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1.
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Central Role in pathogensis of NAFLD - Non alcoholic Liver disease
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Defect in impared insulin-mediated supression of lipolysis with a net increase in FFA.FFA impair signaling and in striated smooth muscle/ promote gluconeo HIGH SUGAR and stimulate Insulin release via pancreas which eventually fails
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2.
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Tx for NAFLDComplications of NAFLD
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ALT>ASTTx: wt loss, control of DM, control lipids, exercise, remove agent. complications: cirrhosis/ liver fail/ hepatocellular CA
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3.
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Gilberts Syndrome
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Autosomal Dominant variable expressivityDx after pubertyReduction in UGTI A1 activityRelieved by PhenobarbitolJaundice upon stress/ infection
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4.
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Crigler Najjar, Type 1.
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NO UGTIAI activity.Auto Recessive.Most babies die of KernicterusTx. Liver tp... Phototherapy, CaCOH- Bile sequest. Heme oxidase inhibitor.
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5.
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Crigler Najjar Type 2.
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Auto Recessive Reduced UGTIAI...Ilness can increase bilirubin: Stress and Fasting also.Tx; Phenobarbitol
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6.
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Normal Bilirubin
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Less than 1.5Icterus/ jaundice= 2.0-2.5 mg/dLRecall Fat soluble will cross the BBB==> kernicterus
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7.
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Blood flow vs Bile flow
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Blood --> Portal, sinusoid, venule. 1-3Bile --> , sinusoid, portal. 3-1Zone 3 is farthest from the blood supply.
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8.
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Kupffer cells
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Macrophages in sinusoid (filter)Stellate cells = lipocytes, synthesize collagen give that fibrosis and cirrhosis dur damage.
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9.
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Pt presents with Jaundice whats the first test you do?
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UA.Bilirubin (CONJUCATED) greater than 3-4 shows up in the URINEOnce conjugated its UNBOUND in serum.
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10.
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90 percent of those affected at birth become chronic Hepatitis, which virus is it?
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Hep B.,,, thus testing is mandatory in 1rst trimester of pregnancy also: if + HBV immune globulin and Hep B vaccine given to baby within 12 hours of birth2-7% of adults become chronic after infection.
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11.
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Lab for acute Hep A
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IgM anti-HAV
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12.
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Lab for actue Hep B
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IgM anti-HBcHBsAG
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13.
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Lab for acute Hep C
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Anti-HVC
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14.
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If the patient wants HAV vaccine
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check the total anti-HAV first ---> pos they are immune
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15.
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Check for the immunity for HBV of vaccine
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anti- HBs should be greater than 10mlU/mL.
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16.
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How much alcohol allowed for male/female before they develop alcoholic liver disease
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>60g/day for 10 years MALE 1 beer/ 4oz wine = 12 g.>20-40 g/d for 10 yr WOMAN
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17.
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Nutritional supplement for the Alcoholic Hepatitis
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Thiamine, folate.restrict protein, stop the ETOH,
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18.
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MC causes of Cirrhosis
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Autoimmune hepatitis
Alcohol-induced LR
injury
Drug or toxin induced
LR injury
Viral hepatitis B, C,
D
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19.
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HBV infection can become more severe if?
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HDV (RNA) virus, dependent on HBV. Can cause fulminant liver. spontaneous acceleration to cirrhosis. Tx the HBV and that is all you do.
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20.
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The smallest functional unit of the liver, comprising all of the liver parenchyma supplied by a terminal branch of the portal vein and hepatic artery; typically involves segments of two lobules lying between two terminal hepatic venules.
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acinus
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21.
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elevated ALKALINE PHOSPHATASE
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Elevated when there is obstructionCholestatic Disease
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22.
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Best liver test in the actue setting
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PT
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23.
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Indicators of liver cell injuryAmount of elevation doesnt indicate prognosis
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ALT > AST but in alcholic liver disease AST>ALT 2:1.Al
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24.
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Made by Hepatocytes and may be low in chronic hepatitisBinds to unconjugated Billirubin for blood transport
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albumin
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25.
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AMA- anti-mitochondrial antibody
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screens for pirmary biliary cirrhosis
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26.
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Shell fish congestion may result in?
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Hep A.
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27.
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10-20 percent mortality rate in woman
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Hep E.
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