Liver/Biliary System/LI

Question 1

How does Alcoholic Cirrhosis differ from Biliary Cirrhosis?

Answer 1

Alcoholic: Hepatocyte Damage

Biliary: Bile canaliculu and Bile duct damage

Question 2

What drains the gallbladder?

Answer 2

Cystic Duct

Question 3

A Patient comes to clinic with liver damage and is found to have damage to cells which produce globulin proteins. What symptoms may he experience?

Answer 3

• Hypocholeserolemia
• Low level of testosterone
• Reduced ability to clot
• Hepatitis from Trypsin activation in liver

Question 4

Obese Patient presents with peripheral insulin resistance, increases TGs, increased FAs, and blood tests reveal increase in LFT. Patient reports no past history of chronic alcoholism? What is likely diagnosis?

Answer 4

Non-alcoholic fatty liver

Question 5

Describe pathology of Hepatic encephalopathy. How is it treated?

Answer 5

Liver damage —> DEC ammonia metabolism —> Ammonia in brain —> Encephalopathy

Treat with Lactulose or neomycin

Question 6

What organs send blood through the liver before entering the IVC?

Answer 6

Colon, SI, pancreas, and stomach

Question 7

What are the two stimulators of bile secretion?

Answer 7

Ach - Vagus

CCK - Duodenum

Question 8

What is the rate limiting enzyme of bile acid synthesis?

Answer 8

Cholesterol 7 alpha hydroxylase

Question 9

What percentage of cholesterol is in bile?

Answer 9

5%

Question 10

What is a big risk factor for gall stones?

Answer 10

Lodging in sphincter of Oddi —> Pancreatitis

Question 11

What is the effect of Ileal resection?

Answer 11

• Resection removes the portion of intestine which normally transports bile acids into liver for recirculating
• No bile acids —> No micelles —> Steatorrhea

Question 12

Describe Gilbert’s syndrome

Answer 12

• Abnormal conjugation Of Bilirubin due to familial bilirubin glucoronidation

*** Lab shoes everything is normal except unconjugated bilirubin

Question 13

Describe Dublin-Johnson Syndrome

Answer 13

• genetic Decreased hepatocyte excretion of conjugated bilirubin
• LFT/ALK normal
• Increase in conjugated bilirubin

Question 14

What are the two main types of Gall Stones?

Answer 14

Pigmented: Dark Brown - Black; Calcium salts of unconjugated bilirubin; Hemolytic anemia

Brown pigment stones: Secondary to Bacterial infection of biliary tract —> Release of Beta-glucoronidase

Question 15

What is the main causes of biliary sludge?

Answer 15

• Gallbladder Hypomotility

- Prolonged TPN or Octreotide

Question 16

What are the functions of different segments of LI?

Answer 16

Ascending colon: Absorption of Water and Ions

Transverse: Bacterial fermentation

Descending: Storage of waste

Question 17

What are the three secretions of the LI?

Answer 17

1. Alkaline secretions foe bacterial acids
2. Mucous secretions for protection
3. Vitamin B and K absorption made from bacterial flora