Chapter 11 ( Exocrine Pancrease , Gallbladder , Liver ) Flashcards by Ahmed Safwat

Complication of annular pancreas ?

Duodenal obstruction

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Mechanism of acute pancreatitis ?

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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Most common causes of chronic pancreatitis ?

Recurrent acute pancreatitis
Alcohol
Cystic fibrosis

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Dystrophic calcification of pancreatic parenchyma on imaging ?

Chain of lakes : due to dilatation of pancreatic ducts

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Major risk factors for pancreatic carcinoma ?

Smocking

Chronic pancreatitis

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Trousseau sign in pancreatic carcinoma ?

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

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Serum tumor marker of pancreatic carcinoma ?

CA19-9

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Whipple procedure ?

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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Mechanism of gallstones ?

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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Percentage of radiopaque cholesterol stones ? Mechanism ?

10%

Due to associated calcium

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Risk factors for cholesterol stones ?

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

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Risk factors for bilirubin stones ?

1- extravascular hemolysis

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

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Mechanism of biliary colic ?

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

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Mechanism of acute cholecystitis ?

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

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What enzyme increases in acute cholecystitis ?

Serum alkaline phosphatase

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Rokitansky-Aschoff sinus ?

Herniation of gallbladder mucosa into the muscular wall in chronic cholecystitis

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Mechanism of ascending cholangitis ?

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

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Mechanism of gall stone ileus ?

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

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Presentation of gallbladder carcinoma ?

As cholecystitis in elderly woman

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Mechanism of gallbladder carcinoma ?

Adenocarcinoma that arises from glandular epithelium that lines the gallbladder

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Hall mark of Dubin-Johnson syndrome ?

Dark liver

Otherwise not clinically significant

Rotor syndrome ?

Similar to Dubin-Johnson syndrome but lacks liver discoloration

Lab findings of obstructive jaundice ?

⬆️ Conjugated bilirubin
⬇️ Urobilinogen
⬆️ Alkaline phosphatase enzyme

In viral hepatitis , dark urine is because of increased ?

Urine Bilirubin

Urobilinogen in liver hepatitis ?

Normal or decreased

Causes of Viral hepatitis ?

Hepatitis viruses CMV EBV

Inflammation involves what in acute and chronic hepatitis ?

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

Why is HEV infection is dangerous in pregnant women ?

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

Incidence of chronic hepatitis in HBV infected patients ?

20%

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

TGF-Beta | From Stellate cells ( which lies beneath the endothelial cells that lines the sinusoids )

Coagulapathy of liver cirrhosis is followed by ?

Manifestations of hyperestrinism in liver cirrhosis ?

Gynecomastia Spider angiomata Palmar erythema

Most common cause of liver disease in the west ?

Alcohol

Alcoholic hepatitis mediated by ? Characteristics ? Presentation ?

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 )

Mechanism of Mallory bodies ?

Damaged cytokeratine filaments

Incidence of cirrhosis in alcoholics ?

10-20%

Liver enzymes with non-alcoholic fatty liver disease ?

ALT > AST

Iron deposition in tissues ?

Hemosiderosis

Iron organ damage by generation of free radicles ?

Hemochromatosis

Primary hemochromatosis defect ?

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

Liver biopsy finding in Hemochromatosis ?

Accumulation of brown pigment in hepatocytes | Iron is distinguished from Lipofuscin by Prussian blue stain which stains iron by blue color

Lipofuscin ?

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

Wilson disease defect ?

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

Mechanism of tissue damage in Wilson disease ?

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

Lab findings of Wilson disease ? Ttt ?

⬆️ urinary copper ⬇️ ceruloplasmin ⬆️ copper on liver biopsy Ttt : D-penicillamine ( chelates copper )

Primary biliary cirrhosis mechanism ? Presentation ?

Autoimmune granulomatous destruction of INTRAHEPATIC bile ducts Presents with features of obstructive jaundice

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

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

Mechanism of Reye syndrome ?

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

Hepatic adenoma is associated with ? Complications ?

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

Mechanism of Aflatoxins fro Aspergillus in causing heaptocellular carcinoma ?

Induce p53 mutation

Hepatocellular carcinoma increases risk for ? Presentation ?

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