¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Hepatology ´ëÀå°æ Á¤¸®

1. IgG¡è: autoimmune hepatitis

IgM¡è: primary biliary cirrhosis

IgA¡è: alcoholic liver cirrhosis

2. GGT: ´ãµµ°è Áúȯ¿¡ °¡Àå ¹Î°¨Çϳª ƯÀ̵µ´Â ³·´Ù.

¿¹> ÀӽŽà ALPÁõ°¡µÇ¾î ÀÖÀ» ¶§ °£ÁúȯÀ» ¹èÁ¦Çϱâ À§ÇØ ½ÃÇàÇÒ °Ë»ç? GGT

3. cholestasis¶§ lipid º¯È­: unesterified(free) cholesterol¡è, phospholipid¡è

acute parenchymal liver disease: TG¡è, CE¡é

chronic parenchymal liver disease: LCAT deficiency

4. °£°æº¯¿¡¼­ insulin resistanceÀÇ ±âÀü

i) functioning hepatocellular mass°¨¼Ò

ii) hepatocyteÀÇ receptor and postreceptor defect

iii) portal-systemic shunt·Î ÀÎÇØ insulinÀÇ hepatic clearance°¨¼Ò

5. °£°æº¯¿¡¼­ hyperglycemia¸¦ À¯¹ßÇÏ´Â °ü·Ã ÀÎÀÚ

i) hepatic glucose uptake¡é

ii) hepatic insulin resistance

iii) peripheral insulin resistance

iv) portal-systemic glucose shunting

v) hepatic glycogen synthesis¡é

vi) hormonal abnormality: glucagon¡è, cortisol¡é, insulin¡è(¡é in hemochromatosis)

6. °£°æº¯¿¡¼­ hypoglycemia¸¦ À¯¹ßÇÏ´Â °ü·ÃÀÎÀÚ

i) gluconeogenesis¡é

ii) hepatic glycogen content¡é

iii) hepatic glucagon resistance

iv) hyperinsulinemia secondary to portal-systemic shunt

v) poor oral intake

7. °£ÀÇ ÇØµ¶ÀÛ¿ëÁß phase I reaction

oxidation, reduction, hydroxylation, sulfoxidation, deamination, dealkylation, methylation

°ü·ÃÈ¿¼Ò: cytochromic P450(microsomal), glutathione S-acyltransferase(cytoplasmic),

mixed function oxidase

8. °£ÀÇ ÇØµ¶ÀÛ¿ëÁß phase II reaction

Áö¿ë¼º ¹°ÁúÀÌ ¼ö¿ë¼º À¯µµÃ¼·Î ¹Ù²î´Â °úÁ¤

°ü·ÃÈ¿¼Ò: UDP glucuronyl transferase

9. cytochrome P450À» induction½ÃŰ´Â ¾à¹°

ÇÒ¹ÙÀ̰¡ ±Û½ê ¼ú¸Ô°í P450À» induction½ÃÄÑ cyclosporine levelÀ» °¨¼Ò½ÃÄ×´Ù ¾ÆÀ̰¡.

ÇÒ: ÇÒ·ÎÆä¸®µ¹, ¹Ù: ¹ÙºñÆ©·¹ÀÌÆ®, ±Û: Glutethimide, ¼ú: ethanol

cf. ethanolÀº P450 ¾ïÁ¦ ¹× ÃËÁø ¸ðµÎ °¡´É

10. phase I reaction¿¡ ÀÇÇÑ ¾à¹°º¯È­

INH, acetaminophen: toxic compounds·Î ¹Ù²ñ

cortisone: Ȱ¼ºÈ­

barbiturate: ºÒȰ¼ºÈ­

some carcinogen: Ȱ¼ºÈ­ ȤÀº ºÒȰ¼ºÈ­

11. °£¿¡¼­ÀÇ ¾Æ¹Ì³ë»ê ´ë»çÀÇ 2°¡Áö °æ·Î

transamination, oxidative deamination

12. kernicterus risk¡è

hemolysis, hypoalbuminemia, acidosis

albumin°ú °æÀïÀûÀ¸·Î °áÇÕÇÏ´Â ¾à(sulfonamide, penicillin, furosemide, salicylate)

glucuronyl transferase¾ïÁ¦(chloramphenicol, novobiocin, vit K)

hypothyroidism

13. °£¼¼Æ÷¿¡ Èí¼öµÈ bilirubinÀÌ ´Ù½Ã Ç÷ÀåÀ¸·Î ¿ª·ùÇÏ´Â °ÍÀ» ¸·´Â ´ëÇ¥ÀûÀÎ ligandin?

GST(glutathione-S-transferase)

14. Gilbert syndrome¿¡¼­ Ȳ´Þ ¾ÇÈ­¿äÀÎ : proloned fasting or calorie deprivation

±× ¿Ü> surgery, infection, fever, excessive exertion, alcohol

15. Dubin-Johnson syndrome: conjugated hyperbilirubinemia, black color liver

BSP test: 90ºÐ¿¡¼­ Ư¡Àû Áõ°¡, oral GB-nonvisualization

16. cholestasis of pregnancy

ÀÓ½ÅÁß estrogen°ú progesteroneÀÇ °£¼¼Æ÷¿¡ ´ëÇÑ °¨¼ö¼º°ú ¹Î°¨¼ºÀÌ Áõ°¡ÇÏ¿© »ý±ä´Ù.

17. ÀÓ½ÅÁß ¹ß»ýÇϴ Ȳ´ÞÀÇ °¡Àå ¸¹Àº ¿øÀÎ? viral hepatitis

18. acute fatty liver of pregancyÀÇ »ç¸Á¿øÀÎ: DIC with massive hemorrhage, renal failure

19. precore mutant: pre-C gene last codonÀÇ 2¹øÂ° G->A·Î ġȯ(TGG->TAG)

(Gluanine -> Alanine)

20. escape mutant: immunodominant a determinantÀÇ 145¹ø À§Ä¡¿¡¼­ G->Aġȯ

(glycine -> arginine)

21. escape mutationÀ» À¯¹ßÇÏ´Â ¿äÀÎ 2°¡Áö: active & passive immunization

(¶Ç´Â HB vaccine & HBIG)

22. °ËÃâµÈ CÇü ¹ÙÀÌ·¯½º¿¡µµ ´Ù¾çÇÑ º¯À̸¦ °¡Áø ¹ÙÀÌ·¯½º°¡ ¼¯¿© ÀÖ´Â °ÍÀ» ¹«¾ùÀ̶ó

Çϴ°¡? Quasispecies(=intragenotypic difference)

23. HBV pathogenesis¿¡¼­ cytotoxic T cellÀÇ °ø°Ý¸ñÇ¥´Â?

HBcAg, possibly HBeAg

24. BÇü °£¿° ¹ÙÀÌ·¯½º °¨¿°ÈÄ carrier°¡ µÇ±â ½¬¿î °æ¿ì

: neonate, Down's syndrome, chronically hemodialyzed patient, immunosuppressed

patients

25. ±Þ¼º ¹ÙÀÌ·¯½º¼º °£¿°¶§ ¹ß°ßµÉ¼ö ÀÖ´Â Ç×ü

: smooth m. Ab, RF, ANA, heterophil Ab, anti-LKM

26. BÇü °£¿° ȯÀÚ¿¡¼­ anti-HDV°Ë»ç°¡ À¯¿ëÇÑ °æ¿ì

i) severe and fulminant case

ii) severe chronic case

iii) acute hepatitis-like exacerbation

iv) frequent percutaneous exposure

v) HDV endemic area¿¡ °ÅÁÖÇÏ´Â »ç¶÷

27. HAV¿¡¼­ Àü°Ý¼º °£¿°ÀÌ Àß »ý±â´Â ¿¬·É: 10¼¼ ÀÌÇÏ, 40¼¼ ÀÌ»ó

28. fulmiant hepatitisÀÇ ¿øÀÎ ¹ÙÀÌ·¯½º: HBV, HDV, HEVµî

HCV´Â ÀÏÀ¸Å°Áö ¾Ê´Â´Ù.

HAV´Â ±âÁ¸ °£ÁúȯÀÌ ÀÖ´Â °æ¿ì

29. acetaminophen¿¡ ÀÇÇÑ fulminant hepatitis¿¡¼­ liver transplantation ÀûÀÀÁõ

i) pH < 7.3 or

ii) PT INR > 5.5 and s-creatinine > 3.4 mg/ÀÌ

30. alcoholic hepatitisÀÇ Æ¯Â¡Àû °£Á¶Á÷ ¼Ò°ß

fatty infiltration, neutrophilic inflammatory reaction, alcoholic hyaline

cf. ¾ËÄݼº °£¿°ÀÇ Á¶Á÷ÇÐÀû ¼Ò°ßÁß °¡Àå Æ¯Â¡Àû ¼Ò°ß? neutrophil infiltration

31. °£¿°À» ÀÏÀ¸Å³¼ö ÀÖ´Â ¹ÙÀÌ·¯½º¼º Áúȯ(A, B, CÇü °£¿° Á¦¿Ü)

infectious mononucleosis, CMV, HSV, Coxsackievirus

32. HCV vaccine°³¹ßÀÌ ¾î·Á¿î ÀÌÀ¯

quasispecies, rapid mutation

33. HBV prevention

34. Drug-induced hepatitis

1) chronic hepatitis: oxyphenisatin, methydopa, isoniazid

2) cirrhosis: halothane, MTX

3) portal hypertension without cirrhosis: vit A, arsenic, vinyl chloride, thorium dioxide

35. viral hepatitis-like reaction(Á¶Á÷ÇÐÀûÀ¸·Î)

h: halothane, p: phenytoin a: ¥á-methyldopa, t: troglitazone, I: INH, s: sulfonamide

36. toxic: 28-48½Ã°£ÈÄ ÀÓ»óÁõ»ó ¹ßÇö

37. HAIÀÇ 4°¡Áö Ç׸ñ

periportal necrosis, intralobular inflammation, portal inflammation, fibrosis

38. ¸¸¼º BÇü °£¿° °æ°úÁß flare°¡ ÀϾ ¶§ °¡´É¼º ÀÖ´Â ¿øÀÎ

i) seroconversion

ii) spontaneous reactivation

iii) superinfection(HCV, HDV, HAV)

iv) drug or alcohol

v) HCC¹ß»ý

vi) precore mutant¹ß»ý

39. HBV Áõ½Ä¾ïÁ¦ È¿°ú°¡ ÀÖ´Â nucleoside À¯µµÃ¼ 3°¡Áö: lamivudine, famciclovir, ganciclovir

40. HCVÀÇ interferon Ä¡·áÁß ¹ß»ýÇÏ´Â breakthrough ±âÀü

i) interferon Ab»ý¼º

ii) HCV genome mutation

41. HCV extrahepatic manifestation

1) immune-complex mediated: EMC

2) unrelated: Sjogren's syndrome, lichen planus, porphyria cutanea tarda

<Cecil> GN, malignant lymphoma(B cell), fibromyalgiaÃß°¡

42. autoimmune hepatitis¿¡¼­ steroid¿¡ ¹ÝÀÀÀÌ ÁÁÀº °æ¿ì

i) young female

ii) no recent transfusion

iii) HBV, HCV(-)

iv) anti-LKM-1(+)

43. autoimmune hepatitis

type IIa(typical autoimmune) anti-LKM1 titer¡è, ÀþÀº ¿©ÀÚ, globulin¡è

type IIb(HCV-associated) anti-LKM1 titer¡é, ³ëÀÎ ³²ÀÚ, globulin Á¤»ó

44. anti-LKM1: HCV, autoimmune

LKM2: drug-induced hepatitis

LKM3: HDV

45. autoimmune hepatitisÀÇ poor prognostic signs

i) multilobular collapse at initial presentation

ii) 2ÁÖ Ä¡·á¿¡µµ biliruinÀÇ È£ÀüÀÌ ¾øÀ» ¶§

<Sleisenger>

Áø´Ü½Ã aminotransferase >10¹è, marked hyperglobulinemia

aggressive histology(bridging necrosis or multilobular collapse, cirrhosis)

HLA B8, DR3

46. alcoholic hepatitis¿¡¼­ fibrosis¿¡ °ü¿©ÇÏ´Â ¹°Áú

IL-1, 6, PDGF, TNF, TGF-¥â

47. alcoholic hepatitis¿¡¼­ central hyaline sclerosis°¡ º¸ÀÌ¸é °£°æº¯À¸·Î ÁøÇàÇÒ °¡´É¼ºÀÌ

³ô´Ù.

cf. ¾ËÄݼº °£¿°¿¡¼­ º´¸®Á¶Á÷ ¼Ò°ß»ó °£°æº¯À¸·Î ÁøÇàÇÒ °¡´É¼ºÀ» ¿¹°ßÇÒ¼ö ÀÖ´Â ¼Ò°ß?

: perivenular fibrosis or sclerosing hyaline necrosis

48. alcohol abuse ÁöÇ¥

CDT(carbohydrate-deficient transferrin), MCV¡è, GGT, uric acid, TG

49. Wernickie's encephalopathyÄ¡·á? thiamine

50. °£°æº¯ ȯÀÚÀÇ hyperdynamic circulationÀÇ ¿øÀι°Áú·Î »ý°¢µÇ´Â vasodilator?

NO, VIP, substance P, PG µî

p286¹®Á¦¿¡´Â ¶ó) glucagonµµ ´äÀ¸·Î µÇ¾î ÀÖ´Ù.

51. LC with ascites¿¡¼­ º¹¸·¿°ÀÌ »ý°åÀ» ¶§ ´Ù¸¥ °÷ÀÇ °¨¿°¿¡ ÀÇÇÑ 2Â÷ÀûÀÎ °ÍÀ»

»ý°¢ÇÏ´Â °æ¿ì?

i) ascites WBC > 20,000

ii) multiple organism culture

iii) ÀϹÝÀûÀÎ Ç×»ýÁ¦ Ä¡·á·Î 48½Ã°£ÈÄ¿¡µµ È£ÀüÀÌ ¾øÀ»¶§

52. SBP prophylaxis°¡ ÇÊ¿äÇÑ °æ¿ì(high risk)

ascites albumin < 1g/dl, variceal bleeding, prior SBP

53. hepatorenal syndromeÀÇ pathologic roleÀ» ´ã´çÇÏ´Â µÎ°¡Áö ¹°Áú? PG & TX

54. hepatorenal syndrome¿¡¼­ FENa´Â renal type

55. hypokalemic alkalosis°¡ hepatic encephalopathy¸¦ ¾ÇÈ­½ÃŰ´Â ±âÀü

i) alkalosis¶§ nonionic NH3 »ý»ê¡è: nonionic NH3¸¸ÀÌ BBB¸¦ Åë°úÇÏ¿© CNS¿¡ ÃàÀû

ii) alkalosis°¡ Á÷Á¢ renal NH3 »ý»êÀ» Áõ°¡½ÃÅ´

56. hepatic encephalopathyȯÀÚ Ä¡·áÁß °£±â´É Çâ»ó°ú µ¶¼Ò clearance¸¦ Áõ°­½ÃŰ´Â ¾àÁ¦

Zinc, ornithine-aspartate, benzoate, phenylacetate

57. lactuloseÀÇ ÀÛ¿ë±âÀü

i) osmotic diarrhea

ii) colonic lumen acidification: NH3 -> NH4+·Î Àüȯ

iii) bacterial metabolism¿¡ Á÷Á¢ ÀÛ¿ëÇÏ¿© ammonia»ý»êÀ» °¨¼Ò½ÃŲ´Ù.

58. hepatopulmonary syndromeÀ» ÀǽÉÄÉ ÇÏ´Â ÁøÂû¼Ò°ß

: digital clubbing, cyanosis, spider angioma

59. hepatopulmonary syndrome Áø´Ü

: contrast-enhanced echocardiography

99mTc-macroaggregated albumin lung perfusion scan

pulmonary angiography

60. Wilson's disease

- ¿©¼º¿¡¼­ ½À°üÀû À¯»êÀ» ÀÏÀ¸Å°´Â °ÍÀº Àڱó» ºÐºñ¹°¿¡ free Cu°¡ °úµµÇÏ°Ô ÇÔÀ¯µÇ¾î

Àֱ⠶§¹®ÀÌ´Ù.

- ½Å°æÇÐÀû Áõ»óÀº »çÃá±â Àü¿¡´Â µå¹°¸ç, early adulthood¿¡ ÈçÇÏ´Ù.

- Ä¡·áÈ¿°ú ÆÇÁ¤½Ã free serum Cu°¡ ÀÌ¿ëµÈ´Ù(total Cu¾Æ´Ô)

cf. Ä¡·á¸ñÇ¥ free s-Cu < 10 ug/ÀÌ

61. °£À̽ÄÈÄ °ÅºÎ¹ÝÀÀÀÌ ÀǽɵǾî IV methylPd¸¦ ¹Ýº¹»ç¿ëÇÏ¿´À¸³ª È¿°ú°¡ ¾øÀ» ¶§ ´ÙÀ½

»ç¿ë¾àÁ¦? OKT3

62. 99mTc sulfur colloid scan(liver scan)

¸ðµÎ cold spotÀ̳ª FNH´Â hot spot(Kupffer cellÀÌ ÀÖÀ¸¹Ç·Î)

63. hepatoma angio»ó hypervacularÇÑ °æ¿ì DDx

hemangioma, adenoma, FNH, HCC

64. HCC°¡ CT»ó Á¶¿µÀÌ Àß ¾ÈµÉ ¶§ »ý°¢ÇÒ¼ö ÀÖ´Â »óȲ

tumor necrosis, ¼¶À¯È­¸¦ µ¿¹ÝÇÑ °æÈ­¼º Á¾¾ç, ´ãµµ¾Ï°ú È¥Àç, Ãʱ⺴º¯À¸·Î ¼º¼÷µÇÁö

¾ÊÀº °æ¿ì

65. pyogenic liver abscessÀÇ single most reliable lab finding: ALP¡è

66. amebic liver abscessÀÇ aspiration indications

i) pyogenic liver abscess¿Í ±¸º°ÀÌ ¾ÈµÉ ¶§, ƯÈ÷ multiple abscess

ii) ruptureÀ§ÇèÀÌ Å¬ ¶§

iii) pericardiumÀ¸·Î ruptureµÉ °¡´É¼ºÀÌ ÀÖÀ»¶§(left lobe abscess)

iv) 3-5ÀÏ Ç×»ýÁ¦ Ä¡·á¿¡µµ ¹ÝÀÀÀÌ ¾øÀ» ¶§

67. HCCÀÇ À§ÇèÀÎÀÚ

HBV, HCV infection, cirrhosis, ¥á1-AT deficiency, hemochromatosis, tyrosinemia

aflatoxin, hormone(androgen, estrogen), thorium dioxide, vinyl chloride

68. HCC paraneoplastic syndrome

erythrocytosis, hypercalcemia, hypercholesterolemia, hypoglycemia

acquired porphyria, dysfibrinogenemia, cryofibrinogenemia

69. angiosarcomaÀ¯¹ß¹°Áú: ºñ¼Ò

ºñ: vinyl chloride, arsenic

¼Ò: thorium dioxide, anabolic steroid