Gastro - Pathology (Part 3) Flashcards

1
Q

What is the finding seen in this image and what is the associated disease?

A

String sign; Crohn’s disease

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2
Q

Pictured is the large intestine of a 25-year-old female with a history of bloody diarrhea and weight loss. What is the likely diagnosis?

A

Ulcerative colitis (pseudopolyps)

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3
Q

What is the name for this classic ocular finding, and with which disease is it associated?

A

Kayser-Fleischer ring; associated with Wilson’s disease

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4
Q

What cancer is associated with Wilson’s disease?

A

Hepatocellular carcinoma

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5
Q

What movement disorder is associated with Wilson’s disease?

A

Choreiform movements due to preferential copper deposition in the basal ganglia

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6
Q

With what medication are patients with Wilson’s disease treated?

A

Penicillamine

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7
Q

With what pattern of inheritance is Wilson’s disease passed?

A

Autosomal recessive

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8
Q

What specific type of anemia is associated with Wilson’s disease?

A

Hemolytic anemia (remember ABCD to recall the other common findings: Asterixis, Basal ganglia degeneration, Ceruloplasmin [decreased], Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma (hepatocellular), Choreiform movements, and Dementia)

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9
Q

A 30-year-old patient presents with new-onset dementia, choreiform movements, and flapping hand tremor; he also has severely elevated liver enzymes and discolored rings around his irises on ocular exam. What lab results will confirm the diagnosis? How will you treat the patient?

A

This patient has Wilson’s disease. Decreased ceruloplasmin; chelation with penicillamine

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10
Q

Hemochromatosis classically affects what three organs?

A

Liver, skin, and pancreas

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11
Q

Hemochromatosis classically causes what liver finding?

A

Micronodular cirrhosis

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12
Q

A man presents to the office with new-onset insulin-dependent diabetes. His skin is darkly pigmented and he is found to have elevated liver enzymes. What is his likely diagnosis?

A

Hemochromatosis

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13
Q

Iron deposition in the heart due to hemochromatosis can lead to what condition?

A

Congestive heart failure secondary to restrictive cardiomyopathy

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14
Q

Hemochromatosis is associated with an increased risk of what cancer?

A

Hepatocellular carcinoma

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15
Q

With what pattern of inheritance is primary hemochromatosis passed?

A

Autosomal recessive

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16
Q

True or False: It is possible to develop hemochromatosis without being genetically predisposed to the disease.

A

True (secondary hemochromatosis); due to recurrent blood transfusions

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17
Q

What is the most common cause of secondary hemochromatosis?

A

Chronic transfusion therapy

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18
Q

Describe ferritin capacity, iron capacity, and total iron-binding capacity and transferrin saturation in patients with hemochromatosis.

A

High; high; low; high

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19
Q

What two treatments are often used for hemochromatosis?

A

Repeated phlebotomy and deferoxamine chelation

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20
Q

Hemochromatosis is associated with what genetic marker?

A

Human leukocyte antigen A3

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21
Q

Is primary sclerosing cholangitis intrahepatic, extrahepatic, or both?

A

Both; the entire biliary tree is affected

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22
Q

What is the underlying change in primary sclerosing cholangitis?

A

Fibrosis of the bile ducts

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23
Q

What is likely to be found on biopsy of a patient with primary biliary cirrhosis?

A

Lymphocytic infiltrate and granulomas

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24
Q

What is the appearance of primary sclerosing cholangitis on endoscopic retrograde cholangiopancreatography?

A

Alternating strictures and dilation of the bile ducts, which is also called “ beading”

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25
Which symptoms are common in the presentation of biliary tract disease?
Jaundice, light stool, pruritus, dark urine
26
What disease is associated with primary sclerosing cholangitis?
Ulcerative colitis
27
Which autoantibodies are seen in the serum of patients with primary biliary cirrhosis?
Antimitochondrial antibodies
28
The biliary stasis caused by PSC can be so severe as to cause liver failure, a process known as what?
Secondary biliary cirrhosis
29
What abnormal lab results are common to most forms of biliary tract disease?
Increased conjugated bilirubin, cholesterol, and alkaline phosphatase
30
Primary biliary cirrhosis is commonly associated with what autoimmune disorders?
Rheumatoid arthritis, CREST syndrome, celiac disease
31
What class of immunoglobulin is elevated in primary sclerosing cholangitis?
Immunoglobulin M
32
What causes secondary biliary cirrhosis?
Extrahepatic biliary obstruction
33
In secondary biliary cirrhosis, increased pressure in the intrahepatic ducts leads to what?
Hepatic injury and fibrosis
34
Secondary biliary cirrhosis is often complicated by what infectious process?
Ascending cholangitis, a bacterial infection facilitated by biliary stasis
35
Disproportionately high amounts of _____ and/or _____ in bile tend to favor the formation of gallstones.
Cholesterol; bilirubin
36
Which substances in bile increase the solubility of bilirubin and cholesterol to prevent formation of gallstones?
Bile acid and lecithin
37
List the two types of gallstones.
Cholesterol stones and pigment stones
38
Are most cholesterol stones radiolucent or radiopaque?
Radiolucent; as a result, ultrasound is the preferred method of imaging
39
About what percent of cholesterol stones are radiopaque?
10% to 20%
40
Why are some cholesterol stones radiopaque?
Calcified stones are radiopaque
41
Why does Crohn's disease predispose patients to gallstones?
Because of the inability of the diseased terminal ileum to absorb bile salts
42
List the risk factors associated with formation of cholesterol stones.
Obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin
43
What percentage of gallstones are cholesterol stones?
80%
44
Are pigment stones radiolucent or radiopaque?
Radiopaque
45
A patient presents with right upper quadrant pain, jaundice, and fever. He is found to have gallstones on ultrasound and a high white blood cell count. What is the likely diagnosis?
Acute cholangitis
46
In addition to biliary infections, what two other medical conditions are associated with pigment stone formation?
Chronic RBC hemolysis and alcoholic cirrhosis
47
Gallstones are best diagnosed by what radiologic modality?
Ultrasound
48
Symptomatic gallstones are treated with \_\_\_\_\_.
Cholecystectomy
49
Gallstones can cause what four major complications?
Ascending cholangitis, acute pancreatitis, bile stasis, and cholecystitis
50
Define biliary colic.
Pain caused by gallstones interfering with bile flow, causing bile duct contraction
51
In what population of patients is biliary colic uncommon?
Diabetic patients; neuropathy can reduce the sensation of pain from gallstones
52
What radiographic finding is associated with obstruction of the ileocecal valve by a gallstone?
Air in the biliary tract (also known as pneumobilia)
53
Name the "four F's" associated with increased risk of developing gallstones.
Female, fat, fertile, and forty
54
Name the components of Charcot"s triad of symptoms of cholangitis.
Jaundice, fever, and right upper quadrant pain
55
A patient presents complaining of abdominal pain. On deep palpation of the right upper quadrant, she appears to hold her breath. Name this finding.
The patient has a positive Murphy's sign, which is inspiratory arrest on deep palpation
56
Name three possible causes of cholecystitis.
Gallstones (most common), infection (cytomegalovirus), ischemia
57
Define the pathophysiology of acute pancreatitis.
Pancreatic enzymes become activated leading to the autodigestion of the pancreas
58
List the causes of acute pancreatitis.
Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hypercalcemia/hyperlipidemia, drugs (sulfa drugs) (remember: **GET SMASHeD**)
59
What pattern of pain is characteristic of acute pancreatitis?
Epigastric pain that radiates to the back
60
What two laboratory findings are classically diagnostic of acute pancreatitis?
Elevated amylase and lipase
61
Which has higher specificity for acute pancreatitis: amylase or lipase?
Lipase
62
What are complications of acute pancreatitis?
Disseminated intravascular coagulation, acute respiratory distress syndrome, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage, infection, multisystem organ failure
63
Chronic calcifying pancreatitis is strongly associated with what condition?
Alcoholism
64
What is the mechanism causing hypocalcemia in acute pancreatitis?
Ca2+ collects in pancreatic calcium soap deposits, causing hypocalcemia
65
Chronic pancreatitis leading to pancreatic insufficiency results in what constellation of symptoms?
Steatorrhea, fat-soluble vitamin deficiency, and diabetes mellitus
66
Is acute or chronic pancreatitis associated with an increased risk of pancreatic cancer?
Chronic
67
What is the average survival of a person newly diagnosed with pancreatic adenocarcinoma?
Six months or less
68
A patient presents with weight loss, night sweats, and painless jaundice. He is found to have a mass on his pancreas suspicious for malignancy. What is the most likely location of the mass?
The head of the pancreas
69
A mass is found on the head of the pancreas of a patient. What abnormal lab findings would be found in this patient?
Increased alkaline phosphatase and bilirubin levels indicating obstructive jaundice
70
True or False? Pancreatic adenocarcinoma often presents with inguinal lymphadenopathy.
False; presentation typically includes abdominal pain that radiates to the back, weight loss, migratory thrombophlebitis, and obstructive jaundice
71
What is an abdominal exam finding in a patient with pancreatic adenocarcinoma?
Courvoisier's sign (palpable gallbladder)
72
When migratory thrombophlebitis is noted in patients with pancreatic adenocarcinoma, it is called what?
Trousseau's syndrome
73
What two ethnic groups have an increased risk of pancreatic cancer? Male or female?
Jewish and African-American males
74
Name two tumor markers associated with pancreatic cancer.
Carcioembryonic antigen and carbohydrate antigen 19-9
75
True or False? Pancreatic cancer has a strong association with alcohol abuse.
False; pancreatic cancer has been linked to cigarette smoking
76
What is the inheritance pattern for familial adenomatous polyposis ?
It is inherited in an autosomal dominant fashion. Afflicted individuals inherit one faulty copy of the gene and lose the other through an acquired mutation; this is two-hit hypothesis
77
A patient with this finding after liver biopsy is at increased risk for which malignancy?
Hepatocellular carcinoma
78
What prognosis does a patient with this liver pathology have?
Good; the macrovesicular fatty change may reverse with cessation of alcohol intake