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Digestive System > Chemical Pathology > Flashcards

Chemical Pathology Flashcards

1
Q

What is the normal resting tone of the lower oesophageal sphincter?

A

15- 24mmHg

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2
Q

The relaxation of the lower oesophageal sphincter immediately after swallowing is mediated by what ?

A

VIP and NO with myenteric plexus

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3
Q

Fill in the blanks. “During swallowing relaxation occurs _____ of bolus while contraction is _______ bolus.”

A

Relaxation occurs INFRONT bolus while contraction occurs BEHIND bolus.

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4
Q

What is Dysphagia?

A

It is difficulty swallowing

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5
Q

What is Odynophagia?

A

This is painful swallowing

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6
Q

What are the classifications of dysphagia based on their etiolgoy?

A

Mechanical : obstruction in lumen, wall or compression from outside.

Functional

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7
Q

What are some mechanical causes of dysphasia ?

A
  • Strictures
  • Malignancy: primary, secondary
  • Webs
  • Diverticulum
  • Atresia
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8
Q

What are some functional causes of dysphagia?

A
  • Esophageal motility disorders:Achalasia, esophageal spasm
  • Poor function post CVAs
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9
Q

What is Achalasia?

A

Achalasia is characterized by the triad of incomplete lower esophageal sphincter (LES) relaxation, increased LES tone, and esophageal aperistalsis.

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10
Q

What is the pathophysiology associated with achalasia ?

A
  • Loss of NO, VIP secreting interneurons in myenteric plexus.
  • This creates an imbalance between excitatory and inhibitory stimulation.
  • Result is a contracted LES that fails to relax on swallowing
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11
Q

What type of cells present first during Achalasia?

A

Cytotoxic T-cells, eosinophils, mast cells

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12
Q

What are the two types of Achalsia?

A

Primary and Secondary

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13
Q

Which type pf Achalasia is associated with Chagas disease (trypanosoma cruzi protozoa) and Psudoachalasia from malignant infiltration into LES?

A

Secondary type

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14
Q

Fill in he blanks. “Primary Achalasia is normally ________.”

A

Idiopathic - but can be related to Hereditary, Autoimmune & Viral infections.

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15
Q

What are the symptoms of Achalasia?

A
  • Dysphagia (most common)
  • Regurgitation of undigested foods (80%) * Chest pain (25-50%)
  • Aspiration (wheezing, cough, pneumonia)
  • Weight loss ..not usually severe
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16
Q

What are the findings of Achlasia during Barium Swallow study?

A

A” bird beak “appearance

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17
Q

What is the gold standard used for the diagnosis of Achlasia?

A

Manometry

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18
Q

What are drugs given to treat achalasia?

A
  • Nitrates
  • Ca channel blockers
  • Sildenafil
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19
Q

True or False? Achalsia is as a result of
Loss of NO, VIP secreting interneurons in Meissener’s plexus.

A

FALSE!! It is a loss of NO, VIP in the MYENTERIC PLEXUS!

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20
Q

What is the most effective treatment for Achlasia?

A

Surgery - Modified single anterior myotomy , Ernest Heller 1913

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21
Q

What do TRUE liver function tests indicate?

A

It provides assessment of functional hepatic cell activity – non routine.

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22
Q

What do ROUTINE liver function tests indicate?

A

Routine LFTs indicate nature of disease but less often a specific diagnosis.

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23
Q

What are the functions of Liver Function tests?

A
  1. Detect the presence of liver disease,
  2. Distinguish among different types of liver disorders, eg - differentiating between acute viral hepatitis, various cholestatic disorders and chronic liver disease,
  3. Assess the severity and predict the outcome.
    4.Follow up/monitoring – evaluate response to therapy.
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24
Q

Which enzymes are biomarkers for liver injury?

A

Transaminases: Alanine and aspartate aminotransferase (ALT & AST respectively).

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25
Q

True or False? Albumin is used to test for the excretory function of the liver while Direct and total bilirubin is used to indicate synthetic function.

A

FALSE!! Excretion: Direct and total bilirubin.

Synthetic function: Albumin.

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25
Q

Which enzymes indicates diseases linked to biliary tract?

A

Alkaline phosphatase (ALP)
Gamma glutamyl transferase (GGT)
5’-nucleotidase.

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26
Q

True or False? Serum bilirubin is a True test of liver function.

A

TRUE!!

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27
Q

What is the normal serum bilirubin levels?

A

< 18 mol/L ( conjugated )

< 6 mol/L ( unconjugated)

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28
Q

How is Indirect Bilirubin Calculated?

A

Indirect bilirubin = Total Bilirubin - Direct Bilirubin

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29
Q

True or False? Conjugated bilirubin is Water soluble, so it is excreted by kidneys while Unconjugated - insoluble in water, bound to albumin in blood.

A

TRUE!!

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30
Q

Fill in the blanks. “ __________ is the yellow breakdown product of normal haem catabolism.”

A

Bilirubin

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31
Q

What is the name of the enzyme that converts haem to biliverdin?

A

Haemolytic Oxygenase

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32
Q

What is the enzyme that reduces biliverdin to unconjugated bilirubin?

A

Biliverdin reductase.

Duhh must be a reductase if its gonna reduce

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33
Q

Fill in the blanks. “Unconjugated bilirubin circulates in plasma bound tightly but reversibly to ________.”

A

Albumin

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34
Q

What is the name of the structure that carries bilirubin from cytosol into the smooth endoplasmic reticulum of the hepatocytes?

A

Ligandin

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35
Q

In the liver, where does the unconjugated bilirubin disassociate from albumin?

A

At the sinusoidal surface of the hepatocyte.

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36
Q

By what process is the unconjugated bilirubin after being disassociated by albumin taken up by the hepatocytes?

A

Facilitated diffusion that requires inorganic anions, such as Cl-.

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37
Q

What are examples of Haem proteins?

A

Catalase
Perioxidase
Cytochromes
Myoglobin
Tryptophan pyrrolase

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38
Q

In what part of the hepatocyte, is bilirubin conjugated with glucoronic acid?

A

Smooth Endomplasmic Reticulum

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39
Q

What is the rate-limiting step in bilirubin metabolism?

A

Secretion of conjugated bilirubin into the bile canaliculi.

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40
Q

What happens to conjugated bilirubin in the GI tract?

A

Conjugated bilirubin is degraded by bacterial action (bacterial proteases) mainly in the colon, to urobiligen( colourless )

Urobiligen is then further metabolised to stercobiligen and further OXIDIZED to stercobilin in large intestines.This gives faeces its brown colour.

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41
Q

What is the name of the process in which A small amount of urobilinogen (10%) is reabsorbed by the intestines (terminal ileum) and reaches the liver by portal blood supply and is then resecreted by the liver into the small intestine?

A

Enterohepatic circulation

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42
Q

What is the name of the substance that gives urine its yellow/straw colour?

A

Urobilin

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43
Q

What is the name of the substance that gives faeces its brown colour?

A

Stercobilin

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44
Q

What percentage of reabsorbed urobilinogen is transported by the blood to the kidneys where it is oxidized to urobilin and excreted.

A

ABout 5%

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45
Q

In which diseases are urobilin/urobilinogen and stercobilin are absent in urine and stool respectively. The stool will have a pale colour ( clay colour)?

A

Severe intrahepatic cholestasis or complete obstruction of the bile duct.

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46
Q

In what diseases , will there be urinary urobilinogen excretion increase?

A

In liver disease and states of increased bilirubin production.

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47
Q

What is the normal amount of serum bilirubin in the body?

A

Less than 18 micro -mol/L).

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48
Q

If the body’s serum bilirubin exceeds about 50 micro-mol/L , what disease can be indicated?

A

Jaundice (Icterus)

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49
Q

What are the three types of Hyperbilirubinaemia?

A

Pre-hepatic/ hemolytic - pathology is occurring prior to the liver.

Hepatic/ hepatocellular - The pathology is located within the liver.

Post-Hepatic/ cholestatic- pathology is located after the conjugation of bilirubin in the liver.

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50
Q

When does Prehepatic Hyperbilirubinaemia occur?

A

Results from excess production of bilirubin (beyond the livers ability to conjugate it) following hemolysis

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51
Q

What can cause pre-hepatic hyperbilirubinaemia ?

A

1.Excess RBC lysis the result of - autoimmune disease; hemolytic disease of the newborn.

  1. Structurally abnormal RBCs (sickle cell disease); or breakdown of extravasated blood.
  2. Ineffective erythropoiesis
  3. Bleeding into tissues
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52
Q

What are the laboratory findings of Prehepatic hyperbilirubinaemia?

A

1.Urine: Urobilinogen may be increased.

  1. Serum: increased unconjugated (indirect) bilirubin in the blood.

” Pre hepatic - increased UNCONJUGATED”

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53
Q

True or False? Hepatic Hyperbilirubinaemia occurs as a result Impaired uptake, conjugation, or secretion of bilirubin and normally reflects a generalized liver (hepatocyte) dysfunction.

A

TRUE!!

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54
Q

What are the causes of Hepatic Hyperbilirubinaemia?

A

Acute Hepatitis
Hepatotoxicity
Alcohol Liver disease
Primary biliary cirrhosis
Gilberts’s syndrome (Low UDP-glucuronosyltransferase activity

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55
Q

What is the name of the enzyme which catalyses the production of conjugated bilirubin?

A

Uridine diphosphate (UDP)-glucuronosyltransferase

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56
Q

What are the laboratory findings of Hepatic Hyperbilirubinaemia?

A

Urine: Conjugated bilirubin; urobilinogen (x 2 ULN) variable.

Serum: increased conjugated (direct) bilirubin in the blood (due to inability to excrete).

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57
Q

Which type of Hyperbilirubinaemia is caused by an obstruction of the biliary tree?

A

Posthepatic Hyperbilirubinaemia

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58
Q

Fill in the blanks. “Posthepatic Hyperbilirubinaemia is characterized by ________”

A

Pale coloured stools (absence of fecal bilirubin or urobilin),

Dark urine (increased conjugated bilirubin )

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59
Q

Fill in the blanks. “ In a complete obstruction of the biliary tree , ________ is absent from urine.

A

Urobilin

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60
Q

What are the most common causes of the Post- hepatic Hyperbilirubinaema ?

A

Gallstones in the common bile duct
Pancreatic cancer at the head of pancreas

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61
Q

Which type of Posthepatic Hyperbilirubinaemia occurs in acute hepatocellular cholestasis, cirrhosis, intrahepatic carcinoma, primary biliary cirrhosis etc?

A

Intrahepatic hyperbilirubinaemia

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62
Q

Which type of Posthepatic Hyperbilirubinaemia occurs occurs in gallstones, carcinoma of the head of the pancreas, carcinoma of the biliary tree, bile duct compression etc.

A

Extrahepatic hyperbilirubinaemia

(Extra occurs outside liver )

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63
Q

What are the laboratory findings of Posthepatic Hyperbilirubinaemia?

A

Urine: Dark (increased conjugated bilirubin),

Serum: increased conjugated bilirubin,

Decreased urobilinogen, in urine.

Stool colour: pale.

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64
Q

What is the test used to test serum bilirubin?

A

Van den Bergh test

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65
Q

In what type of hyperbilirubinaemia will give a Biphasic result when using the Van den Bergh test?

A

Hepatic Hyperbilirubinaemia

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66
Q

Fill in the blanks.”When testing with the Van den Bergh test , Pre- hepatic hyperbilirubinaemia will give a __________ result while Post hepatic hyperbilirubinaemia will give a_________ result.”

A

Pre- hepatic —–> Indirect Positive

Post- hepatic ——> Direct Positive

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67
Q

In which type of hyperbilirubinaemia is the AST and ALT levels very high?

A

Hepatic hyperbilirubinaemia

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68
Q

What are the types of bilirubin elevated in pre- hepatic , hepatic & post-hepatic bilirubinaemia?

A

Pre- hepatic —- Unconjugated bilirubinaemia

Hepatic Bilirubinaemia—— Unconjugated & Conjugated bilirubunaemia

Post - Hepatic —– Conjugated Bilirubinaemia

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69
Q

Which liver function test, tests for hepatocellular damage?

A

ALT & AST

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70
Q

Which liver function test, tests for cholestasis, impair conjugation or biliary construction?

A

Bilirubin

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71
Q

Which liver function test, tests for the synthetic function of the liver?

A

PT & Albumin

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72
Q

Which liver function test , tests for Cholestasis , Infiltrive disease or biliary obstruction ?

A

ALP

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73
Q

Which liver function test , tests for cholestasis or biliary construction ONLY?

A

GGT , Bile acids & 5’ nucleotidase

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74
Q

Which organ has the highest AST levels?

A

Heart

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75
Q

Which organ has the highest ALT levels?

A

Liver

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76
Q

True or False? Alanine aminotransferase ALT is more specific for liver diseases than AST.

A

TRUE!!

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77
Q

What is the normal reference interval in serum for ALT in males?

A

6-21 IU/ml

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78
Q

What is the normal reference interval in serum for ALT in females?

A

4-17 IU/ml

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79
Q

Greater than (>1,000 IU/mL ) in ALT will indicate what?

A

Extensive hepatocellular damage (viral acute hepatitis, ischemic liver injury , toxin /drug induced liver injury

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80
Q

What is the normal reference interval in serum for Aspartate aminotransferase (AST )?

A

7 - 32 U/L

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81
Q

Where is AST found in liver cells?

A

In the mitochondria and cytosol of liver cells

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82
Q

Where is ALT found in the liver cells?

A

ONLY in the cytosol

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83
Q

True or False? In Hepatobiliary diseases, Mild hepatobiliary injury the causes the plasma membrane to be damaged while in severe hepatocellular injury the mitochondrial membrane
damaged.

A

TRUE!!

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84
Q

Fill in the blanks. “In relation to liver function tests, In inflammatory or infective conditions, the ____________sustains the main damage. Leakage of cytoplasmic contents causes a relatively greater increase in ______than __________.

A

Cytoplasmic membrane sustains main damage

Increase in plasma ALT activities than AST activities

” InfLammatory - ALT&raquo_space;» AST

85
Q

Fill in the blanks. “In relation to liver function tests , In infiltrative disorders in which there is damage to both __________, there is a proportionately greater increase in _______ activity than ______. “

A

Both mitochondrial and cytoplasmic membranes

Greater increase in plasma AST than ALT

Infiltrative - AST&raquo_space;> ALT

86
Q

Where is Alkaline phosphatase (ALP) found in the liver ?

A
  • Sinusoidal surface of hepatocytes
  • The microvilli of the bile canaliculi.
87
Q

Where is Alkaline phosphatase (ALP) produced from?

A

Produced by biliary epithelial cells

87
Q

True or False? Placental isoenzyme ( isozyme of ALP) rises during the first 6 weeks of pregnancy .

A

FALSE!! It rises during the LAST 6 weeks of pregnancy.

87
Q

Which isoenzyme of alkaline phosphatase rises after a fatty meal and may increase during various GI disorders?

A

Intestinal isozyme

88
Q

What are the different isozymes of alkaline phosphatase?

A

Hepatic isozyme
Bone isozyme
Placental isozyme
Intestinal isozyme

88
Q

Which liver function test is a marker for biliary dysfunction?

A

ALP

88
Q

If the plasma ALP is usually increased to levels greater than three times ULN (Normal range, 15-105 U/L, this can be an indication of?

A

Obstructive cholestasis

89
Q

Which enzyme is a microsomal enzyme in which its synthesis is induced by ethanol and anticonvulsant drugs?

A

Gamma - glutamyl transferase (GGT) .

90
Q

Where is Gamma Glutamyl transferase located?

A

Bile canaliculi
Epithelial cells lining the bile ducts
Peripheral hepatocytes

91
Q

True or False? In biliary obstruction, plasma GGT activity may increase before that of alkaline phosphatase.

A

TRUE!!

92
Q

What are the causes of an elevated serum gammaglutamyl transferase (SGGT)?

A

Hepatobiliary disease
Pancreatic disease
Alcoholism
COPD
Renal failure
Diabetes
Myocardial Infarction
Drugs

93
Q

Which specific drugs will cause an increase in Serum gammaglutamyl transferase (SGGT)?

A

C- Carbamazepine
P- Phenytoin
B - Barbiturates

94
Q

What is the normal reference interval in serum for GGT ?

A

10-70 U/L

95
Q

Which enzyme liver function test can be used to confirm hepatic origin of elevated ALP levels?

A

5’-Nucleotidase

96
Q

What is the half life of Albumin?

A

20 days.

97
Q

True or False? Albumin significantly increases in chronic liver disease ex cirrhosis.

A

FALSE!! Significantly decreases in chronic liver disease (e.g. cirrhosis).

98
Q

An abnormally low content of albumin may indicate ?

A

Kidney disease
Malnutrition
Extensive burns
Malabsorption syndromes

99
Q

Which liver function test is a poor indicator of acute hepatitis disease?

A

Serum albumin

100
Q

Which tests are useful in determining the etiology of liver diseases ( the special tests of liver functions)?

A
  1. Alpha-1-antitrypsin,
  2. Alpha-fetoprotein,
  3. Immunoglobulins,
  4. Caeruloplasmin,
  5. Iron and Ferritin.
101
Q

What does elevated levels of plasma apple-fetopritein found in 75% of cases normally indicate?

A

Primary hepatocellular carcinoma.

102
Q

Which immunoglobulin is increases in alcoholic liver disease?

A

IgA - A for alcohol

103
Q

Which immunoglobulin is increases in Autoimmune hepatitis ( Chronic Hepatitis)?

A

IgG

( G comes before H - H for hepatitis)

104
Q

Which immunoglobulin is increased in a primary biliary cirrhosis (but these changes are non-specific)?

A

IgM

105
Q

Which liver function tests are useful in the diagnosis of Myocardial infarction also?

A

AST & GGT

106
Q

Conditions such as Osteomalacia, rickets , Paget’s disease , Pregnancy, Hyperparathyroidism will cause an increase in what enzyme?

A

Alkaline phosphatase ( ALP )

107
Q

What is Hepatitis?

A

Hepatitisis defined by the inflammation of theliverand characterized by the presence ofinflammatorycells.

108
Q

Acute hepatitis can be characterised by ?

A

*No evidence of fibrosis or cirrhosis

  • Normal architecture is preserved.
  • May be some lobular disarray
109
Q

What enzymes are increases as a result of cell necrosis in Acute Hepatitis?

A

AST & ALT

ALT»> AST

110
Q

What enzymes are increased as a result of swollen hepatocytes?

A

ALP levels (enzyme induction) and GGT.

111
Q

What are the different forms of alcoholic liver disease?

A

Hepatic steatosis ( Fatty liver disease)

Alcohol hepatitis

Cirrhosis

112
Q

How does alcohol induce alcohol hepatitis?

A

Alcohol seems to injure theliverby blocking the normal metabolism of protein, fats, and carbohydrates.

113
Q

Which enzyme is elevated in severe alcohol hepatitis?

A

Serum aspartate aminotransferase (AST) is typically elevated to a level of 2-6 times the upper limits of normal in severe alcoholic hepatitis.

114
Q

What are the laboratory findings for Alcohol hepatitis?

A
  1. Increased Transaminases AST» ALT
  2. Markedly increase GGT - enzyme induction by alcohol.

3.Elevated total bilirubin

115
Q

What are the symptoms of Alcohol hepatitis?

A

Patients present with :

  • Fever, Jaundice
  • Painful hepatomegaly
    *Absolute neutrophilic leukocytosis
  • Macrocytic anaemia ( due to folate deficiency )
  • Abnormal coagulation test ( Prolonged PT)
116
Q

According to the histopathology of chronic hepatitis, Inflammatory activity confined to PORTAL areas is classified as?

A

Chronic persistent hepatitis

117
Q

According to the histopathology of chronic hepatitis, inflammation that has spilled into the adjacent lobule of associated with necrosis or fibrosis, which progresses to cirrhosis and liver failure is calcified as?

A

Chronic Active hepatitis.

118
Q

According to the histopathology of chronic hepatitis, Chronic lobular hepatitis is classified as?

A

Inflammatory activity and necrosis scattered throughout the lobule.

119
Q

True or False? Neither hepatitis A nor hepatitis E causes chronic hepatitis.

A

TRUE!!

120
Q

What specific drugs are associated with the causes of Chronic hepatitis ?

A

Methyldopa
Nitrofurantoin
Isoniazid
Ketoconazole

121
Q

Which hereditary diseases are associated with causing Chronic hepatitis?

A

Wilson’s disease & alpha 1-antitrypsin deficiency .

122
Q

Fill in the blanks. The albumin level is _______ in Chronic Alcoholic hepatitis.

A

DECREASED

123
Q

What are causes of Chronic Persistent Hepatitis include?

A

Causes include hepatitis B (HBV), hepatitis C (HCV), hepatitis D (HDV), autoimmune diseases such aslupus, alcohol, and drugs.

124
Q

What is Cirrhosis?

A

Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules .

125
Q

What is the most type of Liver cancer?

A

Hepatocellular carcinoma

126
Q

What are the main risk factors for hepatocellular carcinoma?

A

Alcoholism
Hepatitis B
Hepatitis C
Cirrhosis of liver
Haemochromatosis
Wilson’s disease
Typer 2 diabetes

127
Q

What is Wilson’s disease?

A

Wilson’s disease is an AUTOSOMAL RECESSIVE genetic disorder in which copper accumulates in tissues; this manifests as neurological or psychiatric symptoms and liver disease.

128
Q

What is Haemochromatosis ( Bronze diabetes) ?

A

An autosomal recessive disease characterized by excessive iron uptake from the gut and iron deposition in the tissues which can affect many organs including the liver.

129
Q

How can one be diagnosed with Haemochromatosis?

A

Measuring Plasma Iron
Total binding capacity (TIBC)

130
Q

What is a major finding in Haemochromatosis?

A

Serum Ferritin is elevated

131
Q

Which inborn errors of metabolism results in an increase in unconjugated bilirubin?

A

Gilbert’s syndrome & Crigler-Najjar syndrome

132
Q

Which inborn errors of metabolism results in an increase in conjugated bilirubin?

A

Dubin-Johnson syndrome & Rotor’s syndrome

133
Q

What are the two types of Crigler-Najjar syndrome?

A

Type I - Absolute deficiency
Type II - Partial deficiency

134
Q

Which type of Crigler-Najjar syndrome results in kernicterus ( too much bilirubin in baby’s blood causes brain damage)?

A

Type I - Absolute deficiency

135
Q

Which type of Crigler-Najjar syndrome results in life-long unconjugated hyperbilirubinaemia>

A

Type II- Partial deficiency

136
Q

True or False? Gilbert syndrome & Crigler-Naijjar Syndrome has no evidence of haemolysis.

A

TRUE!!

137
Q

What is Dubin- Johnson syndrome?

A

This is an autosomal recessive disorder due to defective excretion of conjugated bilirubin, but not of bile acids, and is characterized by slightly raised plasma conjugated bilirubin levels that tend to fluctuate.

138
Q

True or False? Gilbert Syndrome is autosomal recessive.

A

FALSE!! Gilbert syndrome is Autosomal Dominant

Gilbert is dominant lol

139
Q

True or False? Crigler-Najjar Syndrome & Rotor Syndrome is autosomal recessive.

A

TRUE!!

140
Q

Which in born error metabolism of the liver results in hepatomegaly and liver histology reveals a darkly pigmented liver that is black (or dark brown) on gross inspection?

A

Dubin -Johnson syndrome

141
Q

What is the main symptom of Rotor Syndrome?

A

Non- itching jaundice

142
Q

True or False? Rotor syndrome has many things in common with Dubin-Johnson syndrome, an exception being that the liver cells are not pigmented (normal histology and appearance).

A

TRUE!!

143
Q

What is Zollinger - Ellison syndrome?

A

A malignant tumor that secretes gastrin, leading to increased acid production with widespread gastroduodenal ulcers.

144
Q

What is the average circulating serum gastrin in a Fasting individual?

A

0 – 100 pg/mL

145
Q

Fill in the blanks. “ Maximal gastric acid secretion can be measured by ___________.”

A

The pentagatrin test.

146
Q

What are the causes of Acute Pancreatitis?

A

Excessive Alcohol Ingestion
Gallstones
Elevated trigylcerides in blood
Hypercalcaemia

147
Q

What laboratory test can be used to determine acute pancreatitis?

A

Serum amylase
Serum lipase
2-hour urinary amylase
Blood glucose
Serum calcium
Trigylcerides

148
Q

Which laboratory diagnosis is most preferred for acute pancreatitis?

A

Serum lipase - it is more specific and remains elevated longer than amylase after disease presentation.

149
Q

At what time is peak hour for serum amylase in detection of acute pancreatitis?

A

12-72 hours

150
Q

True or False? If the lipase level is 2 – 3 times that of amylase it is an indication of acute pancreatitis due to alcohol or gallstones.

A

TRUE!!

151
Q

What are the laboratory findings of Acute Pancreatitis?

A

1.Serum may be lipaemic ( due to hypertriglyceridaemia).

  1. There may be mild increase in bilirubin concentration (direct and total)

3.ALP (and GGT) activity in acute pancreatitis due to alcohol use.

4.Hypocalcemia is a frequent finding in acute pancreatitis.Exact mechanism of hypocalcemia in acute pancreatitis is unknown.

  1. Hyperglycemia
152
Q

What is Chronic pancreatitis characterised by?

A

It is a benign inflammatory process & fibrosing disorder characterized by :

  1. Irreversible morphologic changes
  2. Progressive & Permanent loss of exocrine & endocrine function .
153
Q

Steatorrhea (increasein fat excretion in thestools) is noted in many conditions such as?

A

Exocrine pancreatic insufficiency (EPI)
Celiac disease
Tropical sprue

154
Q

Fill in the blanks. “ _________ is one of the clinical features of fat malabsorption.”

A

Steatorrhea

155
Q

What is the typical triad for Chronic pancreatitis?

A

Chronic upper abdominal pain
Malabsorption ( Stteatorrhoea & weight loss)
Calcification of Pancreas ( on AXR - abdominal x-ray or Ct)

156
Q

What are the different investigations to detect Chronic pancreatitis?

A

F - Faecal elastase
A - Amylase /lipase often normal
S -Secretin stimulation test
C- CT to look for calcification
A- Abdominal X-ray to look for calcification

157
Q

What is the gold standard test to determine Chronic pancreatitis but is rarely used?

A

Secretin Stimulation test

158
Q

What is good diagnostic diagnostic test for chronic pancreatitis?

A

Faecal elastase

159
Q

Where is Elastase -1 ( a protease) produced from?

A

Pancreatic acinar cells

160
Q

What are the functions of Elastases?

A

They are protease enzymes that hydrolyses elastin among many other chemicals.

161
Q

Fill in the blanks. “In Chronic pancreatitis there is a _________ in elastase production.”

A

There is a REDUCTION !

162
Q

What method should be used when testing for faecal elastase?

A

Immunoassay or Monoclonal ELISA.

163
Q

In what condition , can a false positive of the fecal elastase test be given?

A

If the stool is watery .
‘Alice lol’

164
Q

Which test can indicate autoimmune pancreatitis?

A

Immunoglobulin G4 serum antibody, antinuclear antibody ,rheumatoid factor, erythrocyte sedimentation rate.

165
Q

In Chronic pancreatitis, what happens to the parenchyma of the pancreas?

A

Fibrosis
Loss of acini and islets of Langherans
Formation of pancreatic stones

166
Q

In Chronic pancreatitis, what happens to the pancreatic ducts?

A

There is Stenosis ( narrowing )
Presence of pancreatic stones

167
Q

What is a widely used serum marker for pancreas cancer ?

A

Carbohydrate antigen19-9 ( CA 19-9)

168
Q

What are laboratory findings for Pancreatic cancer?

A

Jaundice
Pain
Loss of appetite
Dark urine
Light coloured stool
Increase AST, ALT, ALP, GGT, Direct & Indirect bilirubin

169
Q

What are the main sources of AST?

A

Heart
Liver
Skeletal muscle
Kidney

170
Q

A crush injury, trauma or myopathy would cause an increase in what enzyme?

A

AST

171
Q

When the AST/ALT ratio is > 1.0 but less than 2.0 the pathogenesis is most likely associated with?

A

Cirrhosis of the liver and chronic hepatitis

172
Q

When the AST/ALT > 2.0 it is most likely associated with what conditions?

A

Alcoholic hepatitis or Hepatocellular carcinoma or Wilson’s

173
Q

What are the three enzymes that reflect Cholestasis?

A

ALP
GGT
5’Nucleotidase

174
Q

Which enzyme may be raised in the case of COPD& Diabetes ?

A

GGT

175
Q

Which enzyme liver function test may be used to confirm hepatic origin of elevated serum ALP?

A

5’-Nucleotidase

176
Q

Fill in the blanks. “ Albumin levels ____________ in the early stages of acute hepatitis .”

A

Remain NORMAL

177
Q

Fill in the blanks. “ Albumin levels ____________ Chronic liver diseases ex cirrhosis.”

A

Significantly DECREASES

178
Q

True or False? The Clinical Jaundice phase of Acute viral hepatitis occurs 1-2 weeks after onset of Prodromal phase.

A

TRUE!!

179
Q

What are the forms of Alcoholic liver diseases?

A

Hepatic steatosis( fatty liver diseases)
Alcoholic hepatitis
Cirrhosis

180
Q

What are the clinical features of Alcoholic Hepatitis?

A

Fever, Jaundice
Painful Hepatomegaly
Absolute Neutrophillic leukocytosis
Macrocytic anaemia
Prolonged PT

181
Q

What is the Plasma gastrin concentration for patients with Zollinger- Ellison syndrome?

A

150- 1000

182
Q

What are reasons for a false positive serum amylase test when trying to detect Acute pancreatitis?

A

Salivary gland disease & Macroamylasemia.

183
Q

What is the peak level for Serum Amylase?

A

24 hours

184
Q

True or False? Acute pancreatitis can cause Triaditis in cats.

A

FALSE!! Chronic pancreatitis causes this.

185
Q

What are direct tests used to test pancreatic function?

A

1 ) Measurement of Bicarbonate concentration & Amylase or Trypsin activity following a test meal ( Lundh test) or the administration of Secretin and CCK

186
Q

What are Indirect tests used to test for Pancreatic function?

A

Fluorescein dilaurate ( Pancreolauryl test) and p—aminobenzoic acid (PABA) test.

187
Q

Which test is a non-invasive test of pancreatic exocrine function?

A

Fluorescein Dilaurate Test

188
Q

True or False? Patients has to intubated when using Direct tests for pancreatic function.

A

TRUE!! They are NOT intubated in indirect tests such as Fluorescein Dilaurate Test

189
Q

What is the best test used to investigate the ingestion of carbohydrates and its measurement of their plasma concentrations or urinary excretion?

A

Xylose absorption test.

190
Q

True or False? D- Xylose is a pentose sugar that is NOT normally present in the blood?

A

TRUE!!

191
Q

What is the function of the D- Xylose absorption test?

A

It is used to screen for malfunction of absorption and helps to differentiate intestinal malabsorption syndromes from pancreatitis.

192
Q

Fill in the blanks. “ In intestinal malabsorption syndrome there is ________ D- Xylose absorption while in pancreatitis there is _______ D-Xylose absorption.”

A
  • Reduced D-Xylose absorption in Intestinal absorption
  • Normal D-Xylolse absorption in Pancreatitis
193
Q

In what conditions is one expected to see abnormal amounts of D-xylose?

A
  • Severe coeliac disease
  • Disorders of the proximal small intestine causing malabsorption.
194
Q

What is Lactose Intolerance?

A

Lactose intoleranceis a condition in which people have symptoms due to the decreased ability to digestlactose, a sugar found indairy products.

195
Q

Fill in the blanks. “ Lactose intolerance is due to a deficiency in the enzyme ______.”

A

Lactase

196
Q

True or False? Lactose is a monosaccharide.

A

FALSE!! It is a disaccharide

197
Q

What is the function of the Hydrogen breath test?

A

Ahydrogen breath test(orHBT) is used as a diagnostic tool forsmall intestine bacterial overgrowthandcarbohydratemalabsorption, such aslactose,fructose, andsucrosemalabsorption.

198
Q

Fill in the blanks. “ During hydrogen-breath test , the hydrogen exhaled in the breath is estimated using a _________.”

A

Gas chromatograph.

199
Q

What is a positive result of the Lactulose Small Intestine Bacterial Overgrowth (SIBO) Hydrogen test?

A

If the patient produces approximately 20 ppm of hydrogen and/or methane within the first 60–90 minutes (indicates bacteria in the small intestine),

200
Q

What substance is given to patients when doing the SIBO Hydrogen Test?

A

Glucose,aka DEXTROSE(75–100grams), or Lactulose(10grams).

201
Q

What is the gold standard used for diagnosis of Small Intestine Bacterial Overgrowth ?

A

Quantitative culture of jejunal aspirate

202
Q

How often is a Hydrogen test for Lactose malabsorption taken?

A

Every 15, 30 or 60 minutes for two to three hours.

203
Q

What substance is given to patients who are undergoing a Hydrogen breath test for Lactose absorption ?

A

Lactose (duhhh ) - 20 -25 grams

204
Q

How I a positive result deterred for Lactose & Fructose malabsorption using the Hydrogen Breath test?

A
  • If the level of hydrogen rises above 20 ppm (parts per million) over the lowest preceding value within the test period, the patient is typically diagnosed as a fructose malabsorber or Lactose malabsorber
  • If the patient produces methane then the parts per million for the methane typically rises 12 ppm over the lowest preceding value to be considered positive.
205
Q
A

Digestive System (16 decks)

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