Question 1

Antibodies to mitochondrial dihydrolipoamide acetyltransferase are typically found in 90% of patients who have

Accepted Answer

Antimitochondrial antibodies, proven to most often represent antibodies to the E2 subunit of the pyruvate dehydrogenase complex, dihydrolipoamide acetyltransferase, are found in more than 90% of patients with primary biliary cirrhosis.

Question 2

Which of the following types of hepatocellular carcinoma occurs in young adults, is unrelated to cirrhosis, and has a much better prognosis (i.e., a 60% 5-year survival rate)?

Accepted Answer

Fibrolamellar hepatocellular carcinoma occurs more often in younger persons (20-40 years of age) than the common form of liver cell carcinoma. It is not associated with cirrhosis. It has a better prognosis than other types of liver cancer.

Question 3

An obese 50-year-old woman, whose height is 5 ft 4 in (160 cm) and weight is 220 lb (100 kg), decided to lose weight. She lost 45 lb (approximately 20 kg) over a period of 6 months, and then had an attack of biliary colic and required a cholecystectomy. The gallbladder stones identified by the pathologist were most likely

Accepted Answer

Obesity as well as rapid weight loss are associated with excessive excretion of cholesterol in bile, leading to formation of cholesterol stones.

Question 4

The most common cause of cirrhosis unrelated to alcohol, viral hepatitis, or metabolic diseases (i.e., the so-called "cryptogenic cirrhosis") is

Accepted Answer

Steatohepatitis is considered to be the most common cause of cirrhosis that occurs in persons who do not have a history of any of the well-known risk factors, such as alcoholism or viral hepatitis, or metabolic diseases, such as Wilson disease or hemochromatosis.

Question 5

This liver tumor nodule, measuring 6 cm in diameter, was seen on a computerized tomography (CT) scan of a 40-year-old man. Initially, the nodule was considered to be benign, but when it became painful, the patient decided to have it removed. Histologically, it was composed of well-differentiated hepatocytes, whereas the central scar and the fibrous septa contained proliferating bile ducts. This nodule is most likely

Accepted Answer

This nodule represents focal nodular hyperplasia (FNH), a lesion considered to be neither a benign nor a malignant tumor nor a hamartoma. FNH lesions are hepatocellular nodules arranged around a central fibrous scar. In contrast to hepatocellular adenomas, which are composed exclusively of liver cells, FNH contains fibrous tissue and bile ducts. In contrast to liver cell carcinoma, FNH is composed of normal, non-neoplastic liver cells.

Question 6

Copper accumulates in the liver in Wilson disease but stainable copper also can be seen in liver biopsies of patients who have

Accepted Answer

Copper is excreted in bile, and therefore it accumulates in liver cells in chronic obstructive cholestasis.

Question 7

Centrolobular necrosis is typical of intoxication with

Accepted Answer

Acetaminophen intoxication, most often in persons who attempt suicide, is characterized by centrolobular necrosis.

Question 8

These gallstones surgically removed along with the gallbladder of a 50-year-old obese woman are composed predominantly of

Accepted Answer

Yellow gallstones found in obese women are predominantly composed of cholesterol.

Question 9

HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) occurs typically in

Accepted Answer

HELLP syndrome occurs quite often in preeclampsia. It is characterized by the formation of fibrin deposits in the periportal sinusoids of the liver, accompanied by hemorrhage into the spaces of Disse and periportal coagulative necrosis of hepatocytes.

Question 10

A 55-year-old man known to have drunk a half liter of gin daily for the past 15 years died due to ruptured esophageal varices and massive bleeding. At autopsy, the liver was nodular and

Accepted Answer

In alcoholic cirrhosis, the liver is usually enlarged and yellow due to fatty metamorphosis of hepatocytes. The term cirrhosis was coined by the 19th century French physician Laënnec, who studied the postmortem findings in alcoholics. Because all of the cirrhotic livers were yellow, he used the Greek word for yellow to name the disease. If alcoholics who have cirrhosis are asked to stop drinking, as it is usually done before liver transplantation, their livers lose fat and become brown and much smaller.

Question 11

Which of the following drugs causes microvesicular fatty change of the liver?

Accepted Answer

Tetracycline causes microvesicular fatty change in the liver.

Question 12

Cryoglobulinemia is found in chronic hepatitis caused by which hepatotropic virus?

Accepted Answer

Cryoglobulinemia is found in a significant number of patients who have chronic hepatitis C virus (HCV).

Question 13

Transplacental infection of the fetus will most often occur in women who have been infected with which hepatotropic virus?

Accepted Answer

Hepatitis B virus B (HBV) is readily transmitted across the placenta from the mother to the fetus. Transmission of HCV can also occur across the placenta, but this seldom occurs.

Question 14

Which genetic liver disease results from the mutation of multidrug resistance protein 2 (MRP2) and is characterized by massive accumulation of pigmentary granules in hepatocytes and dark discoloration of the liver?

Accepted Answer

Dubin-Johnson syndrome, a mutation of multidrug resistance protein 2 (MRP2) affecting the canalicular transport of bilirubin in the liver, is characterized by an accumulation of dark pigment causing black discoloration of the liver.

Question 15

What is the most common cause of neonatal cholestasis?

Accepted Answer

In most instances (up to 50% of cases), the cause of neonatal hepatitis is not known and the disease is classified as idiopathic. On the other hand, the most common identifiable causes of neonatal hepatitis are biliary atresia and a₁-antitrypsin deficiency, accounting for 20% and 15%, respectively, of all cases of pathologic neonatal jaundice.

Question 16

A mutation of the gene encoding the hepatic enzyme bilirubin uridine diphosphate-glucuronyltransferase (UGT1A1) associated with congenital jaundice and a complete absence of UGT1A1 is called

Accepted Answer

Crigler-Najjar syndrome type I is an autosomal recessive form of jaundice that is lethal in early infancy. It is caused by the mutation of the gene coding the bilirubin uridine diphosphate-glucuronosyltransferase (UGT), in which this enzyme is completely absent.

Question 17

Peliosis hepatis is a form of primary hepatic sinusoidal dilatation and intrasinusoidal blood stagnation most often caused by

Accepted Answer

Anabolic steroids are the most common cause of peliosis hepatis. Other than steroids, less common causes include other steroid drugs such as danazol, oral contraceptives, and infection with Bartonella henselae, a cause of bacillary angiomatosis.

Question 18

Ascending cholangitis is most often caused by

Accepted Answer

Coliform bacteria, such as Escherichia coli and enterococci, living in the intestinal lumen are the most common causes of ascending cholangitis. This cholangitis is called ascending, because the bacteria ascend from the intestines into the liver through the bile ducts.

Quiz 15: Liver, Gallbladder, and Biliary Tract