Liver & Pancreas Flashcards by Erwin Corinales

Lab evalutwtion of biliary functions

Total, direct bilirubin
Alkaline phosphatase
GGT

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Lab evaluation of hepatocyte synthetic function

Serum alb
PT
Serum ammonia
Aminopyrine breath test
Galactose elimination

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Acute liver illness associated with encephalopathy within 6 mos after the initial diagnosis

Acute Liver Failure

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Acute liver assoc with encephalopathy occurring within 2 wks of onset of jaundice

Fulminant liver failure

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Acute liver illness assoc with encephalopathy within 3 months to onset of jaundice

Sub-fulminant liver failure

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Triad of hepatopulmonary syndrome

Chronic liver disease
Hypoxemia
Intra-pulmonary vascular dilations

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Chief executive worldwide causes of cirrhosis

Alcohol abuse
Viral hepatitis
Non-alcoholic steatohepatitis

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Morphologic features of cirrhosis

Bridging fibrous septa
Parenchyma nodules
Disruption of architecture of entire liver

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Most common clinical consequence of portal hypertension

Ascites

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Clinical manifestation of portosystemic shunting

Caput medusae
Esophageal varices
Hemorrhoids

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Manifestation of impaired estrogen metabolism in hepatic failure

Palmar erythema
Spider angioma
Hypogonadism
Gynecomasta

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Clinical manifestation in cholestasis

Elevated serum alkaline and GGT
Pruritus
Intestinal malabsorption
Deficiencies in fat-soluble vitamins

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Treatment of intrahepatic cholestasis

Liver transplant

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Waterborne hepatitis

Hepatitis E

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Enveloped dsDNA heptitis

Hepatitis B

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Councilman bodies

Acute hepatitis

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Hallmark of chronic hepatitis

Deposition of fibrous tissue

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Differentiates Chronic Hepatitis B from C

Ground-glass hepatocytes

“BGG”

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Differentiates Chronic Hep C from Hep B

Lymphoid aggregates
Bile duct reactive changes
Macrovesicular steatosis

“CLBS”

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Usual causes of nonpyogenic liver abscess

Echinococcus

Amebic infections

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Liver abscess with eosinophilic infiltrates

Nonpyogenic liver abscess

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Live abscess with neutrophilic infiltration

Pyogenic liver abscess

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Nonpyogenic liver abscess with anchovy paste-like material

Amebiasis

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Nonpyogenic liver abscess with laminate cystic wall with hooklet

Echinococcus

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Chronic and progressive hepatitis of unknown etiology positive for anti-smooth muscle antibodies

Autoimmune hepatitis

Marker for autoimmune hepatitis

Anti-smooth muscle antibodies

The leading cause of liver disease

Alcohol consumption

Three distinctive forms of alcoholic liver disease

Hepatic steatosis (fatty liver disease) Alcoholic hepatitis Cirrhosis

Alcoholic liver disease with MALLORY BODIES

Alcoholic hepatitis

Most common cause of CLD in the US | May occur in those who do not consume alcohol or very minimally (

Nonalcoholic fatty liver disease

Accumulation of micro/macrovesicular droplets of fat (TG) with no liver scarring nor inflammation

Steatosis

Mallory bodies, parenchymal inflammation and steatosis with sinusoidal fibrosis

Steatohepatitis

Homozygous recessive inherited disorder of excessive iron accumulation in the body

Primary hemochromatosis

Excessive iron accumulation from iatrogenic causes, chronic liver disease etc.

Acquired hemochromatosis (hemosiderosis)

Clinical triad of hemochromatosis

Hepatomegaly DM Bronze skin pigmentation

Autosomal recessive disorder with impaired copper excretion in bile. Failure to incorporate copper into ceruloplasmin.

Wilson's disease

Brain changes in Wilson's disease

Atrophy and cavitation of putamen and basal ganglia

Found in eye lesions in Wilson's disease; green to brown deposits of copper in the Descemet's membrane in the limbus of the cornea

Kayse Fleischer rings

Autosomal recessive disorder where there is loss of neutrophil proteases leading to panacinar emphysema and liver disease

Alpha-1 antitrypsin deficiency

PAS-positive | Diastase-resistant

Alpha-1 Antitrypsin

Kayser-Fischer rings and Mallory bodies

Wilson's disease

Yellow green liver pigmentation, jigsaw pattern, distended bile ducts, extensive feather degeneration, bile lakes

Secondary biliary cirrhosis

Inflammatory autoimmune disease mainly affecting the intrahepatic ducts

Primary biliary cirrhosis

Laboratory study results in Primary biliary cirrhosis

Elevated alkaline phosphatase and cholesterol | Positive for antimitochondrial antibodies

Autoantibodies seen in primary sclerosing cholangitis

Atypical p-ANCA (80% of patients)

Inflammation and obliterative fibrosis of intrahepatic and extrahepatic bile ducts with dilatation of preserved segments

Primary sclerosing cholangitis

Commonly associated inflammatory bowel disease in primary sclerosing cholangitis

Ulcerative colitis

Shows characteristic beading of contrast medium in radiography of intra and extra-hepatic biliary tree

Primary sclerosing cholangitis

Obstruction of 2 or more hepatic veins

Budd-chiari syndrome

Liver enlargement, pain, ascites. Liver is red-purple, swollen. Tense capsule, with sever centrilobular congestion and necrosis

Budd-Chiari syndrome

Benign liver neoplasm developing from hepatocytes, frequently in women using OCPs

Hepatic Adenoma

Single large hard scirrhous tumor of the liver with fibrous band of well differentiated polygonal cells growing in nests or cords

Fibrolamellar carcinoma

Most common cause of cholelithiasis

Cholesterol stones (90%)

Outpouching of mucosal epithelium into the wall through the muscular layer seen in Chronic cholecystitis

Rokitansky-Aschoff sinus

Extensive dystrophic calcification if the GB wall with increased risk for cancer

Porcelain GB

Massively thickened GB wall, with chronic inflammation, necrosis and hemorrhage

Xanthogranulomatus cholecystitis

Atrophic, chronically obstructed GB containing clear secretions

Hydrops of the GB

Single most frequent cause of death from liver disease in early childhood

Biliary atresia

Most common malignancy of the extra hepatic biliary tract

Gall bladder adenocarcinoma

Most common congenital anomaly of the pancreas

Pancreas divisum

Band like ring of normal pancreas tissue that encircles the 2nd portion of the duodenum

Annular pancreas (Presents as duodenal obstruction)

Most common etiologies of acute pancreatitis

Alcoholism(65%) | Biliary tract disease (35-60%)

The most appropriate treatment for acute pancreatitis

Bowel rest (NPO)

The most appropriate analgesic for patients with acute pancreatitis

Meperidine

Inflammation of the pancreas with irreversible destruction of exocrine parenchyma

Chronic pancreatitis

Most common cause of chronic pancreatitis

Long term alcohol abuse

Fourth leading cause of cancer deaths

Pancreatic adenocarcinoma (60% head of the pancreas)

Strongest environmental influence of pancreatic adenocarcinoma

Cigarette smoking

Migratory thrombophlebitis attributable to elaboration of platelet-aggregating factors and procoagulants from the pancreatic carcinoma or its necrotic products

Trousseau Sign

Tumor marker of Pancreatic cancer

ca19-9

Surgical procedure to treat pancreatic cancer

Whipple procedure

Condition characterized by extrinsic compression of the common hepatic duct, mistake for pancreatic CA

Mirizzi syndrome

Clinical sign characterized by a painless palpable gallbladder associated with jaundice

Couvoissier gallbladder

Lab evaluation of hepatocyte integrity

AST ALT LDH