GIT-Pathology Flashcards
Budd Chiari Syndrome ?
- Hepatic venous outflow tract obstruction
- centrilobular congestion
- necrosis
- Congestive liver Disease
* hepatomegaly
* ascites
* varices
* Abdominal pain
* liver failure
5.Nutmeg liver appearance
6.Associated - Hypercoagulable state,Polycytheemia vera ,Postpartum state
FA-397
Portal vein thrombosis ?
- Portal vein—Thrombosis
- Portal HTN + Ab Pain + Fever
- Bowel ischemia if -extension–Sup mesenteric vein
FA-397
Spontaneous bacterial peritonitis ?
- G(-) E coli Klebsiella
- G(+) streptococcus
- Patient=Cirrhosis + Ascites = Fatal
- Ascitic fluid neutrophil count-ANC = >250 Cells/mm3
- Tx- Cephalosporin/Ceftriaxone
FA-397
Serum marker of Liver patho ?
- Aspartate & Alanine aminotransferase
ALT>AST = most liver disease
AST>ALT =Alchoholic L D
if in Non alchoholic d— it means cirrhosis & fibrosisinc inc inc - Aminotransferase= 3 hepatitis ( ischemic
acute viral
autoimmune)
2.Alkaline phosphatase (inc) - Cholestasis
3.Gama glutamyl transpeptidase - inc same as AP But not In Bone D
397
Functional Liver marker ?
- inc Bilirubin
- inc prothrombin time
3.dec albumin
4.dec platelets
FA-397
Reye Syndrome ?
SHINEE
S=Steatosis(Fatty changes)
H=Hypoglycemia/Hepatomegaly/Hyperammonemia
I=Infection(VZV + Influenza)
N=Not awake COMA
E=Encephalopathy
E=Edema
Tx-Aspirine
not aspirine in children
only in -KAWASAKI disease
FA-398
Alchoholic Liver Disease ?
3 Disease name –
1.Hepatic steatosis-Fatty change
2.Alcoholic hepatitis-
– Swollen and necrotic hepatocytes with neutrophilic infiltration
–Mallory bodies= (intracytoplasmic eosinophilic inclusions of damaged keratin
filaments)
3.Alcoholic cirrhosis -
– Sclerosis around central vein
–nodules surrounded by fibrous bands
– inc portal hypertension and end-stage liver disease.
FA-398
Nonalcoholic fatty
liver disease?
1.Metabolic syndrome
-Obesity
-HTN
-Insulin resistance
-Hypertriglyceridemia
-dec HDL
Obesity=Fatty infiltration = Cellular Ballooning=Necrosis
Non alcoholic steatopatitis=Lobular inflammation = hepatocyte ballooning = fibrosis
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Autoimmune Hepatitis ?
- Chronic inflammatory liver disease
- Female
- Fatigue ,Nausea ,pruritis
- inc ALT
- inc AST
- (+) for AntiSmooth Muscle /AntiLiver /AntiKIdney MIcrosomal-1 AB
- Portal and Periportal Lymphoplasmacytic infiltrate
FA-399
Hepatic Encephalopathy?
Enough tough BOSS …..
Cirrhosis = portosystemic shunts = dec NH3
metabolism neuropsychiatric dysfunction (reversible)
ranging from disorientation/asterixis to difficult arousal or coma.
Triggers:
inc NH3
production and absorption (due to GI bleed, constipation, infection).
dec NH3
removal (due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS).
Treatment: lactulose ( NH4+
+ generation) and rifaximin ( NH3
-producing gut bacteria).
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Liver Tumors ?
Tough TBH >……….
- Hepatic/Cavernous hemangioma=Benign + (30-50)
- Focal nodular hyperplasia=Benign +(35-50) + Hyperplastic reaction of hepatocytes = Central STELLATE scar
- Hepatic adenoma=Benign+OCP releted
- HEPATOCELLULAR Carcinoma/Hepatoma =Malignant
HBV & Other causes of cirrhosis - ( alcoholic and non alcoholic fatty changes , autoimmune d ,wilson d , antitrypsin deficiency , aspergillus )
Anorexia Jaudice Tender hepatomegaly
5.Hepatic angiosarcoma = Maliganant Endothelial Origin
6.Metastases= GI,Lung ,breast ,solitary
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Conjugated / Direct Hyperbilirubinemia ?
Biliary tract obstruction: gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke.
Biliary tract disease: 1° sclerosing cholangitis, 1° biliary cholangitis
Excretion defect: Dubin-Johnson syndrome, Rotor syndrome.
400
Alpha-1 Antitrypsin Deficiency ?
In lungs, dec α1
-antitrypsin uninhibited elastase
in alveoli dec elastic tissue panacinar
emphysema.
Young patient=Liver damage=Dsynea=No History of TOBACCO/SMoking ———
Misfolded gene product protein aggregates in
hepatocellular ER cirrhosis with
PAS ⊕ globules
FA-400
Jaundice ?
Abnormal yellowing of the skin
and/or sclera
Hyperbilirubinemia
HOT Liver
-Hemolysis
-Obstruction
-Tumor
-Liver disease
FA-400
Unconjugated
(indirect)
hyperbilirubinemia
Hemolytic, benign (neonates), Crigler-Najjar, Gilbert syndrome
Mixed
hyperbilirubinemia
Both direct and indirect hyperbilirubinemia.
Hepatitis, cirrhosis
Hereditary
hyperbilirubinemias
Dubin-Johnson syndrome
Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black (Dark) liver due to impaired excretion of epinephrine metabolites. Benign
Rotor syndrome
Phenotypically similar to Dubin-Johnson, but milder in presentation without black (Regular) liver.
Due to impaired hepatic storage of conjugated bilirubin.
Gilbert syndrome ?
Mildly
inc UDP-glucuronosyltransferase conjugation. Asymptomatic or mild jaundice usually with
stress, illness, or fasting. inc unconjugated bilirubin without overt hemolysis.
Relatively common, benign condition
FA-401
Crigler-Najjar
syndrome, type I
Absent UDP-glucuronosyltransferase. Presents early in life, but some patients may not have neurologic signs until later in life.
Findings: jaundice, kernicterus (unconjugated bilirubin deposition in brain), unconjugated bilirubin.
Treatment: plasmapheresis and phototherapy (does not conjugate UCB; but does polarity and
water solubility to allow excretion).
Liver transplant is curative.
Type II is less severe and responds to phenobarbital, which liver enzyme synthesis
400
Biliary atresia ?
Most common reason for pediatric liver transplantation. Fibro-obliterative destruction of bile
ducts —- cholestasis.
Associated with absent/abnormal gallbladder on ultrasonogram. Often
presents as a newborn with persistent jaundice after 2 weeks of life, darkening urine, acholic
stools, hepatomegaly.
Labs: INC direct bilirubin and GGT.
Benign Neonatal Hyperbilirubenemia?
Wilson disease ?
other name Hepatolenticular degenration
- Autosomal recessive mutation
- Hepatocyte Cu Transporting ATPase
- CHR-13—-ATP7B
- dec Cu incorporation in apoceruloplasmin
- dec excretion in bile
- dec serum ceruloplasmin
- Cu accumulates
- Urine Cu (+)Presents before age 40 with liver disease (eg, hepatitis, acute liver failure, cirrhosis), neurologic
disease (eg, dysarthria, dystonia, tremor, parkinsonism), psychiatric disease, Kayser-Fleischer rings
(deposits in Descemet membrane of cornea) A , hemolytic anemia, renal disease (eg, Fanconi
syndrome).
Treatment: chelation with penicillamine or trientine, oral zinc. Liver transplant in acute liver
failure related to Wilson disease
402FA
Hemochromatosis ?
Autosomal recessive. Mutation in HFE gene, located on chromosome 6. Leads to abnormal
(low) hepcidin production, intestinal iron absorption. Iron overload can also be 2° to chronic
transfusion therapy (eg, β-thalassemia major). Iron accumulates, especially in liver, pancreas, skin,
heart, pituitary, joints. Hemosiderin (iron) can be identified on liver MRI or biopsy with Prussian
blue stain A .
Presents after age 40 when total body iron > 20 g; iron loss through menstruation slows progression
in females. Classic triad of cirrhosis, diabetes mellitus, skin pigmentation (“bronze diabetes”). Also
causes restrictive cardiomyopathy (classic) or dilated cardiomyopathy (reversible), hypogonadism,
arthropathy (calcium pyrophosphate deposition; especially metacarpophalangeal joints). HCC is
common cause of death.
Treatment: repeated phlebotomy, iron (Fe) chelation with deferasirox, deferoxamine, deferiprone
FA-402
Acute Gastritis ?
Erosions can be caused by:
NSAIDs— dec PGE2 dec gastric mucosa
protection
Burns (Curling ulcer)—hypovolemia
mucosal ischemia
Brain injury (Cushing ulcer)— +vagal
stimulation +ACh (+) H+ production
FA-386
Chronic Gastritis ?
- Mucosal inflamation
- Hypochlorhydria
- Hypergastrenemia
- Intestinal metaplasia —— Gastric Ca
H Pylori Chronic Gastritis ?
- Antrum——Body of the stomach spread
- inc risk of Ulcer disease
- MALT lymphoma
FA-386
AutoImmune Chronic Gastritis ?
- Body /Fundus of stomach
- inc risk of Pernicious anemia
- Autoantibodies H+/K+ATPase on Parietal cell and to IF
386
Menetrier Disease ?
- Hyperplasia of gastric mucosa
- Hypertrophied rugae - wavy like brain gyri
- dec acid production
- inc protein loss
- WAVEE
W=weight loss
A=anorexia
V=vomiting
E=edema
E= epigastric pain
FA-386
Gastric Cancer ?? INTRO ???
- Gastric adenocarcinoma
- Mutation-KIT / PDGFRA
3.WEAPON
W=weight loss
E=early satiety
A=Ab pain
P=Pain
O=obstruction
N=Nigricans/Lesser trelat sign
Intestinal Gastric Carcinoma ?
- H pylori associated
- Chronic gastritis
- Dietary nitrosamines
- Tobacco smoking
- achlorhydria
- LESSER curvature
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Diffuse Gastric Carcinoma ?
- E-Cadherin mutation
- Signet ring cell
- Mucin filled cell
4.Stomach wall grossly thickened and lethary-LINITUS PLASTICA
Virchow node ?
- metastasis from stomach
- Left supraclavicular node
386
Krukenberg Tumor ?
- Metastasis to ovaries
- Signet ring cells
- Abundant mucin secreting cells
Sister mary joseph nodule ?
- SC periumbilical metastasis
Blumer shelf ?
Palpable mass in digital rectal exam - Metastatsis to retrouterine pouch-(Pouch of Douglas)
FA-386
Peptic ulcer type ?
1. Gastric ulcer 2. Duodenal ulcer
387
Gastric Ulcer ?
1. Greater with meals 2. H pylori-70% 3. dec mucosal protection 4. NSAIDs 5. inc risk of carcinoma
387
Duodenal ulcer ?
1. Dec with meals 2. H pylori-90% 3. dec mucosal protection 4. inc gastric acid secretion 5. Zollinger Ellison Syndrome 6. Benign
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Ulcer complications
3 complications
1.Hemorrhage Gastric----Lesser curvature---Left gastric artery Duodenal---Post wall----Gastroduodenal artety 2.Obstruction --Pyloric channel --Duodenal 3.Perforation Duodenal Air under diaphragm -Pneumoperitoneum refered pain in shoulder via phrenic nerve
FA-387
Acute Gastroduodenal bleeding ?
UPPER GI BLEEDING
1. Ligament of treitz 2. Suspensory ligament of duodenum 3. Hematemesis 4. Melena 5. Pepetic ulcer disease 6. Variceal hemorrhage
FA-387
LOWER GI BLEEDING ?
1. DISTAL to logament of trietz 2. Hematochezia 3. IBD 4. Diverticulosis 5. Angiodysplasia 6. Hemorrhoids 7. Anal fissure 8. Cancer
Malabsorption syndromes name ?
1. Celiac D 2. Lactose intolerance 3. Pancreatic insufficiency 4. Tropical sprue 5. Whipple D
FA-388
Celiac Disease ?
1. Gluten sensitive enteropathy 2. Autoimmune mediated intolerance of GLIADIN 3. GLIADIN=Gluten protein food 4. HLA-DQ2 HLA-DQ8 5. Distal & proximal Dudenum 6. Tx-Gluten free food 7. Dermatitis herpetiformis 8. Iron deficiency anemia 9. dec bone density 10. inc risk of maliganancy 11. D-Xylose test== Abnormal 12. Anti-(Endomysial+Tissue transglutaminase +Deamidated gliadin peptide AB ) 13. loss of villi 14. mucosal atrophy 15. crypt hyperplasia 16. intraepithelial lymphocytosis
FA-388
Lactose intolerance ?
1. Lactase deficiency 2. Normal villi 3. Osmotic diarrhea 4. dec stool pH 5. Colonic bacteria ferment lactose 6. Lactose Hydrogen breath test=(+) if >20ppm
Pancreatic insufficiency ?
1. Chronic pancreatitis 2. Cystic fibrosis 3. Malabsorption of V-A,D,E,K,B12 4. D-Xylose test= Normal 5. dec duodenal HCO3 2-
Tropical sprue ?
1. Celiac sprue same 2. Responds to AB 3. Megaloblastic anemia 4. Folate deficiency 5. B12 deficiency 6. dec mucosal absorption
FA-388
Whipple Disease ?????
1. Infection with Tropheryma whipplei (intracellular gram ⊕); PAS ⊕ foamy macrophages in intestinal lamina propria B filled with PAS ⊕ material. Cardiac symptoms, Arthralgias, and Neurologic symptoms are common. Diarrhea/steatorrhea occur later in disease course. Most common in older males
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