15 Questions
Which of the following is a consequence of retained bile salts in cholestasis?
Deposition of cholesterol in skin folds and tendons
What is the primary function of bile salts in the digestive process?
Emulsification of dietary fats and formation of micelles
Which of the following is a risk factor for the formation of cholesterol gallstones?
All of the above
What is the primary stimulus for gallbladder contraction?
Cholecystokinin (CCK)
Which of the following is a consequence of impaired bile salt secretion?
Increased risk of cholesterol gallstone formation
What is the primary Site of cholesterol absorption in the gastrointestinal tract?
Small intestine
Which of the following dietary factors is associated with an increased risk of cholesterol gallstone formation?
High-fat diet
What is the percentage of normal levels of serum gastrin in untreated ZES?
1%
What is the minimum basal acid output (BAO) considered suggestive of ZES?
15 mEg/h
What is the most common site of abdominal perforation secondary to ulceration in ZES?
Duodenum and jejunum
What is the goal of medical treatment in ZES?
Medical control of gastric acid hypersecretion
What is the preferred medication for controlling gastric acid hypersecretion in ZES?
Proton pump inhibitors (PPI)
What is the prognosis for patients with ZES without metastatic disease?
Excellent
What is the complication of ZES associated with hypergastrinemia, especially in patients with MEN I?
Gastric carcinoids
What is the treatment option for a single confined liver metastatic lesion in ZES?
Surgical resection or thermoablation
Study Notes
Liver Diseases
Hyperbilirubinemias and Jaundice
- Normal plasma concentration of bilirubin: 17 μmol/L (1 mg/dL)
- Bilirubin > 30 μmol/L → sclera become yellow
- Types of hyperbilirubinemias:
- Prehepatic: increased bilirubin production
- Causes: hemolysis, inadequate erythropoiesis, massive transfusion, absorption of large hematomas
- Unconjugated (indirect reacting) bilirubin in plasma is increased
- Intrahepatic:
- Defect of bilirubin uptake in liver cells (Gilbert syndrome)
- Defect of bilirubin conjugation (neonatal jaundice, Crigler-Najjar syndrome)
- Defect in secretion of bilirubin in bile canaliculi (Dubin-Johnson or Rotor syndrome)
- Posthepatic: extrahepatic bile ducts are blocked by gallstones, tumors, cholangitis, or pancreatitis
- Conjugated bilirubin in plasma is increased
- Prehepatic: increased bilirubin production
Cholestatic Liver Diseases
- Bile production:
- Essential for digestion and absorption of dietary fats and fat-soluble vitamins
- 600-1200 mL of yellow-green bile daily
- Bile consists of water, bile salts (0.6 g/day), bilirubin, and cholesterol
- Cholestasis:
- Blockage of bile flow due to intrahepatic disorders (e.g., cystic fibrosis, granulomatosis, drug side effects) or extrahepatic bile duct occlusion (e.g., cholelithiasis or neoplasms)
- Enlarged bile canaliculi, decreased fluidity of canalicular cell membrane, and disrupted cytoskeleton function
- Consequences: jaundice, cholesterol deposition, pruritus, fatty stools, and cholangitis
Gallstones
- Gallstone disease:
- 75% of patients: gallstones consist of cholesterol
- 25%: pigment stones with unconjugated bilirubin
- Formation of gallstones:
- Increased cholesterol secretion
- Reduced bile salts secretion
- Sedentary lifestyle and sugary/high-fat food consumption
- Consequences:
- Colic
- Trauma to gallbladder epithelium
- Bacterial cholangitis
- Gallbladder cancer (rare)
Fatty Liver Diseases
- Alcoholic fatty liver disease:
- Caused by ethanol consumption
- Characterized by steatosis, steatohepatitis, and fibrosis/cirrhosis
- Pathogenesis: ethanol metabolism, lipoprotein secretion, and mitochondrial function impairment
- Non-alcoholic fatty liver disease (NAFLD):
- Insulin resistance and metabolic syndrome
- Characterized by steatosis, steatohepatitis, and fibrosis/cirrhosis
- Pathogenesis: diabetes, central obesity, dyslipidemia, and hypertension
- Clinical features: asymptomatic, transaminase elevation, and possible progression to NASH/cirrhosis
This quiz covers various liver diseases and disorders, including hyperbilirubinemias, cholestatic liver disease, hepatitis, liver cirrhosis, and fatty liver disease.
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