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pathology > Chapter 11 ( Exocrine Pancrease , Gallbladder , Liver ) > Flashcards

Chapter 11 ( Exocrine Pancrease , Gallbladder , Liver ) Flashcards

1
Q

Complication of annular pancreas ?

A

Duodenal obstruction

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2
Q

Mechanism of acute pancreatitis ?

A

Premature activation of trypsin leads to activation of other pancreatic enzymes
Leads to liquefactive hemorrhagic necrosis of pancreas and fat necrosis of the peripancreatic fat

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3
Q

Most common causes of chronic pancreatitis ?

A

Recurrent acute pancreatitis
Alcohol
Cystic fibrosis

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4
Q

Dystrophic calcification of pancreatic parenchyma on imaging ?

A

Chain of lakes : due to dilatation of pancreatic ducts

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5
Q

Major risk factors for pancreatic carcinoma ?

A

Smocking

Chronic pancreatitis

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6
Q

Trousseau sign in pancreatic carcinoma ?

A

Migratory thrombophlebitis , presents as swelling , erythema and tenderness in the extremities
Seen in 10% of patients with pancreatic carcinoma

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7
Q

Serum tumor marker of pancreatic carcinoma ?

A

CA19-9

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8
Q

Whipple procedure ?

A

Used in ttt of pancreatic carcinoma in which we remove :
1- head and neck of pancreas
2- proximal duodenum
3- gallbladder

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9
Q

Mechanism of gallstones ?

A

Precipitation of cholesterol or bilirubin in bile which arises with :
1- supersaturation of cholesterol or bilirubin
2- decreased phospholipids or bile acids
3- stasis

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10
Q

Percentage of radiopaque cholesterol stones ? Mechanism ?

A

10%

Due to associated calcium

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11
Q

Risk factors for cholesterol stones ?

A 
1- age 
2- estrogen 
3- colfibrate 
4- native american ethnicity 
5- crohn disease
6- cirrhosis
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12
Q

Risk factors for bilirubin stones ?

A

1- extravascular hemolysis

2- biliary tract infection ( E coli , Ascaris lumbricoids , Clonorchis sinensis )

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13
Q

Mechanism of biliary colic ?

A

Due to gallbladder contracting against a stone lodged in the cystic duct

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14
Q

Mechanism of acute cholecystitis ?

A

Impacted stone in the cystic duct —> dilatation —> pressure ischemia —> bacterial overgrowth (E coli) —> inflammation

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15
Q

What enzyme increases in acute cholecystitis ?

A

Serum alkaline phosphatase

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16
Q

Rokitansky-Aschoff sinus ?

A

Herniation of gallbladder mucosa into the muscular wall in chronic cholecystitis

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17
Q

Mechanism of ascending cholangitis ?

A

Due to ascending infection with enteric gram negative bacteria
Increased incidence with Choledocholithiasis

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18
Q

Mechanism of gall stone ileus ?

A

Due to cholecystitis with fistula formation between the gallbladder and small bowl —> gallstone enters and obstruct the small bowel

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19
Q

Presentation of gallbladder carcinoma ?

A

As cholecystitis in elderly woman

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20
Q

Mechanism of gallbladder carcinoma ?

A

Adenocarcinoma that arises from glandular epithelium that lines the gallbladder

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21
Q

Hall mark of Dubin-Johnson syndrome ?

A

Dark liver

Otherwise not clinically significant

22
Q

Rotor syndrome ?

A

Similar to Dubin-Johnson syndrome but lacks liver discoloration

23
Q

Lab findings of obstructive jaundice ?

A

⬆️ Conjugated bilirubin
⬇️ Urobilinogen
⬆️ Alkaline phosphatase enzyme

24
Q

In viral hepatitis , dark urine is because of increased ?

A

Urine Bilirubin

25
Q

Urobilinogen in liver hepatitis ?

A

Normal or decreased

26
Q

Causes of Viral hepatitis ?

A

Hepatitis viruses
CMV
EBV

27
Q

Inflammation involves what in acute and chronic hepatitis ?

A

Acute : lobules of the liver and portal tracts and characterized by apoptosis of hepatocytes

Chronic : portal tracts

28
Q

Why is HEV infection is dangerous in pregnant women ?

A

As its associated with fulminant hepatitis ( liver failure with massive liber necrosis )

29
Q

Incidence of chronic hepatitis in HBV infected patients ?

A

20%

30
Q

Which factor mediates fibrosis in liver cirrhosis ? From which cells ?

A

TGF-Beta

From Stellate cells ( which lies beneath the endothelial cells that lines the sinusoids )

31
Q

Coagulapathy of liver cirrhosis is followed by ?

A

PT

32
Q

Manifestations of hyperestrinism in liver cirrhosis ?

A

Gynecomastia
Spider angiomata
Palmar erythema

33
Q

Most common cause of liver disease in the west ?

A

Alcohol

34
Q

Alcoholic hepatitis mediated by ? Characteristics ? Presentation ?

A

Acetaldehyde mediates damage

Characterized by : swelling of hepatocytes with formation of Mallory bodies , necrosis and acute inflammation

Presents with :
Painful hepatomegaly
Elevated liver enzymes ( AST > ALT )

35
Q

Mechanism of Mallory bodies ?

A

Damaged cytokeratine filaments

36
Q

Incidence of cirrhosis in alcoholics ?

A

10-20%

37
Q

Liver enzymes with non-alcoholic fatty liver disease ?

A

ALT > AST

38
Q

Iron deposition in tissues ?

A

Hemosiderosis

39
Q

Iron organ damage by generation of free radicles ?

A

Hemochromatosis

40
Q

Primary hemochromatosis defect ?

A 
Autosomal recessive mutation in the HFE gene 
Usually C282Y ( Cysteine is replaced by Tyrosine at amino acid 282 )
41
Q

Liver biopsy finding in Hemochromatosis ?

A

Accumulation of brown pigment in hepatocytes

Iron is distinguished from Lipofuscin by Prussian blue stain which stains iron by blue color

42
Q

Lipofuscin ?

A

A brown pigment that is a by product from turn over of peroxidized lipids , commonly present in hepatocytes ( the grey hair of hepatocytes )

43
Q

Wilson disease defect ?

A

Autosomal recessive mutation of ATP7B gene which encodes ATP mediated hepatocyte copper transport
Results in lack of copper transport into bile and lack of copper incorporation onto ceruloplasmin

44
Q

Mechanism of tissue damage in Wilson disease ?

A

Copper-mediated production of hydroxyl free radicals leads to tissue damage

45
Q

Lab findings of Wilson disease ? Ttt ?

A

⬆️ urinary copper
⬇️ ceruloplasmin
⬆️ copper on liver biopsy

Ttt : D-penicillamine ( chelates copper )

46
Q

Primary biliary cirrhosis mechanism ? Presentation ?

A

Autoimmune granulomatous destruction of INTRAHEPATIC bile ducts

Presents with features of obstructive jaundice

47
Q

Primary sclerosing cholangitis mechanism ? Appearance on biopsy and imaging ? Etiology ?

A

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

On biopsy : periductal fibrosis appears as Onion-Skin

On contrast imaging : uninvolved regions are dilated giving Beaded appearance

Etiology : unknown but is associated with Ulcerative Colitis
p-ANCA is often positive

48
Q

Mechanism of Reye syndrome ?

A

Mitochondrial damage of hepatocytes leading ti fulminant liver failure and encephalopathy in children with viral illness who take Aspirin

49
Q

Hepatic adenoma is associated with ? Complications ?

A

Oral contraceptive use , regresses upon cessation of the drug
( Tumor is subcapsular and grows with exposure to estrogen )

Complications : risk of rupture and intraperitoneal bleeding especially during pregnancy

50
Q

Mechanism of Aflatoxins fro Aspergillus in causing heaptocellular carcinoma ?

A

Induce p53 mutation

51
Q

Hepatocellular carcinoma increases risk for ? Presentation ?

A

Budd-Chiari syndrome :
Liver infarction secondary to hepatic vein obstruction
Presents with Painful hepatomegaly and ascites

pathology (18 decks)

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