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SP16- Gen Path Exam 3 > Liver, Gallbladder, and Pancreas Diseases > Flashcards

Liver, Gallbladder, and Pancreas Diseases Flashcards

1
Q

The liver accounts for approximately _____% of total body weight.

A

2 to 3%

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2
Q

The liver contains a ______ and a ____ area with which three vessels?

A

central area

portal Triad: (largest to smallest)

  1. hepatic portal vein,
  2. common bile duct
  3. proper hepatic artery,
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3
Q

What are the physiological functions of the liver?

A
  1. MAINTAIN metabolic homeostasis
  2. SYNTHESIZE serum proteins
  3. DETOXIFY xenobiotics and waste products
  4. act as a FUNCTIONAL RESERVE
  5. REGENERATE to mask hepatic injury
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4
Q

True or False: 60-70% of the liver can be removed and the functional reserve capacity allows it to regenerate within 6 to 8 months.

A

True

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5
Q

What are the possible liver responses to injury (5 options)?

A
  1. Degeneration of hepatocytes/accumulation of toxic products
  2. Necrosis
  3. Inflammation (helps or impedes healing)
  4. Regeneration
  5. Fibrosis (loss of function over time)
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6
Q

Liver necrosis and inflammation involves many cells (apoptotic cells, eosinophils, etc), but the inflammation process is usually _____ -based.

A

T-cell

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7
Q

________is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly

A

Cirrhosis

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8
Q

A liver affected by cirrhosis will display ______ scar tissue (fibrosis) and an increased number of ________ hepatocytes.

A

DIFFUSE (not focal, the whole liver will show damage)

regeneration hepatocytes

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9
Q

True or False: Cirrhosis is among the top 10 causes of death in US adults.

A

True

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10
Q

Cirrhosis is the ______ route of liver-related death.

A

primary

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11
Q

What are the five main causes of cirrhosis (from most to least common)?

A
  1. Alcohol abuse
  2. Viral Hepatitis (HepC in particular)
  3. Non-Alcohol Steatohepatitis (NASH=fat buildup)
  4. Biliary Disease
  5. Iron Overload

“(A)lcoholics (H)ave (N)asty (B)reath (I)ncluded” with cirrhosis

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12
Q

What type of changes occur in the liver that will ultimately lead to loss of hepatic function?

A

Fibrosis (bridging septae) with parenchymal nodules

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13
Q

Which type of staining can be used to evaluate cirrhosis histologically?

A

H&E

Trichrome (blue staining collagen)

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14
Q

What are the symptoms associated with Cirrhosis?

A

Weight Loss
Liver Failure
Portal Hypertension (ASCITES, splenomegaly, collateral venous channels)

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15
Q

Cirrhosis can result from alcohol abuse due toxic damage or _______ _______. Other causes of cirrhosis include obesity, Diabetes M, and Medication.

A

nutritional deprivation

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16
Q

Jaundice (aka: icterus) results from the presence of excess _____.

A

bilirubin

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17
Q

What is the normal amount of bilirubin? What is seen in the case of jaundice?

A

Normal: 1.1 - 1.2 mg/dL

greater than 2.0mg/dL

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18
Q

Unconjugated bilirubin is _____ and ______. Conjugated bilirubin is ______ and _______.

A 
Un = insoluble and toxic
Con =  soluble and nontoxic
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19
Q

Other than the overproduction of bilirubin, how can excess accumulation occur?

A

reduced hepatocyte uptake and obstruction of bile flow

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20
Q

What is the #1 cause of Jaundice?

A

HEMOLYTIC ANEMIA

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21
Q

What is hepatitis?

A

hepatocyte injury that is associated with inflammation

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22
Q

True or False: There is a similar pattern of liver injury from hepatitis regardless of the causative agent

A

True

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23
Q

What are the causative agents of hepatitis?

A

viruses
autoimmune
drugs
toxic agents

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24
Q

Hepatitis A is a ______ virus that is spread via _______ transmission.

A

RNA

fecal-oral

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25
Q

Is there a chronic disease or carrier state with Hep A?

A

No

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26
Q

What is the incubation period for Hep A?

A

2-6 weeks

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27
Q

Hepatitis B is a ______ virus that is spread via ______ transmission

A

DNA

parenteral or sexual

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28
Q

What is the incubation period for Hep B?

A

4-26 weeks

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29
Q

Hep B infections will remain in the blood. How effective are Hep B vaccines?

A

95% protective antibody response

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30
Q

Is there a chronic disease state with Hep B?

A

YES, chronic liver disease, cirrhosis, or carrier-state

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31
Q

What percentage of Hep B infections are subclinical and lead to recovery?

A

60-65%

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32
Q

Hepatitis C is a _____ virus that is spread via ______ transmission.

A

RNA

parenteral or sexual

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33
Q

What is the incubation period for Hep C?

A

7-8 weeks (acute phase is asymptomatic)

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34
Q

Is there a chronic disease state of Hep C??

A

YES! the majority progress

chronic liver disease, cirrhosis, or carrier-state

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35
Q

What are the “hallmark features” of HepC (occurs 85% of the time)?

A

Persistent infection + chronic hepatitis

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36
Q

Is there an effective Hep C vaccine?

A

NO! Hep C is too genomically unstable (variable)

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37
Q

Both Hep B and Hep C infections pose a high risk for _______ ________.

A

Hepatocellular Carcinoma

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38
Q

Is there treatment for Hep C?

A

Previously: interferon and ribaviron (only moderate response)
Now: PROTEASE and NUCLEOSIDE INHIBITORS
(Harvoni is a combination of the two that is curative in most patients)

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39
Q

How long of a drug course is Harvoni? What are the side effects and down-sides to its use?

A

8-24 weeks
Side effects: fatigue and headache
Expensive: $100,000-$150,000

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40
Q

How quickly does Acute Viral Hepatitis resolve?

A

~8 weeks

41
Q

What are the symptoms of Acute Viral Hepatitis?

A 
Sometimes none (serologic only)
Possible Symptoms:
-anorexia
-fatigue
-joint aches
-jaundice
42
Q

What is the histological sign for acute viral hepatits?

A

PanLobular Disarray
Inflammation
Hepatocyte necrosis

43
Q

True or False: Acute Viral Hepatitis can transition into a chronic state (Hep B or Hep C)

A

True

44
Q

Chronic Hepatitis is defined as abnormal liver function for more than ______.

A

6 weeks

45
Q

What are the three main features of Alcohol Liver Disease?

A
  1. Hepatic Steatosis (Fatty Change)
  2. Cirrhosis
  3. Alcoholic Hepatitis
46
Q

_____% of chronic liver disease is associated with alcohol overconsumption.

A

60

47
Q

_____% of deaths associated with alcohol liver disease are due to cirrhosis.

A

40-50

48
Q

Hemochromatosis is a genetic disorder in which the body loads too much _____.

A

iron

49
Q

Excess iron will usually accumulate in the _____, _____, and _____.

A

liver
pancreas
heart

50
Q

Hemochromatosis is a _________ genetic disorder or can be caused by secondary overload due to ______.

A

autosomal recessive (HFE gene mutation)

excessive iron intake (supplement use)

51
Q

Hemochromatosis puts a patient at increased risk for many diseases (DM, cancers, arthritis, heart attack, etc). How is the disease treated?

A
  1. Phlebotomy (blood removal)
  2. Dialysis
  3. Iron Chelation Therapy (with EDTA-like molecules)
52
Q

What are the features (pathogenesis) of Hemochromatosis?

A

Micronodular Cirrhosis
hepatosplenomegaly
Skin Pigmentation
Diabetes

53
Q

What is Wilson’s Disease?

A

an autosomal rescessive disease that results in

COPPER accumulation in the liver, brain and eyes

54
Q

What type of chelation therapy is used for Wilson’s Disease?

A

D-Penicillamine

55
Q

In what forms do Hepatic Tumors present?

A
  • cysts
  • bile ducts
  • hemangiomas
  • hepatocyte
56
Q

True or False: Hepatic Tumors will commonly result due to metastasis.

A

True, the liver has a rich blood supply and is an important filter for many organs
(common: colon, lung, breast)

57
Q

What is a Cholangiocarcinoma?

A

a carcinoma that arises in the bile ducts inside/outside of the liver

  • very aggressive
  • asymptomatic until late stage detection
58
Q

Hepatocellular adenoma is a _____ tumor that is associated with the use of _________.

A

benign

oral contraceptives

59
Q

How does hepatocellular adenoma present clinically and histologically?

A 
CLINCAL:
Acute abdomen (pain, nausea)
intra-abdominal bleed

HISTOLOGY:
bland hepatocytes
no bile ducts

60
Q

Hepatocellular _______ is the third leading cause of cancer deaths in Western countries.

A

carcinoma

61
Q

Is hepatocellular carcinoma more common in men or women?

A

H. Carcinoma is more common in men (3:1)

62
Q

In 90% of Hepatocellular Carcinoma cases, ______ is the precursor. Hep B and Hep C could also lead to this form of carcinoma.

A

Cirrhosis

63
Q

True or False: There is a low chance for vascular invasion with Hepatocellular Carcinoma.

A

False, strong propensity for invasion

64
Q

How is Fibrolamellar Carcinoma distinguishable from Hepatocellular Carcinoma?

A

Fibrolamellar = YOUNGER patients (20-40s), no known risk factors, “Scirrhous tumors” with collagen surrounding them

65
Q

What is the treatment and prognosis for Hepatocellular vs Fibrolamellar Carcinomas?

A

HCC: Tx = resection if focal, or liver transplant
Prognosis = grim, new foci may develop
FLC: Tx = surgery
Prognosis = better, 32% 5 yr survival

66
Q

Which are more common: metastatic or primary tumors?

A

Metastatic

67
Q

60-70% of gallbladders will share a common orifice with the ______.

A

pancreatic duct

68
Q

What is Cholelithiasis? How common is it?

A

gallstones

common: 10-20% of adults

69
Q

True or False: Most gallstones are silent.

A

True, 80% are silent

70
Q

What two types of stones are present in the gallbladder?

A

cholesterol stones: 80%

Pigment stones: 20%

71
Q

Radiographically, cholesterol stones are mostly _____ and pigmented stones (ex. bilirubin) are ________

A

radiolucent

radiopaque

72
Q

What are the risk factors for Cholesterol Gallstones?

A

Higher prevalence in:

  • caucasians
  • females
  • later age
  • estrogen use
73
Q

What are the risk factors for Pigmented Gallstones?

A
  • hemolysis (hemolytic anemia)
  • GI disorders
  • biliary infection
74
Q

Cholecystitis (inflammation of the gall bladder) is more common in _______. There is an acute and chronic form.

A

women age 40-60

75
Q

What are the symptoms of acute cholecystitis?

A

Severe upper right quadrant pain

chemical, bacterial, reflux-ischemia

76
Q

What are the symptoms of chronic cholecystitis?

A

symptoms are vague
90% formation of stones
fibrosis + inflammation

77
Q

What is the five year survival rate for adenocarcinomas of the gallbladder?

A

5%

78
Q

How common are carcinomas of the gallbladder?

A

5th most common among GI malignancies

79
Q

Gallbladder adenocarcinoma is most common in _______ and _______ with a peak age of ______.

A

whites
females
70 years

80
Q

Histologically, gallbladder cancer appears as _______ that replace normal crypts.

A

burrowing, thread-like growths

81
Q

The pancreas has both _____ and ______ functions.

A

exocrine

endocrine

82
Q

Endocrine Cells (Islets) account for ____ % of the pancreas; whereas, the exocrine cells (acini and ducts) account for the remainder.

A

1 to 2%

83
Q

What is the endocrine function of the pancreas?

A

regulates glucose homeostasis via insulin and glucagon

84
Q

What is the exocrine function of the pancreas?

A

food digestion via release of amylase, trypsin, chymotrypsin, and lipase

“Lets T.A.L.C about the enzymes of the pancreas”

85
Q

80% of Acute Pancreatitis cases involve which three conditions?

A
  1. cholelithiasis
  2. biliary tract disease (many gallbladders share orifice)
  3. alcoholism
86
Q

What are the potential causes of acute pancreatitis?

A 
gallstones
biliary tract disease
alcoholism
trauma
drugs
septisemia/infection
hypercalcemic states (metabolic)
idiopathic (genetics?)
87
Q

Acute pancreatitis causes a release of ____ and inflammation proteolysis. There is also fat necrosis and ____ necrosis with hemorrhage.

A

lipases

vessel

88
Q

True or False: there is an elevation in enzymes with acute pancreatitis.

A

True, amylase and lipase

89
Q

What are possible complications of acute pancreatitis?

A

organ failure
abscess
8% mortality

90
Q

Chronic pancreatitis is a progressive destruction with early loss of the ______functioning and later loss of the ______ functioning.

A

(1st) EXOcrine

(2nd) ENDOcrine

91
Q

What is the morphological presentation of chronic pancreatitis?

A
  • reduction in acini
  • chronic inflammation
  • fibrosis
  • obstruction of ducts
  • spare islets
92
Q

Behind Lung, Colon, and Breast Cancer, ______ Tumors are the 4th leading cause of cancer death in the USA.

A

Pancreatic Exocrine Tumors

due to late stage detection

93
Q

Most pancreatic carcinoma patients will die within _____ of detection.

A

6 months

94
Q

______ doubles pancreatic cancer risk.

A

smoking

95
Q

Which diseases will also increase risk of pancreatic carcinoma?

A

diabetes mellitus

chronic pancreatitis

96
Q

When is the peak age for pancreatic carcinoma?

A

6th-7th decade (silent growth)

97
Q

Describe the structure of the pancreatic carcinoma.

A

ill-defined
gritty
gray-white
hard

98
Q

Cancers at the head of the pancreas will obstruct the ______ and cause jaundice. Cancers at the body or tail region will be clinically _____.

A

common bile duct

silent (and large at the time of diagnosis)

SP16- Gen Path Exam 3 (12 decks)

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