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DMD 5249 > GI, Liver, Pancreas pathology (6) > Flashcards

GI, Liver, Pancreas pathology (6) Flashcards

1
Q

What is hepatitis

A

inflammation of hepatocytes

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2
Q

What are the forms of transmission for Hep A, B, and C

A

A - fecal-oral

B and C - parenteral

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3
Q

Which type of Hepatitis is most commonly chronic

A

C

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4
Q

what is fulminant hepatitis

A

massive hepatocyte necrosis and liver failure

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5
Q

Which type of Hepatitis can lead to carcinomas

A

type B and C

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6
Q

What is the most common reason for liver transplant

A

Hep C

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7
Q

What is the prognosis for the three types of hepatitis

A

A - benign, self limiting
B - most recover, small % die
C - almost 10% die

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8
Q

Which viruses cause the types of hepatitis

A 
A - Picornovirus
B - Hepadnavirus
C - Flavivirus
D - Defective virus
E  - Herpevirus
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9
Q

which type of hepatitis (acute or chronic) has apoptotic cells

A

acute

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10
Q

What is the progression of Fatty Liver Disease

A
  1. Steatosis - fatty liver
  2. Nonalcoholic steatohepatitis (NASH) - fatty and inflamed
  3. NASH and fibrosis - scarred
  4. cirrhosis - scarred and inflamed
  5. cancer
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11
Q

What are the two types of fatty liver disease

A

alcoholic - classic (ingestion of 5 beers/day)

non-alcoholic - Diet related, most common

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12
Q

how are obesity, NASH, and insulin resistance related

A

Obesity and insulin resistance have a strong correlation to NASH

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13
Q

What is the best treatment for NASH

A

improved insulin sensitivity

diet, weight loss, metformin

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14
Q

What can hepatitis, and Fatty liver disease lead to

A

Cirrhosis
Portal hypertension
jaundice

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15
Q

What is cirrhosis

A

irreversible inflammatory disease that disrupts liver function and structure

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16
Q

what are the manifestations of cirrhosis

A 
decreased hepatic function due to fibrosis
portal hypertension (blood is shunted away from the liver)
this leads to hypoxic necrosis
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17
Q

what are the three types of hepatic portal hypertension

A
  1. prehepatic - narrowing of vessels preceding liver
  2. intrahepatic - cirrhosis (most common)
  3. post hepatic - right heart disorders
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18
Q

what are consequences of hepatic portal hypertension

A

hepatic encephalopathy - CNS disturbance
varices - distended veins (esopahgeal bleeding)
splenomegaly
ascites - fluid accumulation in the peritoneal cavity

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19
Q

how does hepatic portal hypertension cause hepatic encephalopathy

A

liver dysfunction causes toxins to remain in the blood, then they are absorbed and circulate to the brain, those cells are vulnerable to those toxins

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20
Q

What does hepatic portal hypertension cause

A

impaired cognitive function, tremors, and EEG changes

21
Q

what is ascites

A

fluid accumulation in the peritoneal cavity that almost always accompanies liver cirrhosis. It leads to increased hepatic vessel hydrostatic pressure and decreased oncotic pressure

22
Q

What are the products of RBC recycling in the spleen and liver

A

globin - AA
Heme - Iron
bilirubin

23
Q

what happens to the bilirubin from RBC recycling

A
  1. Unconjugated bilirubin is toxic
  2. conjugated in the liver via glucoronyl transferase
  3. conjugated bilirubin is excreted with bile into the small intestine then in feces
  4. some bilirubin is converted to urobilinogen in the small intestine by bacteria
  5. some is excreted, some is reprossed by the liver and excreted, some is excreted in urine
24
Q

What are the causes of jaundice

A
  1. bilirubin production in excess of the livers ability to conjugate (lots of RBC destruction)
  2. decreased bilirubin excretion
25
Q

what can cause decreased bilirubin excretion

A
  1. reduced hepatic uptake (hepatitis, cirrhosis)
  2. decreased conjugation (hepatitis, cirrhosis, enzyme deficiency)
  3. bile duct obstruction
26
Q

What is jaundice

A

excessive bilirubin accumulated in the body, leads to yellowing of skin, nail beds, and whites of the eyes. bilirubin is also very toxic to brain cells

27
Q

how is jaundice treated

A

treat cause of condition
blood transfusion
sun

28
Q

how do you determine the site of the problem causing jaundice

A

color and feces of urine
light feces and dark urine = extrahepatic obstructive jaundice
light feces and light urine = damaged hepatocytes
dark feces and dark urine = hemolytic anemia

29
Q

what is cholestasis

A

a condition where bile can’t flow from the liver to the gut that can lead to xanthomas

30
Q

how do you test urine function

A

test albumin levels (reduced levels in blood with liver problems)
Transaminases (elevated in blood with liver problems)

31
Q

What are oral manifestations of liver failure

A

hematomas, gingival bleeding
glossitis (alcoholic hepatitis)
reduced healing after surgery

32
Q

What is Hemochromatosis

A

autosomal recessive disease that increases iron in the body. this results in cirrhosis, skin pigmentation, liver carcinoma

33
Q

what is wilson disease

A

autosomal recessive disease that increases body copper. this results in liver disease, neurological disruption, and kayser-fleischer rings in cornea

34
Q

What is hepatocellular carcinoma

A

carcinoma of the liver strongly associated with hep B and C and aflatoxin exposure. the median survival is 7 months, death from bleeding, liver failure, and cachexia

35
Q

what is metastatic carcinoma in the liver

A

common malignancy from the colon, lung, breast, pancreas and stomach

36
Q

What is cholelithiasis

A

gall stones (cholesterol and bilirubin)

37
Q

What are the risk factors for cholelithiasis

A

female, fat, fertile, forty, fair

38
Q

how does insulin affect cholelithiasis

A

insulin leads to increased cholesterol production, which causes gallstones

39
Q

how can weight loss lead to gall stones

A

if you are calorie restricted, your body won’t empty the gall bladder often enough

40
Q

what are the exocrine diseases of the pancreas

A

pancreatitis
cystic fibrosis
tumors

41
Q

what are the endocrine diseases of the pancreas

A

diabetes

tumors

42
Q

what are the exocrine functions of the pancreas

A

digestive enzymes

43
Q

what are the endocrine functions of the pancreas

A

alpha cells - glucagon - insulin antagonist
beta cells - insulin - glucose into cells - anabolism
gamma cells - somatostatin - inhibits insulin and glucagon

44
Q

What are the two types of pancreatitis

A

acute and chronic

45
Q

what are the characteristics of acute pancreatitis

A
  • reversible destruction and inflammation of the pancreas
  • symptoms = abdominal pain radiating to back
  • lab = elevated serum amylase and lipase
  • main cause = alcoholism and gallstones
  • most people recover, few die in a week.
46
Q

what are the characteristics of chronic pancreatis

A
  • longstanding irreversible pancreatic destruction
  • cause = most are alcohol related
  • symptoms = none, or bouts of jaundice and pain
  • prognosis = poor (50% mortality over 20 years)
47
Q

what is the biggest risk factor for carcinoma of the pancreas

A

smoking

48
Q

is carcinoma of the pancreas deadly

A

yes, its highly invasive, and has no symptoms until late. 5% last 5 years.

DMD 5249 (10 decks)

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