NBME 23 Liver (NBME Answers)

Retired NBME 23 Answers

nbme23/Block 2/Question#30 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Liver 🔍 / 📺 / 🌳 / 📖
tags:

+2 upvote downvote
submitted by ∗youssefa(162)

get full access to all content ⋅ pick a username

So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI).

get full access to all content ⋅ pick a username

youssefa Correction: I meant Permanent cells instead of Stable cells. The hepatocytes in this case will act as a stable cells which will exit G0 phase and proliferate in response to injury. +2

madamestep Also, the reason why you get the retractions and fat creeping in Chrons! It's inflammation all the way through. UC doesn't go all the way through. +

+0 upvote downvote
submitted by ∗et-tu-bromocriptine(140)

get full access to all content ⋅ pick a username

Anyone know how to rule out small intestine on this one? I thought the omentum played a role in healing in the abdomen, but clearly I'm missing something here.

get full access to all content ⋅ pick a username

what Small intestine has smooth muscle in the walls which will fibrose on injury +

youssefa So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI) +3

thotcandy The way i thought of it was: small intestine PERFORATION repair -> the basement membrane and stem cells were definitely disrupted thus limiting regeneration ability Liver = puncture wound, not necessarily all the way through = basement membranes and stem cells are probably still intact -> regenerate without fibrosis +2

+0 upvote downvote
submitted by ∗veryhungrycaterpillar(30)

get full access to all content ⋅ pick a username

Liver heals without scarring in response to most acute injuries. Only chronic liver injuries will lead to fibrosis (which then leads to cirrhosis.)

get full access to all content ⋅ pick a username

+0 upvote downvote
submitted by brawamigonnagetthismd(2)

get full access to all content ⋅ pick a username

Wait, adipose tissue scars?? What the heck is this? maybe it's that 'fibro' part...Watched all that Botched for nothin'

get full access to all content ⋅ pick a username

-4 upvote downvote
submitted by bigbootycorgi(5)

get full access to all content ⋅ pick a username

So I got this one wrong because I thought that since he didn't have hepatosplenomegaly and ascites his liver was still fine, but I guess if he already has gynecomastia, hypogonadism and the ever obvious spider angiomata he's definitely still ok

Now that I think of it, you don't need hepatosplenomegaly to have alcoholic liver failure I believe.

get full access to all content ⋅ pick a username

bigbootycorgi sorry my bad this was the wrong question i responded to but i still got this one (ED one) and the gynecomastia one wrong i think it's liver for this one because they say it has regenerative potential and because even though the small intestine has regenerative potential, it can apparently fibrose? i have no idea, i put small bowel +

kateinwonderland @bigbootycorgi : I put small intestine too. From what I've searched after, it says that liver fibrosis reversible -> no evidence of fibrous scarring +

goodkarmaonly Just to add to that, a cirrhotic liver is a small shrunken liver so you wont be able to find hepatomegaly anyways. The other signs are the stigmata of Liver disease +

Must-See Comments from nbme23

ferrero on Precapillary resistance
yotsubato on 99%
sne on Triglyceride
sajaqua1 on Area labeled ‘D’ (Spinothalamic tract, right)
stinkysulfaeggs on Hypoglycemia
hayayah on Iris
soph on Peak inspiratory pressure (alveolar): ...
seagull on Area labeled ‘C’ (Cranial nerve 8: ...
water on Dietary change
wired-in on 28.8
beeip on Binding of permeable ligand to nuclear ...
thomasalterman on Hypoglycemia
yotsubato on Inhibition of the cytochrome P450-dependent ...
seagull on Decreased sodium bicarbonate reabsorption in ...