Ch 11 Pathoma Exocrine Pancreas, Gallbladder, and Liver Pathology Flashcards
Annular pancreas is a developmental __ in which the pancreas forms a __ around the __. There is a risk of __.
malformation; ring; duodenum; duodenal obstruction
Acute pancreatitis is __ and __ of the pancreas. Due to __ of pancreatic __ by __. __ activation of __ leads to __ of other pancreatic enzymes. Results in __ of the pancreas and __ of the peripancreatic fat.
inflammation; hemorrhage; autodigestion; parenchyma; pancreatic enzymes; premature; trypsin; activation; liquefactive hemorrhagic necrosis; fat necrosis (when fat acids are released they undergo saponification leading to fat necrosis)
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Acute pancreatitis is most commonly due to __ and __. Other causes include these 7.
alcohol (causes contraction of sphincter of Oddi); gallstones (blocks the ampulla; 1) trauma (MVA in child); 2) hypercalcemia (activator of enzymes); 3) hyperlipidemia; 4) drugs; 5) scorpion stings; 6) mumps; 7) rupture of a posterior duodenal ulcer (pancreas sits posterior to duodenum)
Name 5 clinical features of acute pancreatitis
1) epigastric abdominal pain that radiates to back; 2) N/V; 3) periumbilical and flank hemorrhage (necrosis spreads into the periumb soft tissue and retroperitoneum); 4) elevated serum lipase and amylase (lipase is more specific for pancreatic damage); 5) hypocalcemia (consumed during saponification in fat necrosis)
Name 4 complications of acute pancreatitis
1) shock (due to peripancreatic hemorrhage and fluid sequestration); 2) pancreatic pseudocyst; 3) pancreatic abscess; 4) DIC and ARDS (enzymes get in to blood and chew up anti-coag factors and the capillary alveolar interface)
A pancreatic pseudocyst is a complication of __, which is formed by __ surrounding __ and __. It presents as a __ with __ elevated __. __ is associated with release of enzymes into the abdominal cavity and __.
acute pancreatitis; fibrous tissue; liquefactive necrosis; pancreatic enzymes; abdominal mass; persistently (w/necrosis alone you’d expect enzymes to dec eventually); serum amylase; rupture; hemorrhage
Pancreatic abscesses are a complication of __, and are often due to __. Presents with these 3 symptoms.
acute pancreatitis; E coli; 1) abdominal pain; 2) high fever; 3) persistently elevated amylase
Chronic pancreatitis is __ of pancreatic __, most often 2ndary to __. Most commonly due to __ (adults) and __ (children), however many cases are __.
fibrosis; parenchyma; recurrent acute pancreatitis; alcohol; cystic fibrosis; idiopathic
Name 4 clinical features of chronic pancreatitis. Patients have an increased risk for __.
1) epigastric and abdominal pain that radiates to back; 2) pancreatic insufficiency (results in malabsorption); 3) dystrophic calcification of pancreatic parenchyma on imaging; 4) 2ndary DM; pancreatic carcinoma
Pancreatic insufficiency is a clinical feature of chronic pancreatitis. It results in __ with __ and __ deficiencies. __ and __ are/are not useful serologic markers of chronic pancreatitis.
malabsorption; steatorrhea; fat soluble vitamin; amylase; lipase; are not (malabsorption b/c you need pancreatic enzymes to aid in digestion and absorption)
Dystrophic calcification of pancreatic parenchyma is a clinical feature of ___. Contrast studies reveal a __ pattern due to __ of pancreatic ducts.
imaging; chain of lakes; dilatation
Pancreatic carcinoma is __ arising from the pancreatic __. Most commonly seen in __ (avg age is __ yrs). Major risk factors are __ and __. Serum tumor marker is __. Surgical resection involves __ removal of the __ and __ of pancreas, __ and __ (__ procedure). 1-year survival is __%.
adenocarcinoma; ducts; elderly; 70; smoking; chronic pancreatitis; CA 19-9; en bloc; head and neck; proximal duodenum; gallbladder; Whipple; LT 10%
Name 5 clinical features of pancreatic carcinoma (these usually occur late in the disease)
1) epigastric abdominal pain and weight loss; 2) obstructive jaundice w/pale stools and palpable gallbladder (assoc with head of pancreas); 3) 2ndary DM (assoc w/body or tail); 4) pancreatitis; 5) migratory thrombophlebitis (Trousseau syndrome)
Pancreatic carcinoma can cause obstructive __ with __ and palpable __. Associated w/tumors that arise in the __ of the pancreas (most common location). 2ndary DM is associated w/tumors that arise in the __.
jaundice (block flow of bile so conjugated bilirubin leaks out); pale stools (stool gets its color from a derivative of bilirubin); gallbladder; head; body or tail
Migratory thrombophlebitis (__ syndrome) is a clinical feature of pancreatic carcinoma. It presents w/these 3 symptoms
Trousseau; 1) swelling; 2) erythema; 3) tenderness in extremities
Name 4 pathologies of the exocrine pancreas
1) annular pancreas; 2) acute pancreatitis; 3) chronic pancreatitis; 4) pancreatic carcinoma
Biliary atresia is failure to __ or early __ of __. Leads to __ within the first __ of life. Presents with __ (due to __ bilirubin) and progresses to __.
form; destruction; extra hepatic biliary tree (failure to form lumen of a tube = atresia); biliary obstruction; 2 months; jaundice; conjugated; cirrhosis (back pressure causes damage)
Cholelithiasis (aka __) is solid, round __ in the __. Due to precipitation of __ or __ in __. Arises due to one of these 3 causes.
gallstones; stones; gallbladder; cholesterol; bilirubin; bile; 1) supersaturation of cholesterol or bilirubin; 2) decreased phospholipids (e.g. lecithin) or bile acids (they both help to solubilize the cholesterol); 3) stasis (inc chance of infxn, which can then deconjugate bilirubin and lead to formation of stone)
Which are the most common type of stones (90%), especially in the West?
cholesterol stones
Cholesterol stones (__ color) are usually radiolucent/radiopaque (10% are __ due to associated __). Risk factors include these 6.
yellow; radiolucent; radiopaque; calcium; 1) age (40s); 2) estrogen (female, obesity, multiple pregnancies, oral contraceptives); 3) clofibrate; 4) Native American ethnicity; 5) Crohn disease; 6) cirrhosis
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Cholestyramine is a __ lowering agent that works by binding __ and preventing __ at ileum. The decrease in __ increases risk for __ stone. Clofibrate is a __ lowering agent, that ends up increasing the activity of __ enzyme, and decreases conversion of __ to __, which both lead to formation of stones.
lipid; bile acids; recycling; bile acids; cholesterol; lipid; HMG-CoA reductase; cholesterol; bile acids
Estrogen increases risk of cholesterol gallstone formation for these 2 reasons.
1) increases activity of HMG-CoA reductase; 2) increases lipoprotein receptors on hepatocytes which increases cholesterol uptake (both supersaturate cholesterol)
Crohn’s disease increases risk for cholesterol gall stones by causing damage to the __, which is where bile acids are __. Decreased bile acids leads to less solubilization of __, increasing risk for stone. Cirrhosis can lead to cholesterol stones by decreased production of __ by hepatocytes
terminal ileum; recycled; cholesterol; bile salts
Bilirubin stones (pigmented) are usually radiolucent/radiopaque. Risk factors include these 2.
radiopaque; 1) extravascular hemolysis (increased bilirubin in bile); 2) biliary tract infxns (when present in the biliary tract, bacteria can deconjugate the bilirubin and increase risk of precipitated bilirubin)
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Name 3 causes of biliary tract infection that can lead to bilirubin stones.
1) e coli; 2) ascaris lumbricoides; 3) clonorchis sinensis
Ascaris lumbricoides is a common __ that infects 25% of world’s population, especially in areas with poor sanitation (__ transmission). Infects __, increasing risk for gallstones. Clonorchis sinensis is endemic in these 3 countries (aka __). Infects the __, increasing risk for these 3 things.
roundworm; fecal-oral; biliary tract; China, Korea, and Vietnam; Chinese liver fluke; biliary tract; 1) gallstones; 2) cholangitis; 3) cholangiocarcinoma
Gallstones are usually a/symptomatic. Complications include these 6
1) biliary colic; 2/3) acute and chronic cholecystitis; 4) ascending cholangitis; 5) gallstone ileus; 6) gallbladder cancer
Biliary colic is waxing and waning __. Due to gallbladder __ against a __ lodged in the __. Symptoms are relieved if the __. __ obstruction may result in __ or __.
RUQ pain; contracting; stone; cystic duct; stone passes; common bile duct; acute pancreatitis; obstructive jaundice
Acute cholecystitis is acute inflammation of the __. Impacted __ in the __ results in dilatation with __, __, and __.
gallbladder wall; stone; cystic duct; pressure ischemia (pressure builds up and bv’s are squeezed); bacterial overgrowth (E coli); inflammation
Acute cholecystitis presents with these 5 symptoms. Risk of __ is left untreated.
1) RUQ pain often radiating to right scapula; 2) fever w/elevated WBC count; 3/4) N/V; 5) inc serum alkaline phosphatase (epithelium that lines gallbladder and biliary tract contains alk phos which leaks when cells are damaged); rupture
Chronic cholecystitis is chronic inflammation of the __. Due to __ from longstanding __, with or without superimposed bouts of __. Characterized by __ of gallbladder __ into the __ (__ sinus).
gallbladder; chemical irritation; cholelithiasis; acute cholecystitis; herniation; mucosa; muscular wall; Rokitansky-Aschoff (pictured)
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Chronic cholecystitis presents with __, especially after __. __ is a late complication, which is a __, __ gallbladder due to __, __, and __. There is an increased risk for __. Treatment is __, especially if __ gallbladder is present.
vague RUQ pain; eating; porcelain; shrunken, hard; chronic inflammation; fibrosis; dystrophic calcification; carcinoma; cholecystectomy; porcelain (pictured)
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Ascending cholangitis is a __ of the __. Usually due to ascending __ with __. Presents with these 3 symptoms. Increased incidence with __.
bacterial infxn; bile ducts; infxn; enteric gram-negative bacteria; 1) sepsis (high fever and chills); 2) jaundice; 3) abdominal pain; choledocholithiasis (stone in biliary ducts)
Gallstone ileus is when gallstone enters and __ the __. Due to __ with __ formation btwn the __ and __.
obstructs; small bowel; cholecystitis; fistula; gallbladder and small bowel
Gallbladder carcinoma is __ arising from the __ that lines the __. __ are a major risk factor, especially when complicated by __. Classically presents as __ in a __. Excellent/poor prognosis.
adenocarcinoma; glandular epithelium; wall; gallstones; porcelain gallbladder; cholecystitis (normally this is a disease of 40s/50s so in elderly think cancer); elderly woman; poor
Name 8 pathologies of the gallbladder and biliary tract
1) biliary atresia; 2) cholelithiasis; 3) biliary colic; 4) acute cholecystitis; 5) chronic cholecystitis; 6) ascending cholangitis; 7) gallstone ileus; 8) gallbladder carcinoma
Jaundice is __ discoloration of the __. Earliest sign is __. Due to increased serum __, usually GT __. Arises with disturbances in __.
yellow; skin; scleral icterus (yellow discoloration of the sclera); bilirubin; 2.5 mg/dL; bilirubin metabolism
Bilirubin metabolism: RBC are consumed by __ of the __. __ (from heme) is converted to __, which is carried by __ to the liver. __ in hepatocytes conjugates __. Conjugated bilirubin is transferred to __ to form __, which is stored in the __ and released into the __ to aid in __.
macrophages; reticuloendothelial system (spleen is most prominent location); protoporphyrin; unconjugated bilirubin (UCB); albumin; uridine glucuronyl transferase (UGT); bilirubin; bile canaliculi; bile; gallbladder; small bowel; digestion