GI, Liver, Pancreas pathology (6) Flashcards
What is hepatitis
inflammation of hepatocytes
What are the forms of transmission for Hep A, B, and C
A - fecal-oral
B and C - parenteral
Which type of Hepatitis is most commonly chronic
C
what is fulminant hepatitis
massive hepatocyte necrosis and liver failure
Which type of Hepatitis can lead to carcinomas
type B and C
What is the most common reason for liver transplant
Hep C
What is the prognosis for the three types of hepatitis
A - benign, self limiting
B - most recover, small % die
C - almost 10% die
Which viruses cause the types of hepatitis
A - Picornovirus B - Hepadnavirus C - Flavivirus D - Defective virus E - Herpevirus
which type of hepatitis (acute or chronic) has apoptotic cells
acute
What is the progression of Fatty Liver Disease
- Steatosis - fatty liver
- Nonalcoholic steatohepatitis (NASH) - fatty and inflamed
- NASH and fibrosis - scarred
- cirrhosis - scarred and inflamed
- cancer
What are the two types of fatty liver disease
alcoholic - classic (ingestion of 5 beers/day)
non-alcoholic - Diet related, most common
how are obesity, NASH, and insulin resistance related
Obesity and insulin resistance have a strong correlation to NASH
What is the best treatment for NASH
improved insulin sensitivity
diet, weight loss, metformin
What can hepatitis, and Fatty liver disease lead to
Cirrhosis
Portal hypertension
jaundice
What is cirrhosis
irreversible inflammatory disease that disrupts liver function and structure
what are the manifestations of cirrhosis
decreased hepatic function due to fibrosis portal hypertension (blood is shunted away from the liver) this leads to hypoxic necrosis
what are the three types of hepatic portal hypertension
- prehepatic - narrowing of vessels preceding liver
- intrahepatic - cirrhosis (most common)
- post hepatic - right heart disorders
what are consequences of hepatic portal hypertension
hepatic encephalopathy - CNS disturbance
varices - distended veins (esopahgeal bleeding)
splenomegaly
ascites - fluid accumulation in the peritoneal cavity
how does hepatic portal hypertension cause hepatic encephalopathy
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
What does hepatic portal hypertension cause
impaired cognitive function, tremors, and EEG changes
what is ascites
fluid accumulation in the peritoneal cavity that almost always accompanies liver cirrhosis. It leads to increased hepatic vessel hydrostatic pressure and decreased oncotic pressure
What are the products of RBC recycling in the spleen and liver
globin - AA
Heme - Iron
bilirubin
what happens to the bilirubin from RBC recycling
- Unconjugated bilirubin is toxic
- conjugated in the liver via glucoronyl transferase
- conjugated bilirubin is excreted with bile into the small intestine then in feces
- some bilirubin is converted to urobilinogen in the small intestine by bacteria
- some is excreted, some is reprossed by the liver and excreted, some is excreted in urine
What are the causes of jaundice
- bilirubin production in excess of the livers ability to conjugate (lots of RBC destruction)
- decreased bilirubin excretion
what can cause decreased bilirubin excretion
- reduced hepatic uptake (hepatitis, cirrhosis)
- decreased conjugation (hepatitis, cirrhosis, enzyme deficiency)
- bile duct obstruction
What is jaundice
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
how is jaundice treated
treat cause of condition
blood transfusion
sun
how do you determine the site of the problem causing jaundice
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
what is cholestasis
a condition where bile can’t flow from the liver to the gut that can lead to xanthomas
how do you test urine function
test albumin levels (reduced levels in blood with liver problems)
Transaminases (elevated in blood with liver problems)
What are oral manifestations of liver failure
hematomas, gingival bleeding
glossitis (alcoholic hepatitis)
reduced healing after surgery
What is Hemochromatosis
autosomal recessive disease that increases iron in the body. this results in cirrhosis, skin pigmentation, liver carcinoma
what is wilson disease
autosomal recessive disease that increases body copper. this results in liver disease, neurological disruption, and kayser-fleischer rings in cornea
What is hepatocellular carcinoma
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
what is metastatic carcinoma in the liver
common malignancy from the colon, lung, breast, pancreas and stomach
What is cholelithiasis
gall stones (cholesterol and bilirubin)
What are the risk factors for cholelithiasis
female, fat, fertile, forty, fair
how does insulin affect cholelithiasis
insulin leads to increased cholesterol production, which causes gallstones
how can weight loss lead to gall stones
if you are calorie restricted, your body won’t empty the gall bladder often enough
what are the exocrine diseases of the pancreas
pancreatitis
cystic fibrosis
tumors
what are the endocrine diseases of the pancreas
diabetes
tumors
what are the exocrine functions of the pancreas
digestive enzymes
what are the endocrine functions of the pancreas
alpha cells - glucagon - insulin antagonist
beta cells - insulin - glucose into cells - anabolism
gamma cells - somatostatin - inhibits insulin and glucagon
What are the two types of pancreatitis
acute and chronic
what are the characteristics of acute pancreatitis
- 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.
what are the characteristics of chronic pancreatis
- longstanding irreversible pancreatic destruction
- cause = most are alcohol related
- symptoms = none, or bouts of jaundice and pain
- prognosis = poor (50% mortality over 20 years)
what is the biggest risk factor for carcinoma of the pancreas
smoking
is carcinoma of the pancreas deadly
yes, its highly invasive, and has no symptoms until late. 5% last 5 years.
