Liver Quiz!

Wilson's disease is the correct answer. In the TV show HOUSE, MD, Dr. House's best friend, Dr. James Wilson, is diagnosed with Wilson's disease. This disease is an autosomal recessive disorder that causes impaired biliary excretion of copper. It results in the accumulation of copper in various organs, particularly the liver and brain, leading to symptoms such as liver dysfunction, neurological problems, and psychiatric disturbances.

A high IgM level would indicate primary biliary cholangitis (PBC). IgM is an immunoglobulin that is produced in response to an infection or inflammation in the body. In PBC, the immune system mistakenly attacks the bile ducts in the liver, leading to inflammation and damage. This immune response triggers the production of IgM antibodies. Therefore, a high IgM level can be a marker of PBC. It is important to note that a high IgM level alone cannot definitively diagnose PBC, and further testing and evaluation are necessary for a proper diagnosis.

The statement "There is a vaccine for HCV" is false. As of now, there is no approved vaccine available for Hepatitis C Virus (HCV). While there are vaccines for other types of hepatitis, such as Hepatitis A and Hepatitis B, there is no vaccine specifically for HCV. The primary mode of prevention for HCV is through avoiding high-risk behaviors such as sharing needles or having unprotected sex with an infected person.

The portal vein is the correct answer because it is responsible for carrying blood from the gastrointestinal tract, spleen, and pancreas to the liver. This blood is rich in nutrients and other substances that need to be processed by the liver. The portal vein branches out within the liver and eventually connects to the central vein, which then drains into the hepatic vein and returns blood to the heart. The hepatic artery supplies oxygenated blood to the liver, while the bile duct carries bile produced by the liver to the gallbladder and small intestine.

A high IgG level may indicate autoimmune hepatitis because this condition is characterized by the immune system mistakenly attacking the liver. IgG is a type of antibody produced by the immune system, and elevated levels can be a sign of an autoimmune response. In autoimmune hepatitis, the immune system targets the liver cells, leading to inflammation and damage. Therefore, a high IgG level can be a useful marker for diagnosing autoimmune hepatitis.

Blood flows through the liver in a specific sequence. First, it enters the liver through the hepatic artery (1), which supplies oxygenated blood to the liver. Then, it passes through the liver sinusoids (2), where nutrients, toxins, and waste products are exchanged. Next, the blood flows into the hepatic vein (3), which carries the deoxygenated blood out of the liver and back to the heart. Finally, the blood leaves the liver and continues its circulation throughout the body (B). This sequence ensures that the liver can perform its vital functions, such as detoxification and metabolism.

The portal vein supplies 80% of the blood to the liver. This is because the portal vein is responsible for carrying nutrient-rich blood from the gastrointestinal tract, spleen, and pancreas to the liver. This blood contains nutrients and other substances that are absorbed from the digestive system and need to be processed by the liver. Therefore, the portal vein plays a crucial role in delivering a significant majority of the blood supply to the liver for its various functions, including detoxification, metabolism, and storage of nutrients.

Bile flows in the opposite direction as the blood because it is produced by the liver and stored in the gallbladder. It is then released into the small intestine to aid in the digestion and absorption of fats. The flow of bile is regulated by the sphincter of Oddi, which controls the release of bile into the small intestine. Since the blood flows towards the liver for filtration and processing, the bile flows in the opposite direction to reach the small intestine.

Pruritis is a symptom of cholestatic liver disease, which is characterized by impaired bile flow from the liver. It is also a term used to describe itchiness. Therefore, the correct answer is a and b, as pruritis can be a sign of cholestatic liver disease and is also associated with itchiness.

The central vein is the correct answer because it is a blood vessel that is located in the center of the liver lobule. It receives blood from the hepatic sinusoids, which are small blood vessels that carry oxygenated blood from the hepatic artery and nutrient-rich blood from the portal vein. The central vein then carries this blood out of the liver and eventually merges with other central veins to form the hepatic veins, which empty into the inferior vena cava.

The given serology results indicate that the person has a positive result for anti-HAV antibody, indicating immunity to hepatitis A virus (HAV). They also have a positive result for HBsAg, indicating an ongoing hepatitis B virus (HBV) infection. The negative results for anti-HBs antibody and anti-HCV antibody suggest no immunity to hepatitis B or hepatitis C viruses. Therefore, the interpretation is that the person has an ongoing HBV infection but is immune to HAV.

true because you can't monitor seroconversion.
Treatment includes:
Nucleoside analogues (LAM, ENT, LdT)
Nucleotide analogues (ADF, TNF)
interferon or PEG-IFN

A high IgA level would indicate alcohol consumption. IgA is an antibody that is produced in response to infections and is also found in high levels in individuals who consume excessive amounts of alcohol. This can be used as a marker to assess alcohol consumption and its associated health risks.

If you suspect Wilson's disease and the ceruloplasmin test comes back low, the next step would be to perform a 24-hour urine copper test. Wilson's disease is a genetic disorder that causes copper to accumulate in the body, leading to various symptoms and organ damage. Measuring the amount of copper excreted in a 24-hour urine sample can help confirm the diagnosis. Other tests, such as liver function tests and genetic testing, may also be performed to further evaluate the condition.

The given answer lists four complications of cirrhosis: varices, ascites, encephalopathy, and confusion. These are all common complications that can occur in individuals with cirrhosis. Varices are enlarged veins in the esophagus or stomach that can rupture and cause life-threatening bleeding. Ascites refers to the accumulation of fluid in the abdomen, leading to abdominal swelling. Encephalopathy refers to brain dysfunction that can cause confusion, memory problems, and changes in behavior. Confusion is a symptom that can occur as a result of encephalopathy. Finally, cancer or hepatocellular carcinoma (HCC) is a potential complication of cirrhosis due to the increased risk of liver cancer in individuals with cirrhosis.

The correct answer is female, fertile, fat, family, fasting. These are all risk factors for developing gallstones. Being female and fertile increases the risk due to hormonal changes. Being overweight or obese (fat) also increases the risk. Having a family history of gallstones is another risk factor. Fasting or rapid weight loss can also contribute to the formation of gallstones. However, pharmacology is not a risk factor for gallstones.

Palmar erythema is a common physical finding in patients with cirrhosis, caused by elevated estrogen levels and increased blood flow to the skin. It is characterized by redness and warmth in the palms of the hands. Variceal bleeding, hematemesis/melena, ascites and lower leg edema, and confusion/encephalopathy are all complications commonly associated with cirrhosis. Therefore, palmar erythema is not a complication of cirrhosis.

IgM is a marker of acuity. Therefore, he has an acute HAV infection but a chronic HBV infection.

Hep A is fecal-oral
Hep C is primarily parenteral
Hep B is parenteral/sexual/perinatal (particularly in Asia/Africa)

Hemochromatosis leaves iron deposits in the skin, leaving a "tanned" appearance. Other symptoms include diabetes, arthritis, CHF, arrhythmias, cirrhosis and HCC.

High ferritin or high transferrin saturation will support this diagnosis; treatment is phlebotomy until the ferritin is below 50.

You could still do an abdominal ultrasound, but considering she wasn't complaining of pain, I'd say gallstones would be lower on your DDx.

It could still be autoimmune hepatitis, which you should be concerned about since it CAN lead to ALF, but biopsy shouldn't be your first test (that's painful and expensive!)

PiZZ also causes neonatal jaundice, 1:3500 births

a high GGT would indicate a cholestatic problem, whereas a low GGT would indicate that the high levels of ALP are coming from the bone.

One possible explanation for selecting TSH as the additional test to be done is that TSH stands for Thyroid Stimulating Hormone, which is produced by the pituitary gland and regulates the thyroid gland's production of thyroid hormones. Since the question mentions that all the normal liver tests came back normal, it suggests that the liver might not be the cause of the issue. Therefore, checking the thyroid function through a TSH test could be a relevant next step in investigating the underlying cause of the symptoms.

The CAGE questionnaire is a screening tool used to identify potential alcohol dependency in individuals. Each letter in the acronym represents a question related to alcohol consumption. "Cut down" refers to whether the person has ever felt the need to cut down on their drinking. "Annoyed" asks if others have expressed annoyance or criticism about their drinking habits. "Guilty" inquires if the person feels guilty about their drinking. Lastly, "eye-opener" refers to whether the person has ever felt the need to drink first thing in the morning to steady their nerves or get rid of a hangover.

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yes, it's all of them. HA!

In alcoholics, increased IgA levels are expected because chronic alcohol consumption can stimulate the production of immunoglobulin A (IgA) in the body. AST>ALT indicates that the levels of aspartate aminotransferase (AST) are higher than alanine aminotransferase (ALT), which is commonly seen in alcoholic liver disease. Increased sensitivity to acetaminophen toxicity is observed in alcoholics because alcohol can induce the production of enzymes that metabolize acetaminophen into toxic byproducts. Steatosis, or fatty liver, is also commonly seen in alcoholics due to the accumulation of fat in the liver cells. Fist-pumping is not a relevant finding in alcoholics.

see the super-duper scheme for liver tests... in the cases of PBC, PSC, and biliary stricture, one would see elevated ALP.

ETOH is unlikely since the ALT/AST ratio isn't 2:1 and ALT is greater than 300.

NAFLD is unlikely to produce such high levels.

and he's a man...not likely to be pregnant.