Liver, gallbladder & pancreas Flashcards
La cirrosis hepática tiene posibilidad de evolucionar a:
Hepatocarcinoma
Estadío de daño hepático que NO es reversible
Fibrosis
Gente con mayor probabilidad de daño hepático
Mujeres y asiáticos
Neoplasm with no central scar and no portal tracts
Hepatocellular adenoma
Prominent ballooning of liver cells may form..
Mallory hyaline
Ballooning hepatocites are a hallmark of
Steatohepatitis
Principal cell type that produces scar in a damaged liver
Hepatic stellate cell
Failure of fusion of fetal duct systems of the pancreas
Pancres divisum
Gene that causes pancreas agenesia
PDX1
Place where trypsin activates before activating pancreatic enzymes
Duodenum
Trypsin inhibitors secreted by acinar and ductall cells
Protease inhibitor Kazal type 1
Most common cause of acute pancreatitis
Biliary tract disease and alcoholism
Factor necessary for trypsin activated, increased in pancreatitis
Calcium
Genes associated with hereditary pancreatitis
PRSS1, SPINK1 and CFTR
Trypsinogen gene with a gain-of-function mutation that avoids trypsin self-inactivation
PRSS1
Trypsin inhibitor gene altered in pancretisis
SPINK1
5 basic alterations of acute pancreatitis
Microvascular leak and edema
Fat necrosis
Acute inflammation
Damage (autodigestion)
Blood vessel destruction with interstitial hemorrage
Result of pancreatic fat necrosis in which fatty acids combine with calcium and surviving fat cells look blue in microscope
Saponification
Pancreatic parenchymal necrosis also has intraparenchymal hemorrage.
Hemorragic pancreatitis
Cardinal manifestation of acute pancreatitis
Abdominal pain (constant, intense and referred to the upper or mid back and left shoulder)
+ anorexia, naurea and vomiting
Blood indicators for acute pancreatitis
Lipase and amylase (lipase more specific and sensitive)
Ominous complications of acute pancreatitis
Respiratory distress syndrome and acute renal failure
Advere pronostic indicators of acute pancreatitis
Systemic organ failure and pancreatic necrosis
It starts with destruction of pancreatic exocrine parenchyma, future fibrosis and destruction of endocrine.
Chronic pancreatitis
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.
- KRAS
- TP53
3.SMAD4 - 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
- Chicken wire
- Periportal fibrosis
- 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
- HNF1a-inactivated
- Inflammatory
- 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
