Gastrointestinal Pathology

Question 1

Describe the breakdown of billirubin

Answer 1

Heme metabolized by heme oxygenase to billiverdin

Reduced to bilirubin

Liver removes bilirubin from blood and conjugates it with glucuronate where its excreted into the bile.

Direct bilirubin is conjugated and soluble in water.

Indirect is unconjugated and water insoluble.

Conjugated gets converted in the intestines by bacteria and results in urobillinogen thats excreted as either stercobilin in the stool or urobillin in the kidney.

Question 2

Why does achlasia occur?

Answer 2

Constriction of pyloric sphincter due to loss of myenteric plexus.

Question 3

What is plummer vinson syndrome?

Answer 3

Triad of dysphagia, iron deficiency anemia and esophageal varices.

Question 4

celiac disease

Answer 4

gluten intolerance decreasing mucosal absorption mostly effecting the duodenum and or jejunum.

Question 5

How wuld pancreatic insufficiency present

Answer 5

Pt would not be able to absoarb fats!

Question 6

Yu see foamy macropages in intestinal lamina propria with cardiac symptoms, arthralgias, and neurological symptoms.

Answer 6

Whipple disease

“Foamy whipped cream in a CAN”

Question 7

Skip lesion with cobblestone mucosa, creeping fat and thickened bowel wall.

Answer 7

Crohns disease.

Question 8

Ulcers in the large intestine that are continueous with crypt abcesses and risk of colorectal carcinoma. Extends proximally with bloody diarrhea and sclerosing cholangitis.

Answer 8

This is a sign of ulcerative colitis.

Question 9

Hirschsprung disease

Answer 9

lack of ganglion cells/enteric plexus in the instestine leading to congenital megalo colon.

Increased risk with down syndrome.

Question 10

Elevated ALP levels

Answer 10

Cholestatic and obstructive hepatobiliary disease HCC, Infiltrative disorders, bone disease.

Question 11

Elevated ALT vs AST

Answer 11

Viral hepatitis

or metabolic syndromes

Question 12

Elevated AST vs ALT

Answer 12

Alcoholic hepatitis

“Sippin”

Question 13

Elevated amylase

Answer 13

acute pancreatitis/mumps

Question 14

Decreased ceruloplasm

Answer 14

Wilson disease

Question 15

Elevated lipase

Answer 15

pancreatitis.

Question 16

Mallory bodies found in a swollen necrotic liver?

Answer 16

Alcoholic hepatitits.

Question 17

Alcoholic cirrhosis

Answer 17

Final irreversible form of alcohol damage due to sclerosing around the zone 3 central vein.

Question 18

Crigler Najjar syndrome type I

Answer 18

Absent UDP glucoronsyltransferase leading to the inability to conjugate bilirubin.

Question 19

Dubin Johnson Syndrome

Answer 19

Conjugated hyperbilirubinemia due to defective liver excretion.

Causes a benign grosly black liver.

rotor syndrome is similar but doesnt cause blackened liver.

Question 20

Wilsons disease

Answer 20

inadequate copper excretion leads to copper accumulation in the body.
Especially in the liver, brain, cornea and kidneys “Fancony syndrome”

It is an autosomal disorder

causing hemoytic anemia and kayser fleischer rings in the eyes “Golden brown Ring”

Question 21

Diabetes with skin pigmentation causing a bronze color and cirrhosis.

Answer 21

Hemochromatosis: Excessive deposition of iron in the body. May be due to an autosomal recessive disorder or excessive transfusion. Identified with prussian blue staining.