6.20.16 Pathoma Flashcards
What type of bacteria usually cause ascending cholangitis?
Enteric, Gram negative
What is Porcelain gallbladder? What is the risk of leaving this untreated?
- Dystrophic calcification of the gall bladder secondary to chronic cholecystitis
- Predisposes to gallbladder cancer
What part of the white pulp of the spleen is enlarged in viral infections?
Periarterial lymphatic sheath (PALS)
what is the step before the spinothalamic tract?
cross ant white commissure
What is a gallstone ileus? How do these occur?
-Gallstone that enters and obstructs the small bowel–usually the result of a fistula development between the gallbladder and the duodenum, which allows for a large stone to pass through and obstruct the ileocecal junction
What is the cause of SSC of the esophagus?
Irritation of the esophagus
What are the two viral causes of mononucleosis?
- EBV infection predominate
- CMV less common cause
What is chronic cholecystitis?
Chronic inflammation of the gallbladder due to longstanding chemical irritation from cholelithiasis
Why is it that estrogen increases the risk for cholelithisais? (2)
- Increases HMG-CoA reductase and cholesterol synthesis
2. Estrogen also increase cholesterol receptors on liver
How does biliary atresia present? What type of bilirubin is elevated in this disorder?
- Jaundice, progressing to cirrhosis early in life
- Direct (conjugated) bili is elevated
How does ascending cholangitis present?
Sepsis, jaundice, and abdominal pain
What will happen to a gallbladder in acute cholecystitis if left untreated?
Rupture
What poses an increased risk of developing ascending cholangitis? How?
Choledocholithiasis– decreased flow of bile allows bacteria to grow upwards in the bile duct
—–Where does lymph flow in the upper 1/3 of the esophagus? Middle? Distal?—–
- —–Upper = cervical nodes
- Middle = mediastinal or tracheobronchial nodes
- Lower = celiac and gastric nodes——
How does cholestyramine cause an increased risk for cholelithisasis?
Decreased reuptake of bile acids, which is needed for solubility
What is the treatment for chronic cholecystitis?
Cholecystectomy
—-What is the classical presentation of gallbladder carcinoma?—-
—-Cholecystitis in an elderly women—-
What is the classic presentation of acute cholecystitis? (3)
- RUQ pain with radiation to the right scapula
- Fever + leukocytosis
- N/v
Where does the EBV virus remain dormant?
B cells
How do Achalasia and esophageal webs lead to SCC?
Irritation via food degradation sitting in the esophagus
dorsal column: fx
fine touch, position sense
What is biliary atresia?
Failure to form, or early destruction of the extrahepatic biliary tree
What cancer is associated with cholecystitis?
Adenocarcinoma from the gland cells of the gallbladder
What is the major risk factor for the development of gallbladder adenoCA
Gallstones
spinothalamic tract: fx
pain, temp, touch
How does stasis in the bile duct lead to gallstones?
Bacteria deconjugate the heme into bili, leading to bili
How does cirrhosis increase the risk for gallstones?
Decreased production of bile salts
What are the three causes of cholelithiasis?
- Supersaturation of cholesterol or bilirubin
- Decreased phospholipids / bile acids
- Stasis
What is acute cholecystitis?
Acute inflammation of the gallbladder caused by an impacted stone in cystic duct and bacterial overgrowth
What are the causes of bilirubin stones? (2) How do they appear grossly?
- extravascular hemolysis
- Biliary tract infections
-Black or darkly pigmented stones
What is the IBD that increases the risk for cholelithisasis? Why?
- Crohn’s disease
- Ileum is damaged, so there is poor uptake of bile acids and salts, causing precipitation of cholesterol
What are the three infectious agents that increase the risk for the development of a gallstone (hint: 1 bacteria + 2 parasites)?
- E.coli
- Ascaris lumbricoides
- Clonorchis sinensis
What way does the trachea shift with a pneumothorax? Tension pneumothorax?
Toward in normal, away if tension
What is the classical s/sx of chronic cholecystitis?
Vague RUQ pain after eating
What are the five key complications that can result from gallstones?
- Biliary colic
- Acute and chronic cholecystitis
- Ascending cholangitis
- Gallstone ileus
- Gallbladder CA
What ethnicity has a higher rate of cholelithiasis?
Native americans
What is the major complication that can occur with a tension pneumothorax?
Compression of the heart
Where are B cells found in a lymph node?
Cortex
Where are the T cells present in the spleen?
Around the blood vessels
What is the T cell type that predominates in infectious mononucleosis? What does this result in (3)?
CD8 + T cells
- Generalized LAD
- Splenomegaly
- High white count
What is the definitive test for mono?
EBV viral capsid antigen
What are the s/sx of SCC of the esophagus? (3)
- Progressive dysphagia
- Hematemesis
- Hoarse voice/cough
How does clofibrate increase the risk for gallstones?
It increases the rate of HMG CoA reductase action, leading to increased cholesterol synthesis, and decreases bile acid
What is the cause of tension pneumothoraces?
Penetrating chest wall injuries cause a hole whereby air can come in, but cannot leak out.
What is ascending cholangitis?
Bacterial infection of the bile ducts
What is the most common cause of pneumothorax? In whom is this seen?
Rupture of an emphysematous bleb
Tall Young males
What are the histological characteristics of mononucleosis?
Atypical lymphocytes with a large, odd shaped nucleus
A negative monospot usually indicates that what virus is usually causing the mono-like symptoms?
CMV
What is the most common type of gallstones in the west? How do they appear on imaging?
- Cholesterol stones
- Usually radiolucent (don’t appear)
How long do patients with mono have to avoid contact sports d/t the chance of splenic rupture?
1 year
What does the monospot test assess for?
-IgM to heterophile antibodies
What is in the white pulp part of the spleen? Red pulp?
Red pulp = blood
White pulp = cells
What is the long term complication of chronic cholecystitis?
-Porcelain gallbladder–dystrophic calcification of the gallbladder
What is biliary colic?
Intermittent RUQ abdominal pain caused by contractions of the gallbladder against a stone.
Why is alk phos elevated in gallbladder issues?
Alk phos a key component of the endothelial cells of the gallbladder tract
What are Rokitansky-Aschoff sinuses? What disease are these seen in?
gallbladder mucosa that dives down into the wall. Classic for chronic cholecystitis
A rash can develop if a patient with Mono is given what abx?
PCN
What is the most common esophageal cancer worldwide? Where in the esophagus does this usually arise?
- SCC
- upper or middle third of the esophagus
Which are of the lymph node will be enlarged in a viral infection?
Paracortex
What is the most common type of esophageal cancer in the West? What is this usually associated with? Where in the esophagus does this usually occur?
- Adenocarcinoma
- Barrett’s esophagus
- Distal 1/3
Why is it that esophageal SCC can present with hoarse voice?
Invasion of the SCC beyond the BM may lead to compression of the recurrent laryngeal nerve
