Topic 22. Pathophysiology of the liver. 1.Flabby contraction of gall bladder was revealed in a woman aged 55 after introducing some of vegetable oil into duodenum. What hormone insufficiency with such state? A. Gastrin
2. A patient aged 25 has a diagnosis of chronic hepatitis. A patient has lost 10 kg of his body weight for 2 months. Objectively: the skin is dry, desquamative, and pale with yellowish color, small punctate hemorrhages on the skin, stomatorrhagia. The impairment of what hepatic function do petechial hemorrhage and stomatorrhagia prove?
3.On examination bile congestion in the liver and cholelithiasis were revealed in a patient. Point out the main component of cholelithiasis in this state:
4.What kind of jaundice is characterized by increased amount of direct bilirubin in the blood, appearance of bilirubin in urine, acholic stool?
- E. -
5.Residual nitrogen and urea were determined in the patient’s blood analysis. The amount of urea in the residual nitrogen is considerably reduced. The disease of what organ is characterized by this analysis?
6.A patient complains of general weakness, boring pain in the abdomen, bad appetite, suspicion on jaundice. Blood serum contains 77.3 micromol/L of total bilirubin and 70.76 micromol/L of conjugative bilirubin. What is the most possible type of jaundice? A. Mechanical jaundice*
7.In 70’s the scientists determined that the cause of severe jaundice in newborns was the impairment of connection of bilirubin in hepatocytes. What substance is used for the formation of conjugate?
8.A man aged 38 with icteric skin has anemia, enlarged spleen, hyperbilirubinemia, urobilinuria, hypercholic stool. What condition are these changes typical for?
Syndrome of hepatic insufficiency
9.It’s determined that a patient with jaundice has increased amount of total bilirubin instead of indirect one (free) in blood plasma, high content of stercobilin in stool and urine, the level of direct (connected) bilirubin in blood plasma is normal. What kind of jaundice is it?
Jaundice of the newborn (icterus neonatorum)
10.In inflammatory process colloidal properties of bile are impaired in gall bladder and this results in the formation of gall stones. What substance crystallization is the main cause of the formation?
11.After an accident a completely crashed man’s liver was removed. What disorders do of hepatic absence may cause death during the first hours after operation?
Fall of BP
Hemophilia and hemorrhage
12. Isoosmotic hyperhydration has developed in a patient with hepatocirrhosis. What is the leading mechanism of dyshidria development?
Growth of wall capillary permeability
13.On the background of pain in the right hypochondrium and yellowness ‘a patient with hepatic cirrhosis has constant dyspeptic disorders in a kind of bitter taste in the mouth, feeling of heaviness in epigastric area, nausea, unstable stool, steatorrhea. What is the main cause of the described disorders?
Hypocholia and intoxication*
Increase of stercobilin
14.In a severe course of viral hepatitis, a patient has developed adynamia, sleepiness at day time and insomnia at night, inadequate behavior (delirious ideas). There is fetor hepaticus, Kussmaul’s respiration. What kind of metabolism impairment causes these symptoms?
Carbohydrate metabolism and hypoglycemia
Water and salt metabolism and hyperhydration
Pigmental metabolism and hyperbilirubinemia
15.There is increase of indole amount and decrease of indican 1 in the patient’s urine. This indicate the impairment of
Filtering function of kidneys
Detoxication function of liver*
Reabsorptive function of kidney
Albumin synthetic function of liver
Secretory function of pancreas
16.Increase of direct and indirect bilirubin is determined in blood of a patient with marked yellowness of sclerae and skin. There is great amount of bilirubin and urobilin in the urine, traces of stercobilin, decrease of stercobilin in stool. Define pathogenic type of jaundice in a patient.
17.A patient admitted to the hospital has clearly marked widened subcutaneous veins in the area of umbilicus (“the head of medusa”). Which of the large venous vessels has the impaired passage?
V. iliaca inferior
V. mesenterica superior
V. mesenterica inferior
18.In coprologic investigation it is determined that stool is colorless; there are drops of neutral fat in it. The most possible case of this is impairment of:
Entering the bile into intestine*
Secretion of intestine juice
Acidity of gastric juice
Processes of absorption in the intestine
Secretion of pancreatic juice
19.A patient had nausea and malaise after taking fatty foodstuffs. Sings of steatorrhea developed in this patient some time later. Content of cholesterol in patient’s blood is 9.2 mmol/L. This condition results from deficiency of:
20.Low level of albumins and fibrinogen were revealed in the patient’s blood. The decreased activity of what hepatocyte organelles cause this phenomenon?
Agranular endoplasmic network
Granular endoplasmic network* D. Golgi complex
21.A patient was admitted into a clinic with signs of acute alcohol poisoning. What changes of carbohydrate metabolism are typical for this condition?
Gluconeogenesis increases in the liver
Glycogen decomposition increases in the liver
Aerobic decomposition of glucose increases in the muscles
Anaerobic decomposition of glucose predominates in the muscles. E. The rate of gluconeogenesis decreases in the liver.*
22A man aged 54 was admitted into the clinic with complaints of pains in the right hypochondrium vomiting with blood. Objectively: enlargement of hepatic size, varicose of esophagus and stomach, bleeding from them. The functional disorder of what vessel took place? A. Vena hepatica
Vena cave superior
Vena cava inferior
23.The development of acute pancreatitis in a patient is accompanied by the impairment of permeability of common bile duct. What pathologic process may this result in?
Hepatic coma D. Mechanical jaundice*
E. Portal hypertension.
24.Which of the factors plays the leading role in the development of encephalopathy in hepatic insufficiency?
Increase of concentration of toxic substances in the blood*
25.A patient has a diagnosis of ascites. There are no edemas in the other parts of the body. There are large vessels of cyanotic color on the abdomen. What pathology has this patient?
Hypertension of pulmonary circulation
Portal hypertension *
Chronic circulatory insufficiency
26.Arterial hypertension may develop in a case of hepatic insufficiency. Which of these factors causes the increase of arterial pressure in such cases?
27.A patient aged 25 is ill with jaundice, his skin has got yellow and green color, there’s skin itch, hypocholic stool throbbing gall bladder. What is the origin of jaundice?
28.A patient complains of general weakness, breathlessness. Decrease of BP, ascites, widening of superficial veins of anterior abdominal wall, splenomegaly were established in this patient. What impairment of hemodynamic has this patient?
Portal hypertension syndrome*
Left ventricular failure
Right ventricular failure
29.A patient with jaundice complains of erythrism, headache, and insomnia.
Objectively: pulse-54 beats/min. BP- 90/60 mmHg. Coagulation of blood decreases. There are traces scratching on skin. The action of what component causes these symptoms?
30.A patient was admitted to the hospital with complaints of dyspeptic disorders, melena, hemorrhoidal bleeding. Extensions of the vessels on the anterior abdominal wall in combination with the enlargement of size of the abdomen were revealed on examination of this patient. What pathology of gastrointestinal tract shows these symptoms? A. Ulcerous disease
Colitis E. Enteritis.
31.Yellow color of the skin and the sclera, dark urine appeared in a patient after fungus poisoning. What pigment causes the color of urine in the patient with hemolytic jaundice? A. Biliverdin
32A female patient with chronic hepatitis complains of increase sensitivity to barbiturates which she used previously without any symptoms of intoxication. The disorder of what hepatic jaundice is responsible for this state?
33.Marked jaundice appeared in a patient 3 months later after the operation on his upper jaw. What pathological process may this patient have?
Hereditary hemolytic jaundice
34.A female patient aged 45 was admitted to a hospital with complains of sudden pain in the abdominal cavity, increase of temperature, and leukocytosis. Which of factors caused these changes in the woman’s condition?
35. In a 38-year-old patient, who endued viral hepatitis C and is abusing alcohol, symptoms of hepatic cirrhosis with ascites and edemas on lower extremities developed.
What changes in blood composition underlies edema development?