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¸¦ ¾ÇȽÃŰ´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