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Goljan > 2. Cell Injury > Flashcards

2. Cell Injury Flashcards

1
Q

What is the number 1 drug cause of fulminant hepatitis?

A

Acetaminophen - from free radical damage

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2
Q

Where in the liver does acetaminophen toxicity manifest?

A

Right around the central vein

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3
Q

What is the treatment for acetaminophen toxicity?

A

N-acetylcysteine

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4
Q

What is the neutralizer for superoxide?

A

Superoxide dismutase (SOD)

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5
Q

Where does glutathione come from?

A

HMP shunt (also generates NADPH)

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6
Q

What is glutathione’s main function?

A

Neutralize free radicals - especially anything that comes from peroxide

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7
Q

What does N-acetylcysteine do?

A

N-acetylcysteine is the substrate for glutathione –> body makes more glutathione –> can neutralize the free radicals from acetaminophen

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8
Q

How does leucovorin rescue work with methotrexate?

A

Leucovorin is a substrate for DNA so that body can overcome the block of dihydrofolate reductase?

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9
Q

How does acetaminophen affect the kidney?

A

Destroys the medulla (over years)

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10
Q

What are the enzymes involved in signaling of apoptosis?

A

Caspases

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11
Q

What organs would you expect to be pale with infarction?

A

Organs with good consistency - heart, kidney, liver, spleen

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12
Q

What organs would you expect to be hemorrhagic with infarction?

A

Organs with meshy consistency - lungs, testes, bowel

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13
Q

Where do most emboli in systemic circulation arise?

A

Left side of the heart

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14
Q

The arrythmia most associated with embolization in the systemic circulation is?

A

Atrial fibrillation (stasis of blood in the atria, clot, and then embolus)

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15
Q

Dry gangrene foot - problem where?

A

Diabetes in popliteal artery (atherosclerosis)

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16
Q

How do infarcts usually arise?

A

Lumen narrowing from atherosclerotic plaque (ischemia) then a thrombus

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17
Q

What is the most common cause of intestinal infarct?

A

Adhesions from previous surgery

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18
Q

What is the second most common cause of intestinal infarct?

A

Piece of bowel trapped in indirect inguinal hernia

19
Q

What is the exception to coagulation necrosis underlying the infarction?

A

Brain - instead see liquefactive necrosis (cystic spaces)

20
Q

What is analogous to the fibroblast in the brain?

A

Astrocyte

21
Q

What cells mediate liquefactive necrosis?

A

Neutrophils (acute inflammation/infection) with the one exception being infarct in the brain

22
Q

Why does staph tend to produce an abscess?

A

Coagulase - tends to localize the infection and neutrophils can’t get out

23
Q

What is the most common cause of bronchopneumonia?

A

Strep pneumo

24
Q

Where do we see infarction in the lung?

A

Periphery, wedge-shaped

25
Q

What does caseating granulomas mean?

A

Mycobacteria or systemic fungal (the lipid in the cell wall gives it the cheese-like consistency)

26
Q

Where does pancreatic inflammation radiate pain to?

A

Back

27
Q

Where does peptic ulcer disease radiate pain to?

A

Epigastric

28
Q

What kind of necrosis occurs in pancreatitis?

A

Fat enzymatic necrosis - unique to the pancreas

29
Q

What does enzymatic necrosis look like?

A

Saponification - chalky white calcified areas (appear on X ray)

30
Q

What color does calcium appear as?

A

Blue

31
Q

Which one is more specific for the pancreas - amylase or lipase?

A

Lipase

32
Q

What tends to be the underlying cause of enzymatic necrosis?

A

Alcoholism

33
Q

What is fibrinoid necrosis?

A

Immunologic disease with necrosis that looks fibrin-like

34
Q

What is palpable purpura?

A

Type III hypersensitivity, small vessel disease

35
Q

How do you get damage in type III hypersensitivity?

A

Deposition of immune complexes –> activates complement –> C5a –> recruit neutrophils which are really what mediate the damage

36
Q

When do we see nutmeg liver?

A

Right sided heart failure - congested liver

37
Q

What happens to the liver if you block the portal vein?

A

Nothing - portal vein is before liver

38
Q

What happens to the liver if you block the hepatic vein?

A

Congested liver

39
Q

What part of the liver does yellow fever like to hit?

A

Zone 2

40
Q

What part of the liver is most susceptible to injury?

A

Zone 3 - right around the central vein because it gets the least amount of oxygen (zone 1 gets the most oxygen from the sinusoids, then zone 2, and finally zone 3)

41
Q

What’s the most common cause of fatty change in liver?

A

Alcohol (NADH and acetyl coA)

42
Q

What acid base change do we tend to see in alcoholics?

A

Fasting hypoglycemia with lactic acidosis (pyruvate shunted to lactate) and ketoacidosis (lots of acetyl coA)

43
Q

What’s the main ketone body?

A

Beta hydroxybutyrate

Goljan (21 decks)

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