Barone Flashcards
if liver is green and yellow then what
cirrhosis
fatty liver from alcohol
micronodular cirrhosis is from what
alcohol
marco–> other things
22 year old girl that is sexually active, has UC, collapses and dies: what happened?
toxic megacolon, with UC so bacteria got in lead to peritonitis, then septic shock
gastrinomas: 25% associated with what
MEN1
diagnose gastrinoma
secretin stimulation test
when give this gastrin, should drop
gastrin goes up with this test in gastrinoma
A cell tumor
glucagonoma
hyperglycemia
anemia
skin rash (necrolytic migratory erythema)
somatostatinoma presentation
low acid and malabsoprtion of ood
no GB contaction bc decreased CCK = stones and steatorrhea
also diabetes
WDHA syndrome
watery diarrhea, hypokalemia, achloryridia
VIPoma
migratory thrombophlebitis
trousseous syndrome
pancreatic carcinoma
number 1 risk factor pancreatic carcinoma
smoking
80 yr old pt with new onset DM 1
think pancreatic carcinoma in body
perineural invasion with these tumors is common
pancreatic carcinoma
whipple procudedure
take out part of pancreas, loop of duodenum, bottom part of stomach, and GB
for panc cancer
what pts have increased risk cholesterol gallstones
native americans
biliary tract cancer drug can use
traztuzimab
2/3 have HER2-neu overexpression
cholangiocarcinoma cause and site
bifurcaiton of R and L hepatic ducts
liver fluke in asia
PSC can cause this to (walter peyton)
adenocarcinoma of ampulla of vater
painless jaundice
blocks pancreatic ducts so get pancreatitis and jaundice
CA-15-3 monitors what cancer
breast
3 looks like boobs
what vitamin do you want to give a baby with jaundice when you are using blue light
vitamin B2 bc light breaks it down
what makes the liver black in dubin johnson syndrome
catecholamines
the transporter for excretion of bile is used by catecholamines too so it gets stuck in there
elevated direct bilirubin with no black liver
rotar syndrome
can secrete catecholamines
if you have a biliary disesae that looks like a stone that keeps cumming and going think what
PBC or PSC
stool in biliary disesae
stool is pale
what lab test for biliary disease
alk phos and GGT
what is in the nodule of liver cirhossis
regenerating hepatocytes
what makes fibrosis in liver
what does it store?
stellate (ITO cell)
stores vitamin A
viral and toxins is ____nodular
macronodular
everything else like alcohol is micronodular
if see trichrome stain then pick what
fibrosis
treating esophageal varice
lactulose for upper GI bleed in cirrhosis
flushes out blood and colon
is an acid so binds with ammonia and traps it and then it is pooped out
can give broad spectrum antibiotic too
when the liver fails, what fails next
kidney
gynecomastia in liver failure why
bc estrogen cannot be broken down anymore
ground glass cytoplasm in hepatocytes (fuzzy)
hepatitis B
chronic HCV biopsy
fatty change and lymphoid aggregation
what hepatitis with needlestick in hospital
prison?
post transfusion?
B
C
C
why does hep D need hep B
needs hepatitis B’s capsule to infect the hepatocytes
surface antigen from the B cell
cancer from what hepatitis
b,c,d
hepatitis E in what population
what is its struture
pregnant women from india
unenveloped ssRNA
high mortalitiy rate in infected prengnant women
macrovesicular steatosis
alcoholic fatty liver
binge for 3-4 days in a row
drink for yrs then fibrosis in centrilobular macrovesicular steatosis
GGT will go up with alcohol and stays elevated for several days
GGT normal, ALT>AST =
nonalcoholic fatty liver disease
biopsy same as alcoholic fatty liver
diabetics and obese pts get it
hepatocyte swelling and necrosis
cytokeratin intermdieate filaments
alcoholic hepatitis
mallory bodies
NASH
ALT >AST
looks similar to alcoholic hepatitis
scars
get hisdtory
what nucleus does wilsons disease effect
lenticular nucleus
putamin and GP
AR
wilsons is on what chrom and what gene
chrom 13
ATP7B
wilsons disease population
young people
where is the eye discoloration in wilsons disease
decements membrnae of eye
what does wilsons disesae look like
ADHD with parkinsonism
treat wilsons
d penicillamine chelator
trientine (something else) if allergic to penicilin
liver transplant if get cirrhosis
hemochromotasosis HLA and chromosome
and gene
HLA-A3
chromosome p
HFE gene C282Y
second most common is H63D
physio hemochromatosis
liver stops making hepcidin so Fe unregulated entry through gut
treat hemochromatosis
phlebotomy, women wont get until post menopause
people set off metal detector at airport
hemochromatosis
hemochromatosis can lead to
micronodular cirrhosis and HCC bc of increased free radicals in liver
can deposit into pituitary and stop gonadotropin = hypogonadism
gene in a1 antitrypsin deficiency
SERPINA1
serine protease inhib gene or Pi
Pimm normal
PiZZ abnormal
liver biopsy in a1 antitrypsin
PAS positive, eosinophilic cytoplasmic globules in hepatocytes
what change would you see in reye syndrome
injures mitochondria
hepatic fatty change (MICROVESICULAR steatosis) bc acute so micro
cerebral edema/encephalopathy
most common tumor within liver is
metastatic
most common primary tumor of the liver
benign hemangioma
red and spongy
dont need to treat just dont biopsy
incidental finding
liver neoplasm:
young women related to estrogen
pregnant women and women on OCs
hepatocellular adenoma
woman with severe abdominal pain and tap it, get blood, with well circumscirbed mass under liver, will see normal liver but NO PORTAL TRIADs =
hepatocellular adenoma
hepatocelluar adenoma in man
steroids or transgender
hepatocellular adenoma can turn to
HCC
B-HCA has beta catenein mutations
nodule in liver with central stellate scar
focal nodular hyperplasia
grains that get moldy and then eaten, homeless guy eats old peanut butter, grows on peanuts
aflatoxin B1 =249 mutation in p53
aflatoxin spreads
check what
marker for tumor
looks like what
hematogenously to portal and hepatic veins
can get budd chiari
check lungs
AFP is tumor marker
yellow green single invasive mass
risk factors for hepatic angiosarcoma
VAT
vinyl chloride
arsenic
thorotrast
untreated meningitis
leads to sepsis and DIC then get bilateral hemmorhagic adrenal damage
leptomeninges in meningitis
opaque b have lots of puss
diffuse cerebral edma and fatal herniations
treat rabbies
active vaccination with antigen and give passive Igs (put near bite)
put vaccine far away
rabies binds ____ then ges endocytoses in nerves and goes retrograde in nerves to brain
ACHR
every virus that starts with ___ is and RNA virus
R
double stranded RNA virus
reo
cd4 count for pml
under 50
what lobe does mucor penetrate
frontal
cork screw motiltiy
trich vaginalis
toxo bacterial absecess where
basal ganglia
cruetzfeldt jakob
PrPc (politically correct form)
changes to b pleated sheet conformation (PRPsc (scrape) your brain
spongiform encephalopathy
vacuoulization of neuropil
holey brain all over, kuru plaques
14-3-3 protein
rapid neuronal death with proper history then can diagnose prion disese
amaurosis fugax
curtain closing down virion
warning stroke
global cerebral ischemia location
hippocampus, CA1 area is where you see red neurons
if cerebellum then purkinje
infarction = watershed
what is usually spared in TIA
peripheral gray
use thromboylytics for ___ infarcts seen on CT
pale
spinal tap has blood means what
subarachnoid hemorrhage
most common cause of preceding incident of subarachnoid hemorrhage
sex
also if strenously lifting boxes, or cocaine
CT of subarachnoid hemorrhage
CT will show bleed on bottom of brain
then do CT angiogram so you can localize bleed
get vasospasm from arteries compresed around blood in SAH so give
CCB
mot common sites of subarach hemm
anterior communicating artery most comon
MCA 2nd most common
ICA area is 3rd
crescent shaped bridging vein rupture
subdural hematoma
risk is brain atrophy
subdural hematoma onset of symptoms
long lucid interval, 12-24 hrs
syringomyelia is assocaited with what other problem
arnold chiari malformation
huge cystic space in spot where should have cerebellum, dilated 4th ventricle
dandy walker
youll be a dandy of a walker bc you didn’t develop center of cerebellum (vermis)
arnold chiari type I
asmptomatic
arnold chiari type II
associations
faulty carniospinal junction
bones of posterior fossa fuse too early so too small so no room for cerebellum, so instead it grows down and crushes 4th ventricle and grows down to push on syrnix (syningomyelia)
also associated with lumbar meningomyelocele
HLA for MS
HLA DR2
diagnosing MS
MRI
axons are or are not attacked in MS
not damaged so can remyelinate, never get 100% function back
just oligodendrocytes attacked
different areas of brain involved at different times is key for diagnosis of
MS
treatment for MS
interferon beta
natalizumab
(monoclonal antibody aginast CAM a4-integrin)
natalizumab could reactivate what
JC virus and cause PML
treatment for PNH
eculizumab
knocks out MAC
which is activated at night at lyses red cells bc of decreased pH from decreased breathing at sleep
ew, liz peed on me at night (PNH)
gene mutation possible in parkinsons
SNCA for alpha synuclein (lewy bodies)
most cases sporadic
what increases risk for parkinsons disease
meperidine (demoral)
MPTP
main cause of death in parkinsons
aspiration and bronchopneumonia
intracytoplasmic round eosionphilic inclusion in brain that contains __
a synuclein
lewy body
lewy body dementia
parkinsons with dementia get dementia early visual hallucinations get orthostatic HTN when stand up hyposmia and contipation is early clue
huntingtons mutaiton
CAG repeat
toxic GOF mutaiton
caudate atrophy
treatment for huntingtons
only can treat chorea
dopaine blocking agent
hydrocephalus ex vacuo
normal pressure but more fluid bc brain atrpohy
alzheimers, picks, huntingtons
protective of alzheimers
smoking and high education
increased Ach
APP presenilin 1 and 2
alzheimers
E4 vs E2
E4 is higher risk on apolipoprotein
increased atheroscelrosis
most important for degree of dementia in alzheimers
tangles > plaques
tangles are what
hyperphosphorylated tau
alzheimers
hirano bodies
made of actin filaments in alzheimers pts
affected area in brain in alzheimers
hippocampus in the medial aspect of the temporal lobe
tacrine
to treat alzheimers
SOD1
ALS
accumulation of _____ in cytoplasm of dying neurons for ALS
TDP-43
DNA binding protein should be in the nucleus
also accumulates in the cytoplasm in picks disease
rizluzole
treatment for ALS
decreases release of glutamate
only gives extra 2-3 months to live
think about rizzuto from happy gilmore so relate the baseball player to lou gherigs disease (baseball player)
most common malignant brain tumor in kids
medulloblastoma
most common benign tumor in kids
pilocytic astrocytoma
GFAP positive brain tumor
describe histology
pilocytic astrocytoma
neoplastic astrocytes with long bipolar processes
(looks like hair)
good mutation in Glioblastoma multiforme
IDH1
high mitotic rate, necrosis, vascular proliferation
pseudopallisading of neoplastic tumor cells around areas of necrosis
midline crossing, ring enhanceing
GBM
evil tumor
so evil that neoplastic tumor cells gather around and look at the areas of necrosis (pseudopallisading)
GFAP positive
adults that present with seizure
calcified frontal lobe mass
oligodendolioma
capillaries criss cross each other so look like chicken wire
oligodendroglioma
good muations with oligodendroglioma
1p and 19q
GFAO positive lines ventricles so mass in ventricles
pappillary mass in 4th ventricle of children
ependymoma
what adults get epednymoma
adults get it in the spinal cord when they have NF2
perivascular pseudorossetes in brain tumor
ependymoma
ebryonal tumor
from neuroectoderm
make neuropil
hoer wright rossettes
good mutation in medulloblastoma
WNT
drop metastasis
medullloblastoma that spreads to CSF and goes to spinal cord, gives tumor masses in spinal cord
neuroblastoma in adrenal medulla
like what, mutation, makes what, look for what
cross midline?
just like pheo bc can make epinephrine and norep
n myc mutation
looks for VMA/HVA/free metanephrine
does cross midline bc malignant and it calcifies (so not wilms)
if goes to skin then blueberry muffin baby
