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PA3201 final > Digestive pathology 3 > Flashcards

Digestive pathology 3 Flashcards

1
Q

what is the most common pathological finding of the lver

A

Jaundice

color change due to elevated bilirubin in the body

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2
Q

what is the process of decay of senescent RBCs

A

happens in macrophages

  • Globin chain split off-> heme is present without surrounding globin
  • Heme then separates into iron and unbound unconjugated bilirubin
  • release of unbound unconjugated bilirubin in the blood
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3
Q

What is the liver phase of bilirubin transformation

A
  • unconjugated unbound bilirubin gets into liver
  • liver phase of bilirubin biochem transformation is done via uridine glucosyl treansferase
  • -that enzyme eventually binds unconjugated bilirubin w glucose, creating conjugated bilirubin
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4
Q

Boweel stage of bilirubin transformation

A

In the bowel there is urobilinogen
80% of urobilogen is converted into urobilin (what causes brown stool)
20% returned to circulation
10% released thru kidney

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5
Q

Causes of bilirubin elevation (4)

A
  1. Plasma elevation of unconjugated bilirubin
  2. Plasma elevation of unconjugated/conjugated bilirubin
  3. Unconjugated hyperbilubrubinemia
  4. Congugated hyperbulirubinemia
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6
Q

Why does plasma elevation of unconjugated bilirubin happen

A
  • overprod of bilirubin (due to excessive decay of RBCs)
  • Impaired bilirubin uptake by the liver
  • abnormalities of bilirubin conjugation
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7
Q

Why does plasma elevation of both unconjugated and conjugated bilirubin occur

A
  • hepatocellular disease
  • impaired canalicular excretion of bilirubin
  • biliary obstruction
  • conjugated hyperbilirubinemoa
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8
Q

why does unconjugated hyperbilirubinemia

A

hemolysis
extravasation of blood into tissue
dyserythropoiesis
stress situations

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9
Q

Why does conjugated hyperbiliruvinemia occur

A

(usually occurs with any problem below the liver*)

-Biliary obstruction
-viral hepatitis
-alcoholic hepatitis
-nonalcoholic steatohepatitis
-primary biliary cirrhosis
etc etc

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10
Q

Fraction of conjugated bilirubin below 20%=

A

Unconjugated hyperbilirubinemia

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11
Q

fraction of conjugated bilirubin bw 20-50% (+causes_

A

-mixed Jaundice

causes= hepatitis, tumor of liver

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12
Q

Fraction of conjugated bilirubin greater than 50% (+causes)

A

conjugated hyperbilirubinemia

causes= bile duct obstruction, either intra hepatic, extra hepatic or post hepatic

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13
Q

Clinical manifistations of jaundice

A 
yellow pigmented skin
yellow sclera
malabsorption
light colour chalky stools
dark beer like urine
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14
Q

viral hepatitis + Alcoholic hepatitis ALT and AST ratio

A

Viral hep- ALT more elevated than AST

Alcoholic hep- AST elevated than ALT

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15
Q

What is elevated in cholestasis and cholestatic cirrhosis

A

Elevation of serum alkaline phosphatase

Elevation of gama glutamyl transferase

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16
Q

What markers will you see in a hepatocyte function problem

A

Changes in serum albumin

Changes in prothrombin time

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17
Q

What will you see in tumors of kindney

A

Increase in alpha fetal protein

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18
Q

mc of fatty liver disease

A

alcoholism

metabolic changes and conversion of ethanol into triacyglyerol. Deposition of triacyglyerol through the tissue

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19
Q

What is liver cirrhosis

A

Ongoing liver damage w liver cell necrosis followed by fibrosis and hepatocyte regeneration result in liver function (end stage liver disease)

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20
Q

what are the fibrotic changes in liver cirrhosis stimed by

A
  • chronic inflammation
  • cytokine release-> which signals collagen deposition
  • direct stimuli via hepatitis viruses
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21
Q

Examples of chronic liver disease that leads to cirrhosis

A

Chronic inflammatory pathology (hepatitis)
Chronic hepatic vascular disease
Cholestasis (obstruction of bile flow)

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22
Q

What are the common causes of macronodular cirrhosis

A

Viral hepatitis (B/C)

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23
Q

mc causes of micronodular cirrhosis

A

Chronic alcoholism (nodules less than 3mm in size)

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24
Q

chronic pres of longstanding liver cirrhosis

A
  • Portal hypertension + Caput medusae
  • Markedly decreased detox of liver
  • Excessive estrogen prod of liver
  • Decreased synthesis of hepatic tissue\
  • Decreased gluconeogeneis
25
What is a typical symptom of end stage liver disease
Peripheral edema
26
Portal hypertension and what does it lead to
Portal hypertension is defined as an increase in pressure in portal vein in the liver - ascites - splenomegaly - portosystemic shunting - esophageal varices
27
What is ascites
Changes in architecture of liver build up in area of portal vein - leads to increase in pressure in peritoneal capillaries and starts seeping thru walls of capillaries - liquid leaks thru accumulates in peritoneal cavity
28
What does splenomegaly lead to
Causes suppression of hematopoiesis which results in Anemia/ leukopenia/ thrombocytopenia (manifests as patients propensity to bleed)
29
What is portosystemic shunting of blood
- pressure in portal systems build up to a point where we have no ability to expand anymore - -as a result there are several sites of portal caval anastomoses
30
What are esophageal varices
-prob associated w portal hypertension --submucosal veins of esophagus become dialiated
31
What is hereditary hemochromatosis and what can it lead to
mutation in the hemochromatosis gene (HFE) that leads to increased iron absorption from the gut -Hemochromatosis leads to bronze pigmentation of skin, diabetes mellitus and cardiac arrhythmias
32
What is extrahepatic biliary tract obstruction/cholestatis and what causes it
Obstruction of intra and extra hepatic bile ducts causes accumulation of bilirubin in liver -bile duct/head of pancreas tumor compresses common bile duct, gallbladder stones, tumor of common bile duct
33
What is an intrahepatic biliary tract obstruction/cholestasis and causes
blockage of the intra hepatic bile ducts causes- contraceptive, phenothiazines preg, primary biliary cirrohsis
34
What is a hepatic adenom
Often benign composed of cells that closely resemble normal hepatocytes, but the neoplastic liver tissue is disorganized hepatocyte cords and does not contain normal lobular architecture
35
What is hepatocellular carcinoma and causes
Arise in setting of cirrhotic changes Causes - Hepatitis B/C - Cirrhosis - Alcoholism - Ephla toxin
36
What cancers metastisize to the liver and findings associated
Any kind can, especially ones from the abdominal cavity - Enlarged liver - Elevated levels of ALP - Elevated bilirubin - Some elevation of transaminse levels
37
How is hep A/E, B and C transmited
A/E- fecal orally/water B- Transmitted parentarally, sexually, vertically C- transmitted parentally, sexuall, IV drugg
38
Hep B serological markers (4)
HBsAg- indicates peron is infectipus anti-HBs- indicates recovery, immunity, vac Anti- HBc- previous or ongoing inf IgM anti HBc- recent inf/ accute inf
39
What is cardiac cirrhosis
Heart isn’t pumping blood properly which leads to liver congestions and changes to liver parenchyma (congestive state of liver-> typical findings of cirrhosis)
40
What is extraheypatic biliary atresia
Congenital condition where patient born w no biliary ducts outside liver --Will not survive
41
What is alpha-1-antitrypsin def and what can it cause in future
- Due to def - Common manifestation of obstructive pulmonary diesease - emphasema later
42
What are the causes of pancreatic pathology (5)
- Low temps and hemorrhagic shock cause hyper percussion of the pancreas - alcohol consuption - eating rich and fatty foods - gallstones - viral pathology
43
Effects of alcohol on pancreatic pathology
- alcohol abuse can cause increased permeability of the pancreatic duct to pancreatic digestive enzymes - alcohol increases obstruction of pancreatic duct by increasing mucus concentration and therefore behaving like a plug
44
What is acute peritonitis
Activation of pancreatic pro enzymes lead to auto digestion of the pancrease (trypsin is mc pancreatic enzyme which causes activation of pro enzymes)
45
Tests results for acute peritonitis
Amylase released into blood | Increase in serum immunoreactive trypsin
46
clinical presentation of acute pancreatitis
- mid epigastric pain w retroperitoneal an dmid thoracic pain - nausea and vommiting - fever - deposition of fluids in third space
47
complications of acute peritonitis
- pancreatic necrosis - pancreatic infections - pancreatic abscess - convulsions - ARDS
48
what is chronic pancreatis and causes
continuing inflammatory process with exocrine atrophy and fibrosis -- will eventually lead to complete abolishment of endocrie and exocrine function of pancrease chronic alcohol access is comments cause
49
complicatuons of chronic pancreatis
- intestimal malabsorption and diabetes may occur at advanced stage (since pancreas no longer producing digestive enzymes) - Loss of beta cells in Langerhans - Lack of pancreatic extract (leads to inability to cleve r factor in b12 leading to def)
50
lab tests for chronic pancreatis
amylase/lipase very unreliable | Will see decrease in serum immunoreactive trypsin
51
What is the usually carcinoma of the pancreas and who is it common in/ risk factors
usually ductal adenocarcinoma mc in men (70-80s) cig smoking k-RAS gene mutation
52
tumor marker for carcinoma of pancreas
CA-19-9
53
mc location of pancreatic adenocarcinoma and s/s`
head of pancreas s/s- Signs of common bile duct obstruction, jaundice, superficial migratory thromo-phlebitis, Retroperitoneal hemmorach causing leakage to skin (bruising)
54
What is acanthosis nigricans and what is it found in
found in pancreatic cancer | -severe discolouration of skin (in neck, butt, palms, soes)
55
Common sites of metastisis of pancreatic cancer (2)
Left supra clavicular node | pre umbilical metastissi
56
what are the 2 forms of acute cholecystitis (inflammation of gallbaldder)
Acalculous- inflammation of gallbladder without presence of gallstones Cholelithiasis- gallstones present
57
clinical pres of acute cholestitis
may present as post prandial biliary colic (right upper quad after eating fatty meals) - nausea and vommiting - fever - US is diagnostic
58
What are majority of gallstones made of
cholesterol and some made from bilirubin
59
Risk factros for gallstome
w over 40 oral contraceptives obesity horomone replacement therapy

PA3201 final (20 decks)

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