Liver and Gallbladder Flashcards
Conditions for acute liver injury
80-90% parenchymal loss within 26 weeks post-insult, no pre-existing liver disease, enceph or coagulopathy
Kidney failure in liver failure patients without an intrinsic kidney dysfunction
Hepatorenal syndrome
Transformation of liver into regenerating parenchymal nodules surrounded by dense bands of scar with variable degrees of vascular shunting
Cirrhosis
Most common cause of portal HTN
Cirrhosis
Major outcomes of portal HTN
APES - ascites, portosystemic shunt, enceph, splenomegaly
Present in hepatopulmonary syndrome due to V/Q mismatch
Platypnea (dyspnea on upright position as V/Q mismatch is accentuated)
Hallmark of chronic viral hepatitis
Portal inflammation (absent in acute)
Eosinophilic inclusions found in viral hepatitis
Councilman bodies
Circulating antibodies in type 1 autoimmune hepatitis
ANA and anti-SMA (occurs in older people, more favorable prognosis)
Circulating antibodies in type 2 autoimmune hepatitis
Anti-LKM-1 (occurs in kids and teens, less favorable prognosis)
Predictable, dose-dependent hepatotoxic drug
Paracetamol / acetaminophen
Idiosyncratic, dose-independent hepatotoxic drug
Chlorpromazine and halothane
Three morphologic patterns of alcoholic liver disease
Hepatocellular steatosis, alcoholic steatohepatitis, steatofibrosis
Level of alcohol ingestion needed for development of alcoholic liver disease
80 g/day (AST > ALT elevation)
Found in alcoholic steatohepatitis
Mallory-Denk bodies
Found in alcoholic steatofibrosis
Perisinusoidal chicken wire fence pattern of fibrosis
Triad of hemochromatosis (200x greater risk for HCC)
Micronodular cirrhosis, DM, abnormal skin pigmentation
Impaired copper excretion into bile and incorporation to ceruloplasmin
Wilson disease
Manifestations of Wilson disease in liver, brain, and eye
Liver: steatosis to cirrhosis, brain: putaminal atrophy and cavitations leading to movement d/o, Eye: Kayser-Fleisher rings in corneal limbus
Bilirubin level for jaundice
2-2.5 mg/dl
Most common cause of large bile duct obstruction in children
Biliary atresia
Charcot’s triad of ascending cholangitis
Fever, RUQ pain, jaundice (+ mental status changes and hypotension for Raynaud’s pentad)
Causes of neonatal cholestasis
Neonatal hepatitis vs extrahepatic biliary atresia (correct with Kasai procedure)
Main diseases of autoimmune cholangiopathies
Primary biliary cirrhosis and primary sclerosing cholangitis
Autoimmune cholangiopathy that occurs more in 50 year females
Primary biliary cirrhosis (vs younger males for sclerosing cholangitis)
Autoimmune cholangiopathy associated with Sjogren’s, scleroderma, and thyroid disease
Primary biliary cirrhosis (vs IBD for sclerosing cholangitis)
Autoimmune cholangiopathy 95% AMA positive
Primary biliary cirrhosis (vs ANCA for sclerosing cholangitis)
Autoimmune cholangiopathy that has microndoular cirrhosis with hepatomegaly
Primary biliary cirrhosis
Autoimmune cholangiopathy with increased risk for cholangiocarcinoma
Primary sclerosing cholangitis
Triad of choledochal cyst
Pain, jaundice, abdominal mass
Choldechal cyst with cystic dilatation of intrahepatic bile ducts
Caroli disease
Most common cause of impaired blood inflow and small portal vein obstruction
Schistosomiasis
Most common cause of impaired intrahepatic blood flow
Cirrhosis
Characterized by obstruction of 2 or more hepatic veins via thrombosis, with liver enlargement pain and ascites, and hemorrhagic centrilobular necrosis
Budd-Chiari syndrome
Pattern caused by centrilobular ischemic coagulative necrosis in left sided HF
Nutmeg liver (from hypoperfusion)
Most common benign liver tumor
Cavernous hemagioma
Most common liver tumor of early childhood
Hepatoblastoma
Most common tumor of the liver
Mets
Most common primary malignant liver tumor
HCC
Second most common primary malignant liver tumor
Cholangiocarcinoma
Angiography pattern of liver nodules
Hypervascular (and with normal to increased uptake on liver scan)
Angiography pattern of hepatocellular adenoma
Hypovascular (and with no uptake on liver scan)
Liver mass associated with increased risk of malignant transformation from OCP use
Hepatocellular adenoma
Tumor marker for HCC
AFP
Parasitic causes of cholangiocarcinoma
The liver flukes Opistorchis and Clonorchis
Most common location of cholangiocarcinoma
Perihilar (Klatskin tumor)
Most common congenital anomaly of the gallbladder
Folded fundus or phrygian cap
Condition where large GB stone erodes into adjacent small bowel
Gallstone ileus or Bouveret syndrome
Radiolucent GB stone
Black pigment stone
Mucosal outpouchings seen in chronic cholecystitis
Rochitansky-Aschoff sinuses
Form of chronic cholecystitis associated with increased risk for CA
Porcelain GB
Most common malignancy of the extrahepatic HBT
GB adenocarcinoma
Most common congenital anomaly of the pancreas
Pancreatic divisum (wherein bulk of parenchyma drained by small duct, predisposing to chronic pancreatitis)
Congenital anomaly of the pancreas that can cause duodenal obstruction
Annular pancreas
Most common sites for ectopic pancreas
Stomach, duodenum, jejunum, Meckel’s, ileum
Germline mutation causes pancreatic agenesis
PDX1 mutation
Most common cause of chronic pancreatitis
Alcohol abuse
Most frequently oncogene in pancreatic CA
KRAS (as in pancKReAS) [while smoking is the most important environmental risk factor]
Tumor marker for pancreatic CA
CA 19-9 (because a 9 on its side looks like the pancKReAS)
