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Endocrine and Hepatobiliary Flashcards

1
Q

_____ system
• Maintain metabolic equilibrium (homeostasis)
• Secrete chemical messengers (hormones)
• Regulate activity of various organs
• Process of feedback inhibition
• Increased activity of target tissue, typically down-
regulates activity of gland secreting stimulating
hormone
•diseases
a. diseases of under/over-production of hormones
b. diseases associated with development of mass
lesions

A

Endocrine System

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2
Q 
• Base of brain-sella turcica
• Connected to hypothalamus 
a.  stalk composed of axons
b.  venous plexus
• Central role in regulation of other endocrine 
glands
• Two components
a. anterior lobe (adenohypophysis)
b. posterior lobe (neurohypophysis)
• Diseases divided according to lobe mainly 
affected
A

Pituitary gland

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3
Q

• Produces growth hormone

A

• Somatotrophs

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4
Q

• Produces prolactin

A

• Lactotrophs

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5
Q

• Produces adrenocorticotrophic hormone

A

• Corticotrophs

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6
Q

• Produces thyroid simulating hormone

A

• Thyrotrophs

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7
Q

• Produces follicle stimulating hormone and luteinizing

hormone

A

• Gonadotrophs

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8
Q
  • Pituitary Adenomas
  • Radiation Treatment
  • Neurosurgery
  • Sheehan Syndrome
  • Ischemic necrosis of pituitary gland
  • Pituitary Dwarfism
  • Amenorrhea & Infertility
  • Libido & Impotence
  • Postpartum lactation failure
  • Hypothyroidism
  • Hypoadrenalism
A

Hypopituitarism

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9
Q
  • Pituitary Adenomas
  • Pituitary Hyperplasia
  • Pituitary Carcinomas
  • Hypothalamic disorders
  • Gigantism
  • Acromegaly
  • Cushing disease
A

Hyperpituitarism

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10
Q 
• Primary tumor
• Excess growth hormone (GH)
• Adenoma of anterior 
pituitary
• 2nd most common
• Affects all “growing tissues” 
• Gigantism- before growth 
plate closure
A

Hyperpituitarism

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11
Q 
•Generalized 
overgrowth• 3 standard deviations
•Headaches
•Chronic fatigue 
•Arthritis, 
osteoporosis
• Muscle weakness
•Hypertension
•Congestive heart
A

Gigantism

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12
Q 
• Late diagnosis
• Poor vision; photophobia 
• Enlarged skull, hands, feet, ribs
• Soft tissue, viscera  
• Enlarged maxilla, mandible, nasal and frontal 
bones, maxillary sinus
• Intraoral: 
• Diastemas
• Malocclusion
• Macroglossia
• Enlarged lips
• Sleep apnea
A

Acromegaly

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13
Q 
\_\_\_\_\_\_\_ pituitary issues:
• Diabetes Insipidus (Central)
• Polyuria
• Dilute urine
• Polydipsia
• Secretions of Inappropriately High 
Levels of ADH (SIADH)
• Hyponatremia
• Cerebral edema
• Neurologic dysfuction
• Total Body Water
• Blood volume normal
• No peripheral edema
A

Posterior pituitary

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14
Q

____ controls TSH secretion

A

TRH

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15
Q

_____ controls T3 and T4 production

A

TSH

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16
Q

What 3 things are responsible for thyroid function? (glands)

A

Hypothalamus
Pituitary
Thyroid

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16
Q

What 3 things are responsible for thyroid function? (glands)

A

Hypothatlamus
Pituitary
Thryoid

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17
Q 
\_\_\_\_\_ hypothyroidism
• Intrinsic abnormality 
in the thyroid
• Surgery
• Radiotherapy
• Autoimmune
A

Primary

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18
Q

_____ hypothyroidism

• Pituitary failure

A

Secondary

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19
Q
  • Adult
  • Generalized fatigue
  • Apathy
  • Mental sluggishness
  • Listless
  • Cold intolerance
  • Overweight
A

Myxedema

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20
Q 
• Childhood
• Impaired skeletal 
development
• Severe mental 
retardation 
• Short stature
• Course facial features
• Delayed tooth 
eruption
A

Cretinism

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21
Q

Symptoms of ______:

  • Cold intolerance
  • Fatigue, lethargy
  • Weight gain
  • Constipation
  • Bradycardia
A

Hypothyroidism

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22
Q 
• Autoimmune 
• Painless 
enlargement
• Symmetric & 
diffuse
• Risk of B-cell non-
Hodgkins
Lymphomas
A

Hashimoto thyroiditis

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23
Q 
Clinical signs and symptoms Goiter (small)
Exophtalmus (frequent)
Heat intolerance
Weight loss
Malabsorption and diarrhea
Tachycardia
Irritability and anxiety
Most common causes Autoimmune - Graves’ disease and 
Hashimoto’s thyroiditis
Laboratory T4 and Free T4 elevated 
T3 and Free T3 elevated
TSH and TRH suppressed
A

Hyperthyroidism

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24
Q

Symptoms of _____:

  • Weight loss
  • Nervousness
  • Rapid pulse
  • Goiter
  • Muscle wasting
A

Hyperthyroidism

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25
Q
  • Tachycardia
  • Increased appetite
  • Weight loss
  • Exophthalmos
  • Intolerance to heat
A

Graves disease

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26
Q 
• Diagnosis
• TSH
• Primary-low
• Secondary- normal to high
• T4 (T3) increased
• Treatment
• Ablation
• Significance
• Thyroid storm
• Caused by infection, stress, 
trauma
• Elevated body temp.
• Tachycardia
• 20-40% mortality
A

Graves disease

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27
Q 
• Thyroid enlargement
• Impaired synthesis of thyroid 
hormone
• Iodine deficiency
• Endemic
• Hyperplasia of follicles
• Pituitary stimulation
• Maintenance of minimal function 
(euthyroid)
• Diffuse early on, then nodular
• Diet deficient in iodine
• Decreased output of T3 & T4 by thyroid
• Pituitary responds by secreting TSH
• Thyroid hyperplasia
A

Goiter

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28
Q

Derived from developing pharyngeal pouches
Lie in close proximity to upper and lower poles of each thyroid
lobe
May be found on path of descent of pharyngeal pouches –
carotid sheath, thymus, anterior mediastinum
Secrete Parathormone (PTH) which, with calcitonin regulates
calcium homeostasis –controlled by the level of free (ionized)
calcium

A

Parathyroid gland

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29
Q

_____: Activates osteoclasts activity
Increases Ca renal tubular resorption
Increases conversion of Vit. D into the active
dihydroxy form in the kidneys
Increases urinary excretion of phosphates
Increases Ca absorption by the GI tract.

A

PTH:

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30
Q
  • Hypocalcemia
  • Tetany
  • Chvostek Sign
  • Tapping CN VII
  • Muscle contraction
  • Eye, mouth, nose
  • Trosseau sign
  • Occluding circulation of forearm
  • Carpal spasm
A

Hypoparathyroidism

31
Q

_____ hyperparathyroidism
Adenoma
Hyperplasia
Carcinoma
Morphologic changes
Skeletal changes - bone resorption
- Formation of bone cysts and hemorrhages
(osteitis fibroso –cystica)
- Brown tumors
-Urinary tract stones (nephrolithiasis)
- Metastatic calcification
Serum calcium levels, especially Ionized calcium levels are high
•Hypercalcemia
• Hypophosphatemia
• Increased urinary excretion of both calcium and
phosphate

32
Q

______ hyperparathyroidism:
Calcium is chronically depressed and low serum calcium
levels lead to compensatory hyperactivity of the
parathyroids
Serum phosphate levels are elevated
Causes
Chronic renal failure
Vitamin D deficiency
Inadequate dietary calcium
Steatorrhea
Morphology
Hyperplastic parathyroid glands
Bone chages (see primary hyperparathyroidism)
Metastatic calcification
Not as severe as in primary hyperparathyroidism
Related to symptoms secondary to chronic renal failure
Bone abnormalities (renal osteodystrophy)
Calciphylaxis
Tertiary hyperparathyroidism

33
Q
  • Osteomalacia & loss of lamina dura
  • Brown tumor
  • Nephrolithiasis
  • Peptic/duodenal ulcers
  • Mental changes
A

Hyperparathyroidism

34
Q

• Increases serum calcium
• Activates osteoclasts
• Increases renal tubular reabsorption of
calcium
• Increases renal conversion of Vit D
• Increases urinary excretion of phosphate
• Increased gastric absorption of calcium

35
Q

_____ portion of adrenal gland:
• Aldosterone
• Regulated by angiotensin II

A

• Zona Glomerulosa

36
Q

_____ portion of adrenal gland:
• Glucocorticoids (cortisol)
• Regulated by ACTH (biofeedback)

A

• Zona Fasiculata

37
Q

_____ portion of adrenal gland:
• Androgens
• No feedback with ACTH

A

• Zona Reticularis

38
Q
  • Destruction of adrenal cortex
  • Production of adrenal corticosteroid hormones
  • Autoimmune
  • Metastatic carcinoma
  • Infections
  • TB
  • Deep fungal
  • Secondary hypoadrenocorticism
  • Disorder of hypothalamus or pituitary gland
A

Addison’s disease

39
Q
  • Clinical symptoms appear late
  • Weakness & Fatigue
  • Hypotension (postural)
  • GI disturbances
  • Nausea/ Vomiting (N/V)
  • Anorexia
  • Diarrhea
  • Weight Loss
  • Salt cravings ( K+ ↑, Na+↓,)
  • Hyper-pigmentation (Bronzing)
  • ACTH precursor stimulates melanocytes
  • Frictional areas
  • Adrenal Crisis (Acute)
  • Abdominal pain
  • Hypotension
  • Vascular collapse
A

Addison’s disease

40
Q 
\_\_\_\_\_\_ Hypercortisolism:
• Too much endogenous steroid
• Females 5x
• 3rd decade
• Pituitary adenomas (ACTH)
• 50% 
• Cushing disease
• Adrenal hyper/neoplasia
• 10-20%
• Neuroendocrine tumors
• Produce ACTH
• Small Cell Lung Carcinoma
A

•Primary hypercortisolism

41
Q

______ Hypercortisolism:

• Most common
• Exogenous
• Rule of 2s
• Can become hypocortisol
without taper
A

•Secondary hypercortisolism

42
Q
  • Presentation
  • Central obesity
  • Peripheral wasting
  • Buffalo hump
  • “Moon facies”
  • Abdominal striae
  • Hirsutism
  • Poor wound healing
  • Diabetes
  • Hyperglycemia
  • Osteoporosis
  • Hypertension
A

Cushing syndrome

43
Q 
• AD
• Marfanoid body type
• Medullary thyroid carcinoma 
• Pheochromocytomas
• Adrenal medulla
• Neuromas
• Can be first sign
• Soft painless papules
• Lips, conjunctiva,  tongue, 
palate, buccal mucosa
• Sentinel neuromas
44
Q 
\_\_\_\_\_ Pancreas
• Secretes enzymes
• Digestion
• Inactive proenzymes
• Acute pancreatitis
• Chronic pancreatitis
• Cancer
A

• Exocrine pancreas

45
Q 
\_\_\_\_\_\_ Pancreas 
• Secretes hormones
• Glucose homeostasis
• Other metabolic activities
• Diabetes mellitus  
• Beta cells in the islets of 
Langerhans
A

• Endocrine pancreas

46
Q 
• Injury to acinar cells
• Interstitial or edematous pancreatitis
• Mild 
• Reversible
• Acute hemorrhagic pancreatitis
• Alcoholism
• Chronic biliary disease
Etiology:
• Metabolic
• Alcoholism
• Hyperlipoproteineimia
• Hypercalcemia
• Drugs
• Thiazide diuretics
• Genetic
A

Acute Pancreatitis

47
Q
  • Destruction of pancreatic parenchyma
  • Intermittent “acute” attacks
  • Alcoholism
  • Obstruction of pancreatic duct
  • Mechanical blockage
  • Congenital defects
  • Cancer
  • Inspissated mucous
  • Chronic injury to acinar cells
A

Chronic pancreatitis

48
Q

• Hyperglycemia
• Lack of insulin (Type 1)
• Resistance to insulin (Type 2)
• Combination
• 21 million people ( 7% of population)
• Loss of insulin (anabolic) results in a catabolic state
affecting glucose, fat & protein metabolism

A

Diabetes mellitus

49
Q 
• Archaic terminology: Insulin Dependent DM, juvenile-onset DM
• Autoimmune destruction of B cells in the Islets of Langerhans (insulitis)
• Absolute deficiency
• Destruction of Beta cells
• Only 10% diabetics
• Avg. age of onset- 14 yo
• Emergencies
• Acute: hypoglycemia
• Chronic: ketoacidosis
180
•Cause• Destruction of β-cells
• Autoimmune
• T cell mediated
• Auto-antibodies
• Genetic
• 30-70%  twin concordance
• HLA-DR3, DR4 (90-95%) 
• Environmental? 
• Infectious 
•Diagnosis ( DM1 or 2)
• WNL= 70-120 mg/dL
• Any of these
• ≥ 200 mg/dL + S/S
• Fasting ≥ 126 mg/dL
• OGTT ≥ 200 mg/dl (2 hrs)
50
Q

• Adult onset
• “Relative” lack of insulin
• 80-90% of diabetics
• Insulin resistance
• Early Normal blood insulin level
• Target tissue Resistance
• β-cell dysfunction fails to
compensate
• Demographics are changing
• Ketoacidosis (rare)
• Coma due to hyperosmolarity
• Archaic terminology: Non-Insulin dependent DM, adult/maturity-onset DM
• Inadequate secretion of insulin from the pancreas
• Reduced tissue sensitivity to insulin (liver, skeletal muscle, adipose tissue)
• Initially, hyperinsulinemia may compensate for peripheral insulin resistance
and normal plasma glucose is maintained
• Eventually, B cell compensation becomes inadequate and there is progression
to hyperglycemia

51
Q

• The fraction of glycosylated hemoglobin
in circulating red blood cells
• Reflects the degree of hyperglycemia
during the preceding 6-8 weeks

52
Q

___vascular disease
• Retina –diabetic retinopathy
• Kidneys –nephropathy
• Peripheral nerves - neuropathy

A

Microvascular disease

53
Q 
\_\_\_\_ vascular disease
• Heart - myocardial infarction
• Brain - stroke
• Peripheral vascular disease –lower extremity 
gangrene
A

Macrovascular disease

54
Q

• A dermatosis characterized by velvety,
papillomatous, brownish-black,
hyperkeratotic plaques, typically of the
intertriginous surfaces and neck
• May be associated with insulin resistance
(cutaneous marker for type 2 diabetes)
• May be associated with internal malignancy

A

Acanthosis nigricans

55
Q
  • Oral Complications
  • Infections
  • Candida sp.,
  • Mucormycosis
  • Bacterial
  • Slow healing
  • Gingiva
  • enlargement, erythema
  • Subjective xerostomia
  • Parotid gland enlargement
56
Q 
• Regenerative
• Remove 60% 
• Minimal change in function
• 4-6 weeks for almost total 
regeneration of mass
• The key is the hepatic reticulum
• Type 4 collagen
• Fibrosis= Types 1 & 3 collagen
57
Q 
• Metabolic
• Glucose homeostasis
• Synthetic- plasma proteins
• Albumin, VLDL, LDL,  PT, 
Fibrinogen
• Storage
• Glycogen
• Triglycerides
• Iron, Copper
• Vitamins- A, D, K
• Degrades/Detoxifies
• Phase 1 oxidation 
• -OH, -COOH
• Cytochrome p450
• Phase 2 conjugation
• Glucuronic acid= Soluble
• Exocrine
• Bile (1L/d)
• Endocrine
• D3 to 25-hydroxy-cholecalciferol
• T4 to T3 (active)
• GHRH
• Insulin & glucagon degradation
58
Q 
Causes of \_\_\_\_\_\_
• One of top 10 causes of death 
• ETOH
• Infection (HBV, HCV)
• Biliary disease
• Iron overload  (Hemochromatosis)
• Autoimmune hepatitis
• 10% idiopathic
59
Q 
\_\_\_\_ characteristics
• Diffuse fibrosis and conversion of normal architecture into 
abnormal nodules
• Bridging fibrosis
• Parenchymal nodules
• Micro (3mm);Macro
• regeneration
• Entire liver architecture effaced
60
Q 
\_\_\_\_ clinical consequences:
• Ascites
• Formation of portosystemic venous shunts
• Congestive splenomegaly
• Hepatic encephalopathy
A

Portal hypertension

61
Q
  • NON-SPECIFIC sign of liver dysfunction
  • Retention of bile (>2.0 mg/dL)
  • Hepatitis
  • Obstruction (cirrhosis)
  • Accumulation of conjugated bilirubin
  • Hemolytic anemias
  • Accumulation of un-conjugated bilirubin
  • Cholestasis (Lack of flow of bile)
  • Retention due to obstruction or hepatocyte dysfunction
  • Serum Alk Phos elevated
62
Q

Is jaundice a disease?

63
Q 
Causes of \_\_\_\_ Disease
• Alcohol related
• Drug related
• Infectious (HCV)
• Metabolic
• Neoplasms
• Autoimmune
A

Liver disease

64
Q 
ETOH causes 60% of Chronic Liver Disease
• ETOH accounts for 40-50% of deaths due to cirrhosis
• 5th leading cause of death
• Forms of liver disease
• Hepatitic steatosis
• Alcoholic hepatitis
• Cirrhossis
A

Alcoholic liver disease

65
Q 
\_\_\_\_\_ damage
• Tetracycline
• Anti-neoplastic agents
• Mushroom toxins
• Amanita Phalloides
• Carbon tetrachloride
• ETOH
• Microvesicular fatty change
• Macrovesicular fatty change
• Fibrosis/cirrhossis
• Diffuse/massive necrosis
• Centrilobular necrosis
• Macrovesicular fatty change
• Fibrosis/cirrhossis
A

Hepatocellular damage

66
Q 
\_\_\_\_\_\_ Hepatitis
• Self limiting
• No carrier state
• Life long immunity
• Vaccine
• Epidemics
• Rare fatalities (0.1%)
67
Q 
\_\_\_\_\_\_ Hepatitis
• Prolonged incubation
• Chronic carrier state
• Increased risk of HCCa
• Vaccine- Anti-HBs
• 2 Billion alive today will be 
infected
68
Q 
\_\_\_\_\_\_ Hepatitis
• Similar to HBV, but...
• More cirrhosis risk
• Used to be transfusion 
related 
• IV drug related
• Early Tx hopeful for cure
69
Q 
\_\_\_\_\_\_ Hepatitis
• Needs HBV (HBsAg)
• Coinfection of B & D at same 
time
• low chance
• Super-infection of a carrier of 
HBV that gets a new HDV
• More likely
70
Q 
• Excessive accumulation of Iron
• WNL= 2-6 gms (only 0.5gm in liver)
• Males 5-7:1 ( earlier than females)
• 5th-6th decades
• Iron deposition in liver, pancreas, myocardium, 
skin, joints
A

Hemochromatosis

71
Q
  • Fatty liver changes & encephalopathy in Kids (<4 yo)
  • Associated with viral infection
  • Begins as pernicious vomiting 3-5 days s/p virus
  • Lethargy, irritability, hepatomegaly
  • Mitochondrial hepatopathy (LOF)
A

Reye syndrome

72
Q 
• AR disorder of Copper metabolism
• Chr 13
• 1:30,000
• Accumulation in Liver, brain, & eye
• Normal uptake but:
• Failure to enter circulation as ceruloplasmin
• Inability to be excreted in bile
• Unbound copper spills into circulation
• Hemolysis
• Diagnosis
• Onset prior to age 6
• Elevated hepatic copper, low serum ceruloplasmin, high urinary 
copper
• Acute/Chronic hepatitis
• Neuropsychiatric
• Behavioral changes
• Parkinson-like
• Pychosis
• Kayser-Fleischer rings
A

Wilson disease

73
Q
  • Geographic distributions
  • Asia, Africa
  • 20-40 yo
  • 50% w/o cirrhosis
  • West much lower (8-30x less)
  • Seldom before 60 yo
  • 90% w/ cirrhosis
  • Cirrhosis (alcoholic)
  • HBV (200x), HCV
  • Aflatoxin (Aspergillus flavus)
A

Hepatocellular Carcinoma

Hepatoma

74
Q
  • Located in the upper right quadrant
  • Stores bile
  • 50mL
  • Releases bile
  • Fat digestion
A

Gallbladder

75
Q

______ Cholecystitis
• Acute inflammation
• Obstruction of the neck or cystic duct
• Absence of gallstones

76
Q

______ Cholecystitis

  • Sequel to repeated bouts of acute cholecystitis
  • Absence of acute cholecystitis
  • Gallstones
A

• Chronic

Pathology (26 decks)

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