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PTH560 Pathology > Exam 2 - Liver, Gallbladder, Exocrine pancreas > Flashcards

Exam 2 - Liver, Gallbladder, Exocrine pancreas Flashcards

1
Q

unconjugated bilirubin (UCB)

A
  • end product of heme degradation

- lipid soluble -> indirect bilirubin

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2
Q

Conjugated bilirubin (CB)

A

UCB combines with albumin in blood
-blah conjugated to glucuronic acid

water soluble -> direct bilirubin

-secreted into bile ducts. stored in gallbladder. enters duodenum

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3
Q

urobilinogen (UBG)

A
  • intestinal bacteria convert CB to urobilinogen (UBG)
  • UBG oxidized to urobilin (gives poo color)

-recycled 90% to liver, 10% kidney - give pee color

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4
Q

Jaundice

A
  • due to inc in UCB and/or CB
  • first noticed in sclera
  • classified based on percentage of CB
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5
Q

Causes of jaundice

A
  • viral hepatitis = most common!

- other stuff, defects, cancers, etc

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6
Q

Hepatitis classifications and transmission routes

A
  • Hep A: oral-fecal, sexual
  • Hep B: oral-fecal, sexual, blood
  • Hep C: sexual, blood
  • Hep D: sexual , blood
  • Hep E: oral-fecal
  • **these are caused by a virus

can have autoimmune, neonatal, alcoholic hepatitis

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7
Q

Viral hepatitis

A

acute phases:
-prodrone (initial part of infectious disease. liver gets bigger, inc enzymes, and enzymes peak before jaundice

  • jaundice phase
  • recovery phase
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8
Q

Microscopic findings of viral hepatitis

A

-lymphocytic infiltrate (invade when there is a viral infection)

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9
Q

Fulminant hepatic failure

A

-has to include encephalopathy within 8 weeks of liver being screwed up.

causes: 
reye syndrome (liver failure due to ASA)
-wilson disease = cant handle copper in body
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10
Q

Cirrhosis

A

irreversible diffuse fibrosis of liver with formation of regenerative nodules

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11
Q

Cirrhosis causes

A
  • alcoholic liver disease (most common)
  • postnecrotic cirrhosis
  • autoimmune disease
  • metabolic disease
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12
Q

Cirrhosis complications

A
  • liver failure
  • ascites (excess fluid)
  • hepatorenal syndrome (back up into kidney)
  • hyperestrinism
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13
Q

Ascites

A

tap the belly and see if the fluid moves to the other side

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14
Q

Primary biliary cirrhosis

A
  • cirrhosis due to granulomatous destruction of bile ducts
  • more common in females
  • autoimmune

treatment: liver transplant. treat symptoms

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15
Q

Cavernous hemangioma

A
  • most common benign liver tumor

- danger for hemorrhage

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16
Q

Hepatic cell adenoma

A
  • benign tumor of liver cells
  • causes: oral contraceptives and steroids.
  • if you stop taking the stuff it can get smaller

-tendency to rupture during pregnancy

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17
Q

What is the most common liver cancer?

A

Metastasis***

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18
Q

Hepatocellular Carcinoma (HCC)

A
  • malignant
  • most common primary liver cancer (came from this organ)

causes: due to Hep B or C. lots of others

gross findings: focal, multifocal, or diffusely infiltrating
Micro findings: presence of bile in neoplastic cells

Lab:-liver enzymes will increase
*radiation/chemo not helpful

19
Q

Angiosarcoma (in liver)

A

-caused by exposure to vinyl chloride (plastic pipes) = most common

20
Q

Cholelithiasis

A
  • medical word for gallstone
  • 2 types (cholesterol and pigmented -black or brown)

due to: saturation of bile with cholesterol or decreased bile salts/acids

-risk factors: “Fs”
Female, Forty, fertile, fat

21
Q

Cholelithiasis complications

A
  • cholecystitis (most common)
  • common bile duct obstruction
  • gallbladder cancer
  • acute pancreatitis
22
Q

Choledocholithiasis

A

gallstone in the common bile duct

23
Q

What is Acute cholecystitis? who gets it more?

A
  • inflammation of gallbladder
  • more common in females in 5th and 6th decades
  • inc incidence in native americans
24
Q

Acute cholecystitis pathogenesis

A

Typically

  • lodging of a stone
  • everything behind it backs up
  • over growth of bacteria in area (E.coli)
  • perforation possible

atypical: CMV in AIDS, volume depletion

25
Q

Acute cholecystitis clinical findings

A

-pain in epigastric, RUQ (murphy sign) and it radiates to R arm.

L arm pain you think heart.
R arm pain you think gallbladder possibly

Lab: inc WBC and enzymes
imaging: Most common = UltraSound

26
Q

Chronic cholecystitis

A
  • most common symptomatic disorder of gallbladder

- Cholelithiasis with repeated attacks

27
Q

Gallbladder cancer

A
  • Adenocarcinoma
  • elderly women
  • treat: surgery
  • very poor prognosis
28
Q

Porcelain gallbladder

A
  • due to calcification
  • 50% lead to cancer
  • Remove it!
29
Q

Primary sclerosing Cholangitis

A
  • *70% males!
  • fibrosis of bile duct (in or outside of liver)
  • genetic predisposition
  • associated with IBD
30
Q

Annular pancreas

A
  • embryological buds form ring around duodenum

- results in SBO (small bowel obstruction)

31
Q

Aberrant pancreatic tissue

A

Pancreatic tissue is in a different place in body.

locations: stomach =most common. duodenum, jejunum, meckel diverticulum

32
Q

There are variations to the location of the major pancreatic duct. Why is this important?

A
  • major pancreatic duct empties into terminal CBD

- an obstruction could block both depending on the variation

33
Q

Pancreatitis

A

inflammation of the pancreas

  • autodigestion (eats itself)
  • acute vs chronic
34
Q

Acute pancreatitis

A
  • **most common cause = alcohol (can be from binge drinking)

- pathogenesis: activation of proenzymes (many ways). releases proteases, lipases, and elastases.

35
Q

What enzyme causes the proenzymes to be activated in acute pancreatitis?

A

Trypsin

36
Q

If someone feels a stabbing pain in their back what it is?

A

Acute pancreatitis

37
Q

What are some complications of acute pancreatitis?

A

-pancreatic necrosis
“” pseudocyst
“” abscess

38
Q

Acute pancreatitis Lab stuff

A
  • serum amylase (salavery)
  • serum lipase (pancreas)

-**increase “SIT” serum immunoreactive tyrpsin
(decreased SIT in chronic)

39
Q

What is the treatment for acute pancreatitis?

A
  • NPO = nothing per oral
  • fluids
  • pain control
  • NG tube to suction
40
Q

Acute pancreatitis: ranson criteria

A

Prognostic indicator of mortality

>7 = 100% death
5-6 = 40%
3-4 = 15%
<3 = 1%
41
Q

Chronic pancreatitis

A

-majority idiopathic

Pathogenesis

  • repeated attacks of acute
  • *calcified concretions

Labs: decreased “SIT”!***

42
Q

Pancreatic pseudocyst

A
  • collection of digested pancreatic tissue around pancreas
  • have elevated amylase even if it is under control

Treatment: watch it. or if big drain it

43
Q

Pancreatic cancer

A

7th or 8th decade
-smoking is most common cause

Pathogenesis:
-gene mutations

clin find: virchow node (left supraclavicular), sister mary joseph node (belly button)

REMOVE IT! whipple procedure

PTH560 Pathology (15 decks)

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