LIVER ANATOMY
Name the four lobes of the liver.
Right, left, quadrate, caudate
Which liver enzyme is usually more elevated in patients with viral hepatitis?
ALT>AST
(ALT IS MORE ELLLAVATED)
Which Hepatitis C treatment regimen is no longer recommended, and is only used in resource limited settings?
Pegylated Interferon + Ribavirin
What is a serum tumor marker for HCC?
Alpha fetal protein (AFP)
Which forms of viral hepatitis have fecal-oral transmission?
HAV, HEV (the vowels hit your bowels)
What structures make up the portal triad?
Hepatic artery, portal vein, bile duct (branches)
An H___V infection in pregnant people is associated with ________ (liver failure with massive liver necrosis)
HEV, fulminant hepatitis in EEExpectant mothers
________ is an example of an NS5A inhibitor.
Ledipasvir, Elbasvir, Ombitasvir, Pibrentasvir, Velpatasvir, daclatasvir
T/F metastatic carcinoma of the liver is more common than primary hepatocellular carcinoma.
True
True or false, IgG is protective in HAV but not HCV
True (use RNA for HCV)
The ___vein brings nutrient rich blood to the liver, while the ____ vein brings oxygen poor blood back to the heart via the IVC.
Portal vein, hepatic vein
Which two forms of acute hepatitis have the highest risk of progression to chronic hepatitis and HCC?
HBV,HCV (HBV 20% adults, >50% children under 6/HCV 80%)
_____ is an example of an NS5B inhibitor.
Sofosbuvir, Dasabuvir
How do the aflatoxins from aspergillus lead to HCC?
P53 mutations
Hepatic adenomas are associated with which type of medication?
The _____ cells which produce the collagen responsible for fibrosis/cirrhosis are located in the ______ of the liver.
Stellate cells, perisinusoidal space/ space of Disse
Why is it difficult to produce antibodies/vaccines against HCV?
HCV lacks 3'-->5 exonuclease activity-->no proofreading ability -->antigenic variation of envelope proteins. Antibody production lags behind new mutant strains
Simeprevir, telaprevir, and boceprevir are examples of _______.
NS3/4A Protease inhibitors
Insertion of the ____ genome into its host (human) genome is this virus's primary driver of HCC oncogenesis.
HBV (partially dsDNA)
Andrew's physical exam findings were notable for ______ and ______ which are associated with cirrhosis induced estrogen elevation.
Spider angiomas and palmar erythema
Caput medusa is caused by a portosystemic shunt between which arteries?
Paraumbilical (portal) -->superficial epigastric (systemic)
Which serological marker indicated active viral replication/high transmissibility in a hepatis B infection?
HBeAg
Name two conditions interferon-alfa can be used to treat.
Kaposi Sarcoma, Chronic Hep B, Condyloma Acuminata, Follicular lymphoma, Hairy Cell Leukemia, Melanoma
Name four risk factors for HCC.
Cirrhosis, Chronic Hep B/Hep C, Alcoholic Liver Disease, Non-alcoholic steatohepatitis, Hemochromatosis, Wilson disease, Alpha-1-antitrypsin deficiency, Autoimmune hepatitis, Schistosomiasis, Chronic ingestion of aflatoxin, glycogen storage disease
Liver abscesses with hydatid cysts with eggshell calcifications are caused by _____, while liver abscesses with anchovy paste exudate are caused by _____.
Echinococcus granulosus, Entamoeba histolytica