become pale with obstruction of the biliary system?

unconjugated

defect in one of the first 5 steps of bilirubin metabolism what type of hyperbilirubinemia arises?

intrahepatic cholestasis

block of bile flow inside liver

extrahepatic cholestasis

Block of bile flow outside of liver (ex: bile ducts)

no (unconjugated no water soluble)

Would you expect to see dark urine with UNCONJUGATED hyperbilirubinemia

acute liver disease

high INR + normal albumin