Chapter 11 - Exocrine Pancreas/Gallbladder/Liver Flashcards
What is the major risk with an annular pancreas?
Duodenal obstruction
What is the first step leading to autodigestion in acute pancreatitis?
Premature activation of trypsin leads to activation of other pancreatic enzymes.
Major risk factors for Pancreatic carcinoma?
Smoking and chronic pancreatitis
Serum tumor marker for pancreatic carcinoma?
CA 19-9
Where does pain often radiate with acute cholecystitis?
Right scapula!
What is the Rokitansky-Aschoff sinus?
Herniation of gallbladder mucosa into the muscular wall, seen with chronic cholecystitis.
What enzyme conjugates bilirubin in the liver?
Uridine (UDP) glucuronyl transferase
Causes of jaundice??? (Ddx)
- Extravascular hemolysis/ineffective erythropoiesis
- Physiologic jaundice of newborn
- Gilbert syndrome
- Crigler-Najjar syndrome
- Dubin-Johnson Syndrome
- Biliary tract obstruction
- Viral hepatitis
Clinical features of jaundice caused by extravascular hemolysis/ineffective erythropoiesis?
Dark urine due to increased urine urobilinogen (produced in gut, reabsorbed, then excreted).
Treatment of Physiologic jaundice of the newborn? and why treat?
Phototherapy (which makes UCB more water soluble). Treat to avoid kernicterus (deposition of UCB in fat in basal ganglia)
What is Gilbert syndrome?
AR disease with mildly low levels of UGT activity. See jaundice during stress (severe infection)
What is Crigler-Najjar syndrome?
Absence of UGT. Leads to severe kernicterus and is usually fatal.
What is Dubin-Johnson syndrome?
Deficiency of bilirubin canalicular transport –> see increased conjugated bilirubin. Leads to a dark liver, otherwise not clinically significant. Rotor syndrome the same but with normal colored liver.
In biliary tract obstruction or viral hepatitis, why is the urine dark?
Due to increased bilirubinuria (conjugated bilirubin in urine). NOT urobilinogen.
What can Hep. E virus infection in a pregnant woman cause?
Fulminant hepatitis (liver failure with massive liver necrosis).
Which is worse: Hep D. superinfection w/HBV or HDV coinfection with HBV?
SUPERINFECTION!!!
What type of jaundice do you get with viral hepatitis?
A mixed jaundice. Inflammation disrupts hepatocytes, giving you unconjugated bilirubin, as well as disrupting small bile ductules, giving you conjugated bilirubinemia.
what mediates fibrosis seen in liver cirrhosis?
TGF-b produced by stellate cells
When do you see Mallory Bodies, and what are the made of?
Seen in Alcoholic hepatitis. Made of damaged cytokeratin filaments.
In alcoholic hepatitis, which is higher, ALT or AST?
AST>ALT
What mediates organ damage in hemochromatosis?
Generation of free radicals from iron.
What causes primary hemochromatosis?
Mutation in HFE gene.
Cirrhosis, secondary diabetes mellitus, and bronze skin = ???
Hemochromatosis
What stain must you do to confirm hemochromatosis?
Prussian blue stain, which stains iron deposits blue but NOT lipofuscin (age related deposits).
How to treat Wilson’s disease?
D-penicillamine (copper chelator)
What is primary biliary cirrhosis? What marker is present?
Autoimmune granulomatous destruction of intrahepatic bile ducts.
See antimitochondrial antibody
What is primary sclerosing cholangitis? what marker is present?
Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts. Looks like “onion skin” or “beaded”.
p-ANCA present
What is primary sclerosing cholangitis commonly associated with?
Ulcerative colitis.
What causes damage in Reye sydrome?
Mitochondrial damage of hepatocytes
What is associated with hepatic adenoma?
Oral contraceptive use. Adenoma disappears after discontinuation of OCPs
What is a common cause of hepatocellular carcinoma in other parts of the world (hint, think carcinogen)
Aflatoxins derived from Aspergillus (induce p53 mutations)
What is the serum marker for hepatocellular carcinoma?
alpha-fetoprotein.
