Final: Liver, Gallbladder and Pancreas Flashcards by andrew ryser

what is a important concept about the liver regarding injury

the liver has enormous functional reserve and great regenerative capacity

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what are the possible responses to injury by the liver

fibrosis: reduced loss and function
necrosis
regeneration 
inflammation
degeneration of hepatocytes or accumulation of toxic products

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what is amongst the top ten causes of death in US adults concerning the liver?

cirrhosis

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what is the primary cause of cirrhosis?

what are other causes of cirrhosis?

primary cause of cirrhosis= alcohol!!

other causes: viral hepatitis, non EtOH steatohepatitis, biliary disease, iron overload

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what are the complication of iron overload concerning the liver?

iron overload leads to hepatocyte death and inflammation, reduced liver function, portal hypertension, INC risk for hepatocellular cancer

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whats the pathology of cirrhosis?

bridging septae, parenchymal nodules, fibrosis and parenchymal injury resulting in loss of hepatic function

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what are the non specific symptoms of cirrhosis?

what are the complications of cirrhosis?

nonspecific symptoms: weight loss, weakness, nonspecific bc liver reserve masks symptoms
cirrhosis complications: liver failure, portal hypertension, esophageal varies

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cirrhosis causes portal hypertension, what are the complications of portal hypertension?

ascites, collateral venous channels, splenomegaly

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what is fatty liver disease? what can be the pathogenesis of fatty liver disease

fatty liver disease= cirrhosis

pathogenesis: alcohol (toxin, nutrition deprivation), obesity, DM, medications

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what is the result of excess bilirubin? what measurement says there is excess bilirubin?

excess bilirubin: JAUNDICE

jaundice results from bilirubin more than 2.0 mg/ dl

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what are the 2 types of jaundice?

Etiology of jaundice?

unconjugated: insoluble and toxic
conjugated: soluble, nontoxic
causes: overproduction, reduced hepatocyte uptake and obstruction of bile flow

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what is the number cause of jaundice?

hemolytic anemia!!!

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what is hepatitis? what happens from chronic hepatitis?

hepatitis: hepatocyte injury associated with inflammation

chronic hepatitis leads to scarring

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whats the etiology of hepatitis? whats important to note regarding the etiology of hepatitis?

hepatitis causes: viruses, autoimmune mechs, drugs, toxic agents
similar patterns of liver injury regardless of causative agent

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what are the hepatotriphic hepatitis viruses?

other types of hepatitis?

Hepatitis A, B, and C
hepatitis D - requires HBV
hepatitis E - similar to HAV
hepatitis G- similar to HCV
EBV, CMV, herpes, rubella, etc

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Hepatitis A; genetics, infection, acquired how, chronic or not, transmission, incubation, vaccine?

Hepatitis A is a RNA virus!!, benign self limiting infection that is acquired by ingestion of contaminated water and food, no chronic disease or state exists, transmitted fecal orally, incubation is 2-6 weeks
NO vaccine

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Hepatitis B; genetics, infection, acquired how, chronic or not, transmission, incubation, vaccine? INC risk for what?

hep B: DNA virus!!!
parenteral/ sexual contact transmission
incubation 4-26 weeks
serology remains in blood, carriers, chronic liver disease, cirrhosis states
90% of infections are self limiting
Vaccine = 95% effective 
INC risk for hepatocellular carcinoma

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Hepatitis C: genetics, infection, acquired how, chronic or not, transmission, incubation, vaccine? INC risk for what? what is the hallmark of Hep C infection?

Hep C: RNA VIRUS!!
Parenteral sexual spread
incubation 7-8 weeks, acute phase thats asymptomatic
carrier, chronic liver disease, cirrhosis states
NO VACCINE- genomic instability
INC risk for hepatocellular carcinoma
persistent infection + chronic hepatitis= HEP C infection (85%)

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Hep C tx?

previously interferon + ribacvarin
NOW: protease + nucleoside inhibitors or combo drug of Harvoni (sofosbuvir and ledipasvir) for 8-24 weeks
curative in most pts BUT Harvoni is super expensive!!! 100-150 k!!!

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What are the symptoms of acute viral hepatitis?
what is the fulminant of acute viral hepatitis?
what is the histo of acute viral hepatitis?
how long does it take for acute viral hepatitis to resolve?

acute viral hepatitis symptoms: none, fatigue, anorexia, joint aches, jaundice
fulminant: massive necrosis that results in acute liver failure can transition to chronic state of Hep B or Hep C
histo: panlobular disarray, inflammation, hepatocyte necrosis
resolution in 8 weeks

what is abnormal liver function due to inflammation of more than weeks called?

chronic hepatitis

alcoholic liver disease account for what percent of chronic liver disease?
alcoholic liver disease deaths due to cirrhosis, what %?
what are the features of alcoholic liver disease?

60% of chronic liver disease due to alcoholic liver disease
40-50% of alcoholic liver disease due to cirrhosis
3 main features
1. fatty liver: hepatic steatois
2. hepatitis
3. cirrhosis

what is hemochromatosis? genetics of it?

hemochromatosis is iron accumulation in the liver, pancreas and heart that is AUTOSOMAL RECESSIVE on chromosome 6
secondary overload due to excessive iron intake

whats the morphology of hemochromatosis?
tx?
path features?

hemochromatosis: hemiosiderin and fibrosis
tx: phlebotomy and Fe chelators
path features: micro nodular cirrhosis, hepatosplenomegaly, IDDM, skin pigmentation

what is wilsons disease? genetics of wilsons disease? morphology? chelation?

wilsons disease is accumulation of copper in liver, brain, and eyes genetics: autosomal recessive morpho: acute, chronic, steatosis, necrosis, cirrhosis chelation: D penicillamine

why are metastases in the liver and lungs common?

rich blood supply that filters the blood

what is a cholangiocarcinoma, that arises in bile ducts inside and outside the liver, thats very aggressive but asymptomatic until the late stage

bile duct carcinoma

what is a benign tumor associated with oral contraceptives that may regress if the medication is discontinued?

hepatocellular adenoma

what is the clinical presentation of hepatocellular adenoma? | histo?

hepatocellular adenoma: acute abdomen, intra abdominal bleeding histo: bland hepatocytes and no bile ducts!

for western countries what is the 3rd leading cause of cancers deaths? predominant in who?

hepatocellular carcinoma= 3rd leading cause of cancer deaths | 3 M: 1 M

whats the cause of hepatocellular carcinoma? prognosis is what? tx? strong tendency to do what?

hepatocellular carcinoma causes= hep B and C, aflatoxin, 90% cirrhosis prognosis: grim tx? resection if focal, but may redevelop, liver transplant strong tendency to invade vasculature

what liver cancer occurs in younger pts and has no known risk factors? nickname for its tumor is called what? tx? prognosis?

fibrolamellar carcinoma occurs in people in 20 -40s with NO Known risk factors Scirrhous tumor TX: surgery 32% 5 year survival rate

the gallbladder shares what percent of the common orifice of the pancreatic duct?

60-70%!!

cholelithiasis is what? occurs in what percent of adults? what percent are "silent"? associated with what?

cholelithiasis are gall stones that are in 10-20% of adults 80% of gallstones are silent. cholelithiasis is associated with inflamed gallblader

what percent of gallstones are cholesterol? what % are pigment stones? what are the complications of gall stones?

80% = cholesterol stones! 20%= pigment stones complications: pain, inflammation, obstruction

what is the pathogenesis of gallstones? | types and x ray presentation?

pathogenesis of gall stones: supersaturation, initiation, growth types: cholesterol: radiolucent bilirubin: radiopaque

what are the risk factors for cholesterol gall stones? pigment gall stones?

cholesterol stones: risk INC for caucasians, INC age, INC in females, and estrogens pigment stones: hemolysis, GI disorders, biliary infection

what is cholecystitis? predominant in who? acute? chronic?

cholecystitis is inflammation of the gallstone predominant in 40s-60s more in FEMALES acute: severe RUQ pain, chemical, bacterial, reflux ischemia chronic: vague symptoms, stones (90%), fibrosis and inflammation

what cancer is 5th amongst GI malignancies? peak incidence in who? more predominant in who? what % associated with gall stones? 5 year survival?

gallbladder adenocarcinoma peaks in 7th decade more prominent in whites than blacks and F > males 95% associated with stones and 5% 5 year survival rate

classify the pancreas and describe each classification

endocrine: regulates glucose homeostasis, via insulin and glucagon exocrine: critical for food digestion, pancreatic enzymes include amylase, trypsin and chymotrypsin and lipase

what accounts for 80% of all cases of acute pancreatitis? other causes?

80% of acute pancreatitis causes by cholelithiasis, biliary tract disease and alcoholism other causes, trauma, bunt force, drugs, chemo, septisemia, infection like mumps, metabolic hypercalcemia states, idiopathic

what are the pathological features of acute pancreatitis?

release of lipase, inflammation, proteolysis, necrosis of vessels with hemorrhage, fat necrosis

what are the complications of acute pancreatitis?

``` acute abdomen elevated amylase and lipase levels organ failure abscess 8% mortality rates ```

what is chronic pancreatitis? is it reversible? whats the etiology?

chronic pancreatitis is progressive destruction of exocrine pancreas, destruction of endocrine occurs later in disease IRRERVERSIBLE Etiology is unclear maybe alcoholism, biliary disease, hypercalcemia, hyperlipidemia, genetics?

describe the morphology of chronic pancreatitis

reduced acini, chronic inflammation fibrosis, obstruction ducts, spare islets

whats the 4th leading cause of cancer death in the US? describe the cysts of the pancreas

pancreatic exocrine tumors | cysts of pancreas can be congenital, pseudocysts, neoplastic cysts

Pancreatic carcinoma peaks when? growth is termed as what? at diagnosis what is usually the case? what doubles the risk? what other factors inc the risk?

pancreatic carcinoma peaks in 6th and 7th decade SILENT GROWTH. at diagnosis it is advanced and most die within 6 months. Smoking doubles the risk INC risk with Diabetes and chronic pancreatitis

describe the tumor of pancreatic carcinoma. whats another name for it? cancers at the pancreas head do what? cancers at the body and tail are what?

pancreatic carcinoma tumors are ill defined, gritty gray white, and hard aka ductal adenocarcinomas cancers at the head obstruct common bile duct causing jaundice cancers at the tail and body are clinically silent and large at diagnosis