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PATH MAGIC > HEPATOBILIARY 2 > Flashcards

HEPATOBILIARY 2 Flashcards

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

also seen in periampullary cancer

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/pale stool

Jaundice and cirrhosis in an INFANT

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7
Q

Risk factors for CHOLESTEROL stone formation

A

Supersaturation of bile
DECREASED bile acid, decreased phosphatidylcholine
GB 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

Radio-opaque

Black (no infection)

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10
Q

Causes of brown pigmented 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

Acalculous Cholecystitis causes

A

Critically ill patients (burns, sepsis) to develop cholecystitis w/o stones
Also in biliary sludge.

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14
Q

Which type of calcification causes porcelan gallbladder

A

Dystrophic- think carcinoma

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15
Q

Most common pathogens causing ascending cholangitis

A

gram negative enterics

Parasites that target the liver

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16
Q

Triad of symptoms for Acute ascending cholangitis

A

Sepsis
Jaundice
Abdominal pain

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17
Q

Biggest risk factor for ascending cholangitis

A

Choledocolithiasis

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18
Q

RLQ pain, SBO, Xray reveals air in the biliary tree

A

Gallstone illeus

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19
Q

Gallbladder carcinoma arises from

A

glandular epithleium –> Adenocarcinoma

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20
Q

Classic patient with gallbladder cancer is

A

Elderly female with cholecystitis

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21
Q

Unconjugated hyperbilirubinemia labs (hemolysis)

A

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

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22
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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23
Q

Mixed hyperbilirubinemia is a result of

A

Hepatitis (viral or alcoholi)

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24
Q

Physiologic jaundice of newborn defect

A

low UDPgluconyltransferase levels –> high UCB

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25
Q

Physiologic jaundice of newborn tx and mechanism

A

Phototherapy –> converts UCB to CB

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26
Q

Gilbert syndrome

A

mildly low UDPgluconyltransferase levels

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27
Q

Crigler Najjar 1 syndrome

A

ABSENT UDPgluconyltransferase levels –> high UCB

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28
Q

Crigler najjar presentation

A

neonatal kernicterus

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29
Q

Gilbet inheritance

A

AR

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30
Q

Dubin Johnson and Rotor syndrome defect and inheritance

A

Bilirubin canalicular transport protein defect –> high CB

AR

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31
Q

Classic 5 symptoms in biliary tract obstruction

A 
Dark urine (CB)
Pale stool
Pruritis
Xanthomas
Steatorrhea
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32
Q

Why do hepatitis patients have dark urine

A

Increased urine CB

33
Q

Pregnant woman develops acute onset Jaundice, ascites, AST, ALT through the roof then dies

A

Hepatitis E

34
Q

Confirmatory marker for active hepatitis C infection

A

HCV RNA / IgM

35
Q

markers for chronic hepatitis C

A

HCV RNA / IgG –> IgG is NOT protective

36
Q

Which hepatitis depends on hepatitis B for infection

A

Hepatitis D

Superinfection is worse than Coinfection

37
Q

3 Indicator of active HepB infection

A

HBsAg, High AST/AlT, Presence of HBc antibody

HBeAg / HBV DNA

38
Q

what is the only marker present in the window phase?

A

IgM against the core

39
Q

Markers for a cleared hepB infection

A

IgG against the surface Ag

40
Q

Markers for hepB vacccination

A

IgG against the surface Ag/no other antibodies are present

41
Q

Marker for the chronic carrier state

A

IgG against the core
+ Surface antigen (>6 months)
+ or HBV DNA

42
Q

Cell type that mediates liver cirrhosis

A

Stellate cells that secrete TGFB

43
Q

4 consequenses of hyperesternisim in cirrhosis

A

Gynecomastia
Testicular atrophy
Spider angioma
Palmar erythema

44
Q

2 consequences of decreased proten synthesis in cirrhosis

A

hypoalbuminemia –> edema

coagulopathy

45
Q

how to tell if elevated alkaline phosphatase is of liver orgin?

A

y-glutamyltranspeptidase will also be increased

46
Q

What is the underlying mechanism of tissue damage in hemochromatosis?

A

Free radical generation via the Fenton Rxn

47
Q

Hemochromaosis defect

A

Overactivation of HFE gene (C282Y)

48
Q

What does HFE code for?

49
Q

Hepcidin function

A

Inhibit the release of iron from cell into blood

50
Q

relationship of hepcidin and ferroportin

A

indirect. High hepcidin = low ferroportin

51
Q

Iron studies in hemochromatosis (ferritin,TIBC, serum Fe, transferrin, %saturation)

A

Ferritin high
Low TIBC
High Serum Fe
High %sat

52
Q

How to differentiate between lipofuscin and iron?

A

Prussian Blue stains iron

53
Q

2 other organs affected in hemochromatosis

A

Testes and heart (cardiomyopathy)

54
Q

Pt presents with darkening of skin, polyuria and polyphagia

A

Hemochromatosis (this bronze diabetes)

55
Q

Wilson disease mutation and inheritance

A

AR

ATP7B gene

56
Q

Wilson disease udnerlying defect

A

Defective ATP mediated hepatocyte/copper transfer –> copper accumulates in liver

57
Q

mechanism of damage in wilson disease

A

Free radical production

58
Q

Wilson Dz labs (urinary Cu, serum free Cu, TOTAL Cu, cerruloplasmin)

A

Increased Urinary Cu
Increased Free serum Cu
Decreased TOTAL Cu (low cerruloplasmin)

59
Q

45y/o female with SLE presents with generalized itching

A

Primary biliary cirrhosis

60
Q

25 year old male with hx of bloody diarrhea and abdominal pain presents with jaundice

A

Primary sclerosing cholangitis

61
Q

serum marker for PSC

62
Q

Baby has fever, mom gives a fever reducer, baby develops jaundice, hypoglycemia, vomiting

A

Reye Syndrome

63
Q

hepatic adenomas are associated with which 2 substances

A

Birth control pills

Anabolic steroids

64
Q

Classic case for hepatic adenoma rupture

A

Healthy girl on birth control pills or male body builder suddenly develops severe RUQ pain, hypotension and death

65
Q

how does aflatoxin induce hepatocellular carcinoma

A

p53 mutation

66
Q

hepatocellular carcinoma tumor marker

A

Alpha Fetoprotein

67
Q

5 most common tumors that met to liver

A

Colon > Stomach > Pancreas > lung / breast

“Cancer Sometimes Penetrates Benign Liver”

68
Q

PE signs of 2 most common causes of Obst jaundice

A

Palpable gallbladder that is non tender- Suggestive of adenocarcinoma of the head of the pancreas

Non-palpable gall bladder: Stone in CBD

69
Q

Imaging technique for acute cholecystitis diagnosis

A

Hepatobiliary iminodiacetic acid scan (HIDA)

70
Q

Effect of estrogen on cholesterol/stones

A

Increases HMGCoA reductase –> increases risk of stones

71
Q

Well circumscribed liver mass with cystic blood filled spaces, and vascular proliferation

A

Cavernous Hemangioma

72
Q

hepatolenticular degeneration (AKA)

A

Wilson Disease

73
Q

Which inflammatory cell mediates alcoholic hepatitis?

A

Neutrophils

74
Q

cholangiocarcinoma is associated with which other cancer

A

ulcerative colitis

75
Q

Deficiency of vitamin ADEK

A

Gallstone, steatorrhea

76
Q

night blindness, squamous metaplasia of resp. epithelium, osteomalacia, bleeding tendency - seen in___

A

Gallstone, steatorrhea

77
Q

isolated deficiency of Vit D seen in ___________

A

Uremia/renal failure

78
Q

Casue of renal stone in steatorrhea

A

Increased oxalate absorption from GIT

79
Q

Casue of gall stone in crohns disease

A

Decreased reabsorption of BS from GIT/Ilium

PATH MAGIC (21 decks)

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