Liver + Gallbladder robbins Flashcards
What are the most common type of gallstones?
Cholesterol (80% in western world)
What are Pigment (black + brown) stones made up of?
Billirubin and Calcium salts = Radio opaque
**INcreased Unconjugated billirubin= Hemolysis
BROWN= Due to Infection in Bile tree
**COMMON in Asian countries
What are some risk factors for Cholesterol stones?
Gallbladder Hypomotility Mucus hypersecretion= traps cholesterol crystals AGE FEMALE (hormones) Obesity (Insulin resistance) Rapid Weight reduction Dyslipidemias Inborn errors of Bile metabolism
What kind of Gallstones are seen in a patient with SCD or hereditary spherocytosis or mechanical heart valves?
Calcium Billirubinate = PIGMENT stones
Yellow pale radiolucent gallstone is most likely?
Cholesterol stone
Enlarged, tense gallbladder, with thickened walls, and edema caused by a gallstone?
Acute Cholecystitis
Patient with Severe RUQ pain lasting 6hrs. Pain radiates to shoulder, Fever, nausea, leukocytosis, and Hyperbillirubinemia?
Acute calculous Cholecystitis
**Jaundice= Blockage of CB duct
Recurrent attacks of steady epigastric pain, N/V, and intolerance to fatty foods?
Chronic cholecystitis
What is choledocholithiasis?
Gallstone in the biliary tree (NOT gallbladder)
What is Cholangitis and MCC?
Inflammation of the Bile ducts
Caused by Bacterial infection (e coli)
Pt with Right upper abdominal pain, fever, chills, and jaundice?
Bacterial cholangitis
What consequence of chronic obstruction of extrahepatic biliary tree is seen in the Liver?
Secondary Biliary Cirrhosis–>
Secondary inflammation
Initiates periportal fibrogenesis
Leads to Scarring and nodule formation
Infant with pale stool, malabsorption and inflammation and fibrosis of CB duct and progressive destruction of intrahepatic biliary tree. Liver biopsy shows Portal tract edema, fibrosis, and parenchymal cholestasis. Eventually Cirrhosis and liver failure?
Biliary atresia
What are the serum tests for Hepatocyte integrity?
AST
ALT
LDH
What are the serum tests for biliary excretion function?
bilirubin (serum + urine)
bile acids
ALK
GGT
What are the serum tests for hepatocyte function?
Albumin PT (INR) Ammonia Aminopyrine breath test (hepatic demethylation) Galactose elimination (IV)
Pt with hepatic insufficiency that progresses to Hepatic encephalopathy in 2-3 wks. What are the MCCs?
Acute liver failure–> massive hepatic necrosis
**MCC–> Drugs or Viral hepatitis
What are the signs and symptoms of Hepatic failure?
Jaundice (Bilirubin >2.0) Hypoalbuminemia--> peripheral edema Palmar erythema Spider angiomas Hypogonadism or Gynecomastia- Increased Estrogen Coagulopathy
What is defined as the systemic retention of Billirubin, bile salts, and cholesterol?
Cholestasis
What is the pathogenesis for physiological jaundice of the newborn?
Hepatic conjugation machinery is not fully developed–> Mild Unconjugated Hyperbilirubinemia
Pt develops icterus during long periods of fasting or stress caused by a decreased level of Glucoronosyltransferase (GST)?
Gilbert syndrome
What is Dubin Johnson syndrome?
AR defect in Transport protein responsible for Hepatocellular excretion of bilirubin glucuronides into Caniculi.
- *Conjugated hyperbilirubinemia
- **BLACK LIVER
Patient with black liver has what genetic deficiency?
Conjugated bilirubin transport protein
What are the causes of Jaundice due to excess production of UNconjugated bilirubin?
Hemolytic anemia
Pernicious anemia
Thalassemia
What are the causes of jaundice due to reduced hepatic uptake of Unconjugated bilirubin?
Drugs
Diffuse Hepatocellular disease (Viral or drug induce hepatitis, Cirrhosis)
What is the cause of jaundice due to impaired bilirubin conjugation?
Physio of Newborn
Gilbert syndrome
What are the causes of jaundice caused by Conjugated bilirubinemia due to decreased Hepatocellular excretion?
Def in canalicular membrane transporter (Dubin johnson syndrome)
Drugs (OCT , cyclosporines)
Hepatocellular damage (viral or drug hepatitis)
Gallstone
Carcinoma in head of pancreas
What are some of the signs and symptoms of Cholestasis?
Jaundice Pruritus Skin Xanthomas (increased Cholesterol) Elevated ALK Malabsorption of vitamins ADEK
MCCs of jaundice due to excess conjugated bilirubin?
Hepatitis
Intra-extra hepatic obstruction of Bile
MCC of jaundice due to excess unconjugated bilirubin?
Hemolytic anemia
What are some distinctions between Acute and chronic hepatitis?
Acute= Less inflammation but More hepatocyte death than Chronic
**Both induce T-cell response
Which Hepatitis virus is transferred by Fecal-Oral route and does NOT have a chronic or Carrier state?
HAV + HEV
**Hepatitis A + E only cause AcutE infections
Hepatitis virus that is ssRNA and related to Picornaviruses. What is the laboratory diagnostic test?
Serum Anti-HAV IgM antibodies
What are the most likely outcomes of a HBV infection?
60-65%–> Subclinical= 100% recovery
20-25%–> Acute= 99% recover (1% fulminant)
5-10% –> Carriers
4%–> Chronic= Hepatocellular carcinoma
What is genome and route of infection for the Hepadnavirus?
HBV–> dsDNA
ROI= Parenteral, Sexual, perinatal
**NOT FECAL
Which viral hepatitis is associated with Daycare centers and Jails?
HAV
Which viral hepatitis is associated with Dialysis, Needle-sticks, and IVDA?
HBV
Which part of the HBV is important for establishing Persistent infection? Immunogenic? Developing hepatocellular carcinoma?
HBeAg-> secreted to establish persistant infection
HBsAg–> secreted and is immunogenic
HBV X protein–> HC carcinoma
Describe the clinical course of HBsAg in a HBV infection?
HBsAg appears before onset of Symptoms (1st)
Peaks during Overt disease
Disappears 3-6 post infection
**Anti-HBsAg does NOT rise until Acute infection is over and wks after HBsAg disappears= GAP
What Antibody conferes immunity to HBV infection and is basis for current vaccines?
Anti-HBsAg
What is the significance of HBeAg, HBV-DNA, and persistent HBeAg?
Both signify ACTIVE viral replication
Persistent HBeAg–> progression to Chronic
**Identify INFECTIVE STATE
Ground Glass cells in liver signify?
HBV infection–> Hepatocytes with ER stuffed with HBsAg
What are the potential outcomes of Acute HCV infection?
15%–> Resolve
85%–> Chronic (80%stable) (20%>cirrhosis>HC carcinoma> death)
Why is it hard to develop HCV vaccines?
Highly variable due to infidelity of RNA replication
**Quasispecies–> infected person can carry many HCV species at once
Which Hepatitis virus is associated with Fatty change, PROMINENT Lymphoid infiltrates, and Bile duct injury?
HCV
This hepatitis virus ONLY causes infection when it is encapsulated by HBsAg?
HDV–> NEEDS co-infection with HBV
**D for defective= Needs another virus
What is the best indication of co-infection by HDV and HBV?
IgM against both HDV Ag a& HBcAg
**IgM= denotes current infection which is required for HDV replication
Which Hepatitis virus has a HIGH mortality rate in Pregnant women (20%)?
HEV
Which type of Viral hepatitis is most frequently causes acute hepatitis?
HBV
Which type of virus almost Never cause Fulminant hepatitis?
HCV
What type of Hep Virus is notorious for causing a Chronic hepatitis evolving into Cirrhosis?
HCV
Which type of viral hepatitis is associated with Cryoglobulinemia?
HCV
Carrier states are prevalent in what type of viral hepatitis?
HBV–> infections acquired in Childhood (95%)
**Those acquired in adulthood only 10% become carriers due to Increased Maturity of Cellular immunity
Councilman bodies are seen in what liver infection?
Yellow Fever
**Councilman bodies are Eosinophilic apoptotic Hepatocytes