Chapter 7 A 44-year-old white man was brought to the emergency

Hall: Guyton and Hall Textbook of Medical Physiology, 12th Edition

Chapter 70: The Liver as an Organ

Test Bank

1. Cirrhosis of the liver often leads to hyperbilirubinemia (jaundice). This increase in serum

bilirubin levels in patients with alcoholic cirrhosis most often results from which of the

following?

A. Decreased excretion of bilirubin into bile

B. Increased uptake of bilirubin by hepatocytes

C. Enhanced conjugation of bilirubin

D. Excessive hemolysis

2. A 77-year-old man has a 33-year history of alcoholism and liver disease. He visits his

physician because of swelling in his legs. A decrease in which of the following is likely

to contribute to the development of edema in his legs?

A. Capillary hydrostatic pressure

B. Femoral vein pressure

C. Interstitial fluid hydrostatic pressure

D. Liver lymph flow

E. Plasma albumin concentration

3. Gallstone obstruction at the papilla of Vater can cause acute pancreatitis because of

activation of which of the following substances?

A. Chymotrypsin

B. Enterokinase

C. Lipase

D. Trypsin inhibitor

E. Trypsinogen

4. An 82-year-old man has a 30-year history of alcoholism and liver disease. He visits his

physician because of swelling in his abdomen. An increase in which of the following is a

likely cause of the ascites?

A. Hepatic artery pressure

B. Hepatic vein pressure

C. Hydrostatic pressure of peritoneal fluid

D. Plasma albumin concentration

E. Portal vein pressure

Test Bank

70-2

5. Which portion of the gastrointestinal tract is essential for absorption of bile salts?

A. Colon

B. Duodenum

C. Ileum

D. Jejunum

E. Stomach

6. A 45-year-old African-American male is admitted to the emergency department because

of upper right quadrant pain. The man has a history of sickle cell disease. Laboratory

tests show plasma bilirubin levels are three times greater compared to normal. Ultrasound

studies confirm the presence of gallstones. Which of the following is the most likely

composition of the gallstones in this patient?

A. Bile pigments

B. Calcium

C. Cholesterol

D. Fatty acids

E. Sugar

7. The rate-limiting step in the addition of bilirubin to bile is which of the following?

A. Conjugation

B. Elimination from phagocyte

C. Excretion into bile

D. Release from albumin

E. Uptake by hepatocytes

8. Which of the following cell types produce bile acids?

A. Canalicular epithelial cells

B. Capillary endothelial cells

C. Hepatocytes

D. Kupffer cells

9. A 55-year-old man has a 32-year history of alcoholism and liver disease. He visits his

physician complaining of swelling in his feet and legs. A decrease in which of the

following is the most likely cause of the edema?

A. Arteriolar dilation

B. Capillary hydrostatic pressure

Test Bank

70-3

C. Filtration coefficient

D. Interstitial colloid osmotic pressure

E. Interstitial fluid hydrostatic pressure

F. Plasma colloid osmotic pressure

10. Which component of bile is most abundant on a weight basis?

A. Bile salts

B. Bilirubin

C. Cholesterol

D. Fatty acids

E. Lecithin

11. A 44-year-old white man was brought to the emergency department in an inebriated state.

Physical examination revealed the following: blood pressure of 104/68 mmHg; pulse of

120 beats/min; respiration of 32 breaths/min, and temperature of 99 F. He was markedly

pale with icteric conjunctiva and skin. His abdomen was distended and there was shifting

dullness. The liver was enlarged and tender. The spleen could not be palpated. There was

2+ bilateral edema of his legs and feet. Which of the following values of direct and

indirect bilirubin are most likely in this man (in mg/dL)?

Direct Indirect

A. 1.0 1.3

B. 1.4 2.1

C. 1.8 6.4

D. 2.3 2.4

E. 5.0 1.7

F. 6.8 7.5

12. A 54-year-old man has a 30-year history of alcoholism and liver disease. He visits the

physician because of swelling in his feet and legs. A decrease in which of the following

most likely promotes edema formation in this patient?

A. Albumin production

B. Capillary hydrostatic pressure

C. Filtration coefficient

D. Interstitial colloid osmotic pressure

E. Interstitial fluid hydrostatic pressure

F. Reflection coefficient

13. Which of the following is a forerunner to cirrhosis of the liver?

Test Bank

70-4

A. Colitis

B. Gastritis

C. Pancreatitis

D. Steatohepatitis

E. Tonsillitis

14. Which of the following best describes the liver circulation?

Resistance Pressure Flow

A. High High Low

B. High High High

C. High Low High

D. Low Low High

E. Low Low Low

F. Low High Low

15. A 65-year-old man with a history of alcohol abuse is admitted to the emergency

department after being found lying unconscious in the street. His abdomen was

distended, and there was shifting dullness indicating severe ascites. Which of the

following values for plasma colloid osmotic pressure (PCOP: normal, 28 mmHg), capillary

hydrostatic pressure (PCAP: normal, 17 mmHg), and interstitial hydrostatic pressure (PISF:

normal, −3 mmHg) are likely to be found in the splanchnic organs of this man (in

mmHg)?

PCOP PCAP PISF

A. 10 12 0

B. 12 7 0

C. 14 17 +2

D. 16 21 +1

E. 29 16 −2

F. 34 22 −4

16. The Kupffer cells of the liver are located primarily in which structure?

A. Bile canaliculi

B. Portal vein

C. Sinusoids

D. Space of Disse

E. Terminal lymphatics

Test Bank

70-5

17. A 35-year-old woman is admitted to the emergency department because of severe upper

right quadrant pain. The woman is 5 feet 2 inches tall and weighs 254 pounds (BMI =

46.5). She states that her stools are clay colored and that her urine is dark orange.

Physical examination shows an enlarged liver and icteric conjunctiva. Laboratory results

show elevated serum bilirubin levels. Absorption of bile salts is most likely to be

decreased to the greatest extent at which of the following locations in this patient?

18. Elimination of bilirubin from the body requires several steps under normal conditions

that include (1) conjugation of bilirubin with glucuronic acid, (2) carriage of bilirubin by

albumin in plasma, (3) excretion of bilirubin into bile, and (4) uptake of free bilirubin by

hepatocytes. Which of the following best describes the correct temporal order of events?

A. 4, 3, 2, 1

B. 3, 1, 4, 2

C. 3, 4, 1, 2

D. 2, 1, 4, 3

E. 4, 2, 1, 3

F. 2, 4, 1, 3

G. 1, 2, 3, 4

H. 1, 3, 2, 4

19. An experimental device containing hepatocytes is developed to provide effective support

for patients with hepatic failure pending liver regeneration or liver transplantation.

Hepatocyte viability is best documented by an increase in which of the following?

A. Albumin output

B. Carbon dioxide uptake

C. Ethanol output

D. Lactate dehydrogenase (LDH) uptake

E. Oxygen output

A.

B.

C.

D.

E.

20. Which of the following best describes the rate-limiting step for the addition of bilirubin

to bile?

A. Conjugation

B. Elimination from phagocyte

C. Excretion into bile

D. Release from albumin

E. Uptake by hepatocytes

21. A 45-year-old physician drinks himself into oblivion on a regular basis. What are the

long-term complications of cirrhosis of the liver?

Jaundice Ascites Esophageal Varices Peripheral Edema

A. No Yes Yes No

B. No No Yes Yes

C. Yes Yes No Yes

D. Yes Yes Yes No

E. Yes Yes Yes Yes