Liver, gallbladder & pancreas Flashcards by Herik Valles

La cirrosis hepática tiene posibilidad de evolucionar a:

Hepatocarcinoma

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Estadío de daño hepático que NO es reversible

Fibrosis

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Gente con mayor probabilidad de daño hepático

Mujeres y asiáticos

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Neoplasm with no central scar and no portal tracts

Hepatocellular adenoma

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Prominent ballooning of liver cells may form..

Mallory hyaline

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Ballooning hepatocites are a hallmark of

Steatohepatitis

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Principal cell type that produces scar in a damaged liver

Hepatic stellate cell

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Failure of fusion of fetal duct systems of the pancreas

Pancres divisum

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Gene that causes pancreas agenesia

PDX1

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Place where trypsin activates before activating pancreatic enzymes

Duodenum

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Trypsin inhibitors secreted by acinar and ductall cells

Protease inhibitor Kazal type 1

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Most common cause of acute pancreatitis

Biliary tract disease and alcoholism

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Factor necessary for trypsin activated, increased in pancreatitis

Calcium

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Genes associated with hereditary pancreatitis

PRSS1, SPINK1 and CFTR

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Trypsinogen gene with a gain-of-function mutation that avoids trypsin self-inactivation

PRSS1

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Trypsin inhibitor gene altered in pancretisis

SPINK1

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5 basic alterations of acute pancreatitis

Microvascular leak and edema
Fat necrosis
Acute inflammation
Damage (autodigestion)
Blood vessel destruction with interstitial hemorrage

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Result of pancreatic fat necrosis in which fatty acids combine with calcium and surviving fat cells look blue in microscope

Saponification

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Pancreatic parenchymal necrosis also has intraparenchymal hemorrage.

Hemorragic pancreatitis

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Cardinal manifestation of acute pancreatitis

Abdominal pain (constant, intense and referred to the upper or mid back and left shoulder)
+ anorexia, naurea and vomiting

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Blood indicators for acute pancreatitis

Lipase and amylase (lipase more specific and sensitive)

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Ominous complications of acute pancreatitis

Respiratory distress syndrome and acute renal failure

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Advere pronostic indicators of acute pancreatitis

Systemic organ failure and pancreatic necrosis

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It starts with destruction of pancreatic exocrine parenchyma, future fibrosis and destruction of endocrine.

Chronic pancreatitis

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Most common cause of chronic pancreatitis

Long-term alcohol use

Immunoglobulin associated with autoimmune autoimmune pancreatitis type 1

IgG4

Clinical manifestation of chronic pancreatitis

Acute symptoms repeatedly, attacks precipitated by a alcohol and medications that increase sphincter of oddi

Mediators shown in chronic pancreatitis as a result of repeated episodes acinar cell injury

Profibrogenic cytokines (TGFB) and PDGF

Macroscopic aspect of pancreas in cronic pancreatitis

Hard gland with visibly dilated ducts

Phlebitis and lymphoplasmatic inflammation is characteristic of this type of pancreatitis

Autoinmune pancreatitis type 1

Granylocyte epithelial lesions and neutrophilic infiltrates of medium-sized pancreatic ducts is characteristic of

Autoimmune pancreatitis type 2

Lining of pseudocysts

Fibrous tissue and granulation tissue, lack epithelial lining

65 y/o women presents non-specific symptoms (abdominal pain). Imaging shows a mass in the tail of pancreas with small cavities. Probable diagnosis and gene associated to the condition.

Serous cystic neoplasm, VHL tumor suppresor gene inactivated.

Women presents a mass in the tail of the pancreas. Analysis of the piece shows large cystic cavities filled with mucin. Most common diagnosis and receptors the piece will express. Mutation in KRAS and RNF43

Mucinous cystic neoplasm. Estrogen, progesterone receptors and inhibin.

Men presents mass in the head of the pancreas with absence of ovarian stroma and pancreatic duct. Diagnosis and mutation

Intraductal papillary mucinous neoplasms. KRAS, RNF43 and Gsa mutation.

Pancreatic mass with CTNNB1 B-catenini mutation that presents in young women with abdominal discomfort.

Solid-pseudopapillary neoplasm

Pancreatic cancer precursor lesions that develop in small ducts

Pancreatic intraepithelial neoplasia (PanIN)

Genes most commonly associated with cancer pancreas.

1. KRAS 2. TP53 3.SMAD4 4. CDKN2A

Strongest environmental influence for pancreatic cancer (x2)

Cigarette smoking

Male, 60, presents Courvoisier sign (jaundice + enlarged bladder), weightloss, anorexia and Trousseau sign (migratory thrombophlebitis), is a common smoker. Clinical suspicion and damage locatin and probable mutation.

Pancreatic carcinoma, head pancreas ,BRCA2 mutation

Image of pancreas with prominant cell architecture with minimal stroma. Lacks fibrous component.

Acinar cell carcinoma

Principal cell involved in scare deposition in liver, it normally stores lipid and vitamin A

Stellate cell

Place where liver scarring commence

Space of Disse with loss of sinusoidal fenestration (sinusoidal capillaritazion)

Sinusoidal capillarization in liver suggests

Nonalcoholic steatohepatitis

Predominant fiture in cirrotic noduls due to hepatocytes replication to survive

Regenerative nodules

Appearance of liver in rehabilitation through metalloproteinases

Incomplete septal cirrhosis

Liver illness assoc. with encelopathy and coagulopathy within 26 weeks (8w) after initial liver injury without previous existing disease.

Acute liver failure

Time in which liver failure occures after acetaminophen toxicity

1 week

Patient manifests nausea, vomiting and jaundice, followed by encephalopathy and coagulation deffects.

Actue liver failure

Hepatitis virus that is self-limited and does not lead to chronic hepatitis.

Hepatitis A

Hepatitis virus most often associated with chronic disease

Hepatitis C

Cirrhosis that arises without any clear cause

Cryptogenic cirrhosis

Clinical features of chronic liver failure

Cholestasis, modification in estrogens, hypogonadism

Main circulation altered in hyperdynamic cirucilation due to portal hypertension.

Splachnic circulation

Consequences of portal hypertension

Hepatic encelopathy Ascites Portosystemic venous shunts Congestive splenomegaly

Lack of blood oxygenation due to portal hypertension and dilated lung capilaries

Hepatopulmonary syndrome

Dyspnea and clubbing on the fingers are a manifestation of this portal hypertension condition

Portopulmonary hypertension

Diseases with Mallory hyeline bodies

NASH Alcoholic hepatitis Wilson's disease

Alcohol amount necessary to produce mild, reversible, hepatic steatosis

80 g of alcohol (6 beers u 8 oz of 80-proof liquor)

Amount of alcohool assoc. with severe lever injury

160 g / day for 10-20 years

Enzyme that has 50% of activity in asians and makes them intolerant to alcohol.

ALDH*2

Lobular zone in which alcoholic liver disease changer occur

Lobular zone 3

Hepatic enzyme ratio in liver disease

AST>ALT 2:1

NAFLD injury with similar histologic features to those of alcoholic hepatitis

NASH

Its metabolism is impaired by alcohol, decreasing glutathione and making the liver more susceptible to oxidative injury.

Methionine

Pattern of steatohepatitis fibrosis

Pericellular or perinusoidal, "chicken wire"

Phases of fibrosis in alcoholic liver disease

1. Chicken wire 2. Periportal fibrosis 3. Bridging fibrosis

Micronodular fibrosis of the liver in alcoholic liver disease

Laennec fibrosis

Women presents a mass in the liver with a capsule and central stellate scar. Biopsy IHC for glutamine synthase shows a maplike pattern.

Focal nodular hyperplasia

A surgeon finds small subcapsular lesions in the liver and thought of metastasis. The lesion was obstructing the bile ducts.

Bile duct adenoma or biliary hamartoma

Most common benign liver tumor, looks red-blue, with a subcapsular location, dilated thin-walled vascular channels

Cavernous hemangiomas

Young woman taking contraceptives presents liver mass. Most common diagnosis

Hepatocellular adenoma

Subtypes of hepatocellular adenoma

1. HNF1a-inactivated 2. Inflammatory 3. B-catenin

Subtype of hepatic adenoma with mutation in gp130, associated with obesity and metabolic syndrome.

Inflammatory hepatocellular adenoma

A patient who used to present a liver mass now presents massive abdominal bleeding. Which is the name of the mass?

Hepatocellular adenoma

Child aged 2 presents jaundice and abdominal distention, CT shows a liver mass and metastasis to the lungs. What's the mass, it resembles to embryonal and fetal hepatocytes.

Hepatoblastoma

Asian male of 30 years with acquired infection of HBV presents abdominal pain, fatigue, weightloss and hepatomegaly. US shows a green-yellowish liver mass. Most common diagnosis

Hepatocellular carcinoma

Tumors in the intrahepatic biliary tree

Intrahepatic cholangiocarcinoma

Tumors in the extrahepatic biliary tree

Biliary adenocarcinoma