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HEPATOBILIARY 2 Flashcards

(76 cards)

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1
Q

Jaundice, weight loss, epigastric pain

A

Pancreatic cancer

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2
Q

2 major risk factors for pancreatic cacner

A

Smoking

Chronic Pancreatitis

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3
Q

Unique findings in carcinoma of the HEAD of the pancreas

A

Conjugated hyperbilirubemia / Jaundice
Pale Stools
Dark urine (due to CB)
Itching

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4
Q

Serum marker for pancreatic cancer

A

CA 19-9

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5
Q

biliary atresia embryo defect

A

Failure to form the extrahepatic biliary tree

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6
Q

biliary atresia presentaion

A

conjugated hyperbilirubinemia

Jaundice and cirrhosis in an INFANT

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7
Q

3 risk factors for CHOLESTEROL stone formation

A

Supersaturation of bile
DECREASED bile acid, decreased phosphatidylcholine
Stasis, high estrogen, low cck, high progesterone

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8
Q

Cholesterol stone, gross and Xray

A

Radiolucent…may possibly be radiopaque

Yellow/faceted

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9
Q

Bilirubin stones, gross and Xray

A

Radiolucent

Black

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10
Q

causes of brown stones

A

Biliary Tree infection

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11
Q

the causative organism of acute cholangitis

A

E.coli

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12
Q

RUQ pain radiating to the shoulder, Nausea and Vomiting

A

Acute Cholecystitis

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13
Q

Acute Cholecystitis labs (alk phos)

A

Increased Alk Phos + increased y-glutamyltransferase

(osteoblasts also release alk phos)…non specific

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14
Q

Acalculous Cholecystitis causes

A

Critically ill patients (burns, sepsis) to develop cholecystitis w/o stones

Makes sense b/c critically ill pts often have SHOCK = decreased blood flow = inflammation = infection to gall bladder

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15
Q

Which type of calcification causes porcelan gallbladder

A

Dystrophic

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16
Q

Most common pathogens causing ascending cholangitis

A

gram negative enterics

Parasites that target the liver

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17
Q

Triad of symptoms for ascending cholangitis

A

Sepsis
Jaundice
Abdominal pain

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18
Q

Biggest risk factor for ascending cholangitis

A

Choledocolithiasis

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19
Q

RLQ pain, Xray reveals air in the biliary tree

A

Gallstone illeus

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20
Q

Gallbladder carcinoma arises from

A

glandular epithleium –> Adenocarcinoma

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21
Q

Classic patient with gallbladder cancer is

A

Elderly female with cholecystitis

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22
Q

Unconjugated hyperbilirubinemia labs (hemolysis)

A

Increased UB
Increased urine Urobilinogen (more shunted during enterohepatic cycling)
No urine CB

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23
Q

Conjugated hyperbilirubinemia labs

A

Increased CB
no Urine urobilinogen (no CB made it to the gut to be converted)
Increased Urine CB and bile salts (CB refluxes backward into sinusoids)

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24
Q

Mixed hyperbilirubinemia is a result of

A

Hepatitis (viral or alcoholi)

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25
Physiologic jaundice of newborn defect
low UDPgluconyltransferase levels --> high UCB
26
Physiologic jaundice of newborn tx and mechanism
Phototherapy --> converts UCB to CB
27
Gilbert syndrome
mildly low UDPgluconyltransferase levels
28
Crigler Najjar 1 syndrome
ABSENT UDPgluconyltransferase levels --> high UCB
29
Crigler najjar presentation
neonatal kernicterus
30
Gilbet inheritance
AR
31
Dubin Johnson and Rotor syndrome defect and inheritance
Bilirubin canalicular transport protein defect --> high CB AR
32
Classic 5 symptoms in biliary tract obstruction
``` Dark urine (CB) Pale stool Pruritis Xanthomas Steatorrhea ```
33
Why do hepatitis patients have dark urine
Increased CB
34
Pregnant woman develops acute onset Jaundice, ascites, AST, ALT through the roof then dies
Hepatitis E
35
Confirmatory marker for active hepatitis C infection
HCV RNA / IgM
36
markers for chronic hepatitis C
HCV RNA / IgG --> IgG is NOT protective
37
Which hepatitis depends on hepatitis B for infection
Hepatitis D Superinfection is worse than Coinfection
38
3 Indicator of active HepB infection
HbSAg anticore IgM HBeAg / HBV DNA
39
what is the only marker present in the window phase?
IgM against the core
40
Markers for a cleared hepB infection
IgG against the surface
41
Markers for hepB vacccination
IgG against the sruface
42
Marker for the chronic carrier state
IgG against the core + Surface antigen (>6 months) + or HBV DNA
43
Cell type that mediates liver cirrhosis
Stellate cells that secrete TGFB
44
Veins involved in caput medusae
Paraumbilical --> epigastric
45
Anorectal varices veins involved
Superior rectal (portal) --> inferior/middle rectal
46
4 consequenses of hyperesternisim in cirrhosis
Gynecomastia Testicular atrophy Spider angioma Palmar erythema
47
2 consequences of decreased proten synthesis in cirrhosis
hypoalbuminemia --> edema | coagulopathy
48
how to tell if elevated alkaline phosphatase is of liver orgin?
y-glutamyltranspeptidase will also be increased
49
What is the underlying mechanism of tissue damage in hemochromatosis?
Free radical generation via the Fenton Rxn
50
Hemochromaosis defect
Overactivation of HFE gene Cystine --> Tyrosine in the HFE gene (C282Y)
51
What does HFE code for?
Hepcidin
52
Hepcidin function
Inhibit the release of iron from cell into blood
53
relationship of hepcidin and ferroportin
indirect. High hepcidin = low ferroportin
54
Iron studies in hemochromatosis (ferritin,TIBC, serum Fe, transferrin, %sat)
Ferritin high Low TIBC High Serum Fe High %sat
55
How to differentiate between lipofuscin and iron?
Prussian Blue stains iron
56
2 other organs affected in hemochromatosis
Testes and heart (cardiomyopathy)
57
Pt presents with darkening of skin, polyuria and polyphagia
Hemochromatosis
58
Wilson disease mutation and inheritance
AR ATP7B gene
59
Wilson disease udnerlying defect
Defective ATP mediated hepatocyte/copper transfer --> copper accumulates in liver
60
mechanism of damage in wilson disease
Free radical production
61
Wilson Dz labs (urinary Cu, serum free Cu, TOTAL Cu, cerruloplasmin)
Increased Urinary Cu Increased Free serum Cu Decreased TOTAL Cu (low cerruloplasmin)
62
45y/o female with SLE presents with generalized itching
Primary biliary cirrhosis
63
25 year old male with hx of bloody diarrhea and abdominal pain presents with jaundice
Primary sclerosing cholangitis
64
serum marker for PSC
p-ANCA
65
Baby has fever, mom gives a fever reducer, baby develops jaundice, hypoglycemia, vomiting
Reye Syndrome
66
hepatic adenomas are associated with which 2 substances
Birth control pills | Anabolic steroids
67
Classic case for hepatic adenoma rupture
Healthy girl on birth control pills or male body builder suddenly develops severe RUQ pain, hypotension and death
68
how does aflatoxin induce hepatocellular carcinoma
p53 mutation
69
hepatocellular carcinoma tumor marker
Alpha Fetoprotein
70
5 most common tumors that met to liver
Colon > Stomach > Pancreas > lung / breast "Cancer Sometimes Penetrates Benign Liver"
71
PE signs of 2 most common causes of Obst jaundice
Palpable gallbladder that is non tender Suggestive of adenocarcnioma of the head of the pancreas
72
3 imaging techniques for cholecystitis
Ultrasound Cholescintigraphy Hepatobiliary iminodiacetic acid scan (HIDA)
73
Effect of estrogen on cholesterol/stones
Increases HMGCoA reductase --> increases risk of stones
74
Well circumscribed liver mass with cystic blood filled spaces, and vascular proliferation
Cavernous Hemangioma
75
hepatolenticular degeneration (AKA)
Wilson Disease
76
Which inflammatory cell mediates alcoholic hepatitis?
Neutrophils

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