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).
