Explain how insulin resistance can lead to the development of hepatic steatosis
skeletal resistance -> glucose to liver; adipose resistance -> lipolysis = glycerol + Fatty acids -> fats deposited in liver
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10
Explain the pathogenesis of dyslipidemia
Primary: Genetic - over production/defective LDL or over-clearance HDL; Secondary: lifestyle + other factors -high free fatty acids + high VLDL =excessive fats
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10
Identify the spectrum of disorders of NAFLD
NAFD --> NASH --> Fibrosis --> Cirrhosis
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10
Describe the immunologic mechanisms resulting in hepatic injury from hepatitis
immune systemâmediated cytotoxicity: (HLA) class Iârestricted CD8 CTL's recognize hepatitis B core antigen + e antigen on infected hepatocytes->inflammation
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10
Discuss the Batts-Ludwig grading and staging criteria
Grade-amount of necroinflammatory activity; Stage-amount of fibrosis
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10
Adalimumab - Drug Class, MOA, Indication, Side effect
Anti-TNF IgG1 Antibody; binds TNF-Îą + blocks interaction w/ surface TNF receptors; for UC/CD diseases; side effect-serious infection
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10
Explain the use of osmotic laxatives (lactulose) to manage hepatic encephalopathy.
colonic acidifier that works by decreasing the amount of ammonia in the blood (decrease intestinal production/absorption of ammonia) -> less toxin to brain
shifting dullness: ascites sign, Percuss across abdomen-transition tympany to dull; palmar erythema: red palms from oestradiol; asterixis: negative myoclonus
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10
Compare and Contrast the clinical features and Anatomy of Ulcerative Colitis and Chron Disease
Describe life-threatening complications from cirrhosis including hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and esophageal varices (EV)
HE: toxin build up in blood->brain damage; SBP: infection of ascitic fluid in peritoneum; EV: blood flow to liver blocked->enlarged esophageal veins
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10
Describe the pathophysiology, risk factors, and clinical features of celiac disease
genetic(HLA DQ 2,8)+exposure to prolamins->TTG alter + gliadin w/ zonulin -> IgA against TTG + tight junctions open = inflammation GI ->malabsorption-diarrhea
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10
Identify common comorbidities of NAFLD
hepatic manifestation of metabolic syndrome linked with insulin resistance; obesity, dyslipidemia, diabetes
