Pancreas/Gallbladder/Liver Flashcards
What is annular pancreas?
when pancreas forms ring around duodenum
What two types of necrosis occur during Acute Pancreatitis?
liquefactive of pancreas
fat necrosis of peripancreatic fat
What are the two most common causes of acute pancreatitis?
alcohol and gallstones
Which two serum enzymes are elevated during acute pancreatitis? Which one is more specific?
Amylase and Lipase
Lipase = more specific
Why can acute pancreatitis present with hypocalcemia?
calcium is consumed during peripancreatic fat necrosis
What enzyme is persistently elevated during a pancreatic pseudocyst?
amylase
What bacteria is the most common cause for pancreatic abscess? What enzyme is persistently elevated?
E. coli
serum amylase
What is the most common cause of chronic pancreatitis in adults?
alcohol
What is the most common cause of chronic pancreatitis in children?
cystic fibrosis
How are the markers different between chronic and acute pancreatitis?
amylase and lipase are not elevated in chronic pancreatitis
What is the pathological process of chronic pancreatitis?
dystrophic calcification
In what patient population is pancreatic adenocarinoma most often present?
elderly
What are the two risk factors for pancreatic cancer?
smoking and chronic pancreatitis
What are the three findings on physical exam that may suggest chronic pancreatitis involving the head of the pancreas?
obstructive jaundice
palpable gallbladder
pale stools
Pancreatic adenocarcinoma causing diabetes mellitus are likely to arise in what two locations?
body or tail
What is the serum marker for pancreatic cancer?
CA 19-9
What four things are removed during a Whipple Procedure?
head/neck of pancreas
proximal duodenum
gall bladder
What two substances are most commonly found in gallstoes?
cholesterol
bilirubin
What are the most common types of gall stones?
cholesterol
What is the more common gender to present with gallstones? Why?
women
HMG-CoA reductase is activated by estrogen
What drug can cause gallstones? Why?
clofibrate
reduces activity of HMG-CoA Reductase
What type of ancestry can predispose to forming gall stones?
Native American Ancestry
Which GI tract disease can produce gall stones?
Crohns
Are bilirubin or cholesterol gall stones radiolucent?
Cholesterol
Are bilirubin or cholesterol gall stones radio-opaque?
bilirubin
What are the three infectious risk factors for developing bilirubin gallstones
E. coli, Ascaris lumbricoides, Clonorchis Sinesis
What causes biliary colic?
gall bladder contracting against lodged stone
What are the two primary causes of Acute Cholecystisis?
pressure ischemia
E. coli over-growth
Where does acute cholecystitis pain often radiate?
right scapula
What is the main serum marker for acute cholecystitis?
increased ALP
What is Chronic Cholecystitis marked by? What is another name for this?
herniation of mucosa into muscular wall
Rokitansky-Aschoff Sinus
What is the informal name for the appearance of the gall bladder during chronic pancreatitis?
porcelain gallbladder
What is ascending cholangitis?
bacterial inflammation of the bile ducts
What is the main reason behind ascending cholangitis?
gram-negative infection
Why does a gallstone ileus happen?
fistula formation between gall bladder and small bowel
What are the two most common factors of gall bladder carcinoma?
gallstones
porcelain gall bladder
How does gallbladder carcinoma clasically present?
cholecystitis in an elderly women
What does serum bilirubin have to be higher than to cause jaundice?
greater than 2.5 mg/dL
What part of the brain does kernicterus effect?
basal ganglia
What is defective during Gilbert Syndrome?
mildly low UGT activity
What is the problem during Crigler-Najjar?
absence of UGT
What is the deficiency of Dubin-Johnson Syndrome?
defective bilirubin transport out of bile canaliculi
What syndrome is similar to Dubin-Johnson? What is the only difference?
Rotor Syndrome
liver is not black in rotor syndrome
Would a biliary tract obstruction have an increase in conjugated or unconjugated bilirubin?
increase in conjugated
What are the three lab findings of biliary tract obstruction?
increase conjugated bilirubin
increased ALP
decrease urine urobilinogen
What would the urine look like during a bile duct obstruction? Why?
dark urine
conjugated bilirubin in urine
What would the stool look like during a bile duct obstruction?
pale stool
Why would a bile duct obstruction present with pruritis?
increased plasma bile acids cause itching
What two labs would increase during viral hepatitis?
conjugated and unconjugated bilirubin
How would viral hepatitis present in regards to a patients urine? Why?
dark urine
high conjugated bilirubin in urine
How is Hepatitis A usually contracted?
traveling
What are the two methods to how Hepatitis E usually contracted?
contaminated water
undercooked seafood
What two hepatitis viruses only produce acute hepatitis?
Hepatitis A
Hepatitis E
Which immunoglobulin marks active hepatitis viral infection?
IgM
Which immunoglobulin marks prior hepatitis infection or immunization?
IgG
How is HBV transmitted?
parenterally
Infection with what hepatitis virus can cause fulminant hepatitis in pregnant women?
HEV
How many cases of HBV result in chronic hepatitis?
20%
What test confirms HCV infection?
HCV RNA test
What does decreasing HCV-RNA indicate?
recovery
HDV is dependent on previous exposure with what other hepatitis virus?
HBV
What is hepatitis superinfection?
HBV infection before HDV
What is the first Hepatitis B serological marker to arise?
HBsAG
What serological marker defines the existence of chronic HBV infection? For how long?
HBsAG
longer than 6 months
The presence of what two markers incidate hepatitis infectivity?
HBeAG or HBV DNA
Other than hepatitis, what two viruses can infect the liver?
EBV and CMV
What is the pattern of liver enzymes during acute hepatitis?
ALT > AST
What structure develops on gross appearance during liver cirrhosis?
nodules
What cytokine mediates liver cirrhosis?
TGF-β
What cell is responsible for liver cirrhosis?
stellate cell
What hormone cant the liver degrade when it is failing?
estrogen
What are three signs of hyper-estrinism during liver failure?
spider angioma
gynecomastia
palmar erythema
What does liver failure produce edema?
hypoalbuminemia
Would liver failure have an increased or decreased PT?
increased
What metabolite of alcohol mediates alcoholic liver damage?
acetylaldehyde
What are Mallory bodies composed of? What structure accompanies Mallory Body formation?
cytokeratin
swelling of hepatocytes
Which liver enzymes are elevated during alcohol induced liver damage?
AST > ALT
Which liver enzymes are elevated during non-alcohol induced liver damage?
ALT > AST
What gene is implicated during hematochromatosis?
HFE
What is the amino acid mutation of hematochromatosis? Mode of inheritance?
C282Y
autosomal recessive
What is the triad of hematochromatosis?
cirrhosis, diabetes mellitus and bronze skin
What organ can atrophy during primary hemochromatosis?
testicle
What is the stain used for primary hemochromatosis?
prussian blue
What specific constituent is lipofuscin made of?
peroxidized lipids
What would the ferritin and TIBC measurements be during hematochromatosis?
↑ ferritin and ↓ TIBC
What gene is defective during Wilson Disease?
ATP7B
Wilsons disease results in lack of what two things?
copper transport into bile
copper incorporation into ceruloplasmin
Where does copper deposit in the brain?
basal ganglia
What is the treatment of Wilsons disease? Why?
D-penicillamine
chelates copper
What type of destruction is Primary Biliary Cirrhosis?
autoimmune GRANULOMATOUS destruction of intrahepatic bile ducts
In what patient group does Primary Biliary Cirrhosis often present? What other types of diseases arise?
women of childbearing age
Autoimmune
What type of liver disease can present with an antibody? What is the antibody against?
Primary Biliary Cirrhosis
mitochondrial
What is primary sclerosing cholangitis?
inflammation of INTRAhepatic and EXTRAhepatic bile ducts
What are the two histological appearances of Primary Sclerosing Cholangitis?
onion skin
beaded
What disease is primary Sclerosing Cholangitis associated with? What antibody?
Ulcerative Colitis
p-ANCA
What is the likely cause for the destruction produced during Reye Syndrome?
mitochondrial damage of hepatocytes
What are the three classic symptoms of Reye Sydrome?
hypoglycemia
elevated liver enzymes
nausea/vomiting
Hepatic Adenoma is associated with what medication?
oral contraceptives
What type of liver cancer is produced by aflatoxins? By what mechanism?
Hepatocellular carcinoma
induce p53 mutations
Hepatocellular carcinoma increases the liklihood of developing what other disease?
Budd-Chiari syndrome
What is the tumor marker for hepatocellular carcinoma?
alpha-fetoprotein
What four cancers like to metastisize to the liver?
colon, pancreas, lung, breast
What type of growth is seen during liver metastasis?
multiple nodules
What is the first enzyme to be involved during acute pancreatitis?
trypsin
What is a common board presentation for pancreatitis in children?
trauma/auto accident
What ion disturbance can cause acute pancreatitis?
hypercalcemia
A scorpion bite can cause what GI issue?
acute pancreatitis
Other than the parotid gland, what gland can be infected by mumps virus?
pancreas
An ulcer in the anterior or posterior duodenum can result in acute pancreatitis?
posterior
Rupture of a pancreatic pseudocyst can result in what two pathological happenings?
DIC and ARDS
Where does the pain from chronic pancreatitis radiate?
back
A thin, elderly patient with diabetes in suggestive of what malignancy?
pancreatic adenocarcinoma
Over what age is the most common for the diagnosis of pancreatic cancer?
70
Migratory thrombophlebitis is suggestive of what GI malignancy?
pacreatic cancer
How would a patient with biliary atresia present?
conjugated bilirubinemia
What drug can commonly produce cholelithiasis?
cholestyramine
decreased recirculation of bile acids makes cholesterol less soluble
Other than bile acids, deficiency of what can lead to cholesterol cholelithiasis? Which one specifically?
phospholipids
lecithin
Why can stasis increase formation of cholesterol cholelithiasis?
bacteria can deconjugate bilirubin
What hormone increases the activity of HMG-CoA Reductase?
estrogen
Why can oral contraceptives increase the risk for cholesterol gallstones?
estrogens increase the risk of HMG-CoA Reductase
Which GI disease can increase the risk for cholesterol gallstones? Why?
Crohns
damages terminal ileum where bile acids are recycled –> decreased solubility of cholesterol stones
Why can cirrhosis produce gall stones?
decreased production of bile salts
What is almost the only way to produce a bilirubin gallstone?
extravascular hemolysis
Why can a bacterial infection increase the risk of a bilirubin gallstone?
deconjugate bilirubin
What two helminths infect the biliary tree?
Clonorchis sinesis
Ascaris lumbricoides
What is gallstone ileus?
when a gall stone enters and obstructs small bowel
How does a gallstone ileus happen?
fistula between gallbladder and mucosal wall of intestine
Does hemolytic anemia result in high or low UCB? Why?
high
splenic destruction overwhelms liver conjugating ability
What does the urine look like in hemolytic anemia? Why?
dark
excess production of urobilinogen by intestinal flora
What type of gall stone would present during extravascular hemolysis?
bilirubin
Why does hemolytic disease of the newborn happen? Which enzyme?
infant liver has low conjugating ability
UGT
Why does UV light aid in hemolytic disease of the newborn?
makes UGT more water soluble
Would Gilbert Syndrome present with an increase or decrease in unconjugated bilirubin?
increase in unconjuated
Would Criggler-Najjar Syndrome present with an increase or decrease in unconjugated bilirubin?
unconjugated
Would Dubin-Johnson Syndrome present with an increase or decrease in unconjugated bilirubin?
conjugated
A surgeon goes in and sees a black liver, what is the Dx?
Dubin-johnson
What is the only difference between Dubin-Johnson and Rotor Syndrome?
Rotor does not have dark liver
What color would the urine be in a patient with biliary tract obstruction? Stool?
dark urine
pale stool
Why is urine dark in a patient with biliary tract obstruction? Why is stool pale?
cojugated bilirubin in urine
lack of stercobilin in stool
How would urine urobilinogen levels be in viral hepatitis?
low to normal
Where does inflammation occur during acute hepatitis?
lobule and portal tract
Where does inflammation occur during chronic hepatitis?
mostly portal tract
Which two hepatitis viruses produce acute hepatitis w/o a chronic state?
HAV and HEV
How often does HBV progress to chronic hepatitis?
20%
How often does HCV progress to chronic hepatitis?
almost always
What part of the HBV virus will be present during the window phase?
HBcAB
Will IgG develop against HBV during the chronic state?
no
What does HBV envelope antigen indicate?
envelope = infectivity
What does dropping levels of HCV RNA indicate? What do persistent levels indicate?
dropping levels = recovery
persistent levels = chronic state
What does HDV require for infection?
previous HBV infection
What is hepatitis co-infection?
HBV and HDV simultaneously
What is worse, superinfection or co-infection?
super
Why can portal HTN lead to anemia of thrombocytopenia?
congested spleen can consume RBCs or platelets
Would PT, PTT or both rise during liver failure? Which one is used to follow liver failure?
both
PT
Other than Mallory bodies, what is the key histological finding of alcoholic hepatitis?
swelling of hepatocytes
Mallory bodies are damaged what?
intermediate filaments
Hemochromatosis increases liklihood of developing what cancer?
hepatocellular carcinoma
At what age does Wilsons disease present?
Childhood
What are the three labs of Wilson disease?
increased urinary copper
decreased ceruloplasmin
increased copper on liver biopsy
What are the three common presentations of Wilsons Disease in children?
Liver cirrhosis
neurological issues
Kayser-Fleischer Rings
What cancer does primary sclerosing cholangitis increase the risk of?
Cholangiocarcinoma
How does ascending cholangitis present?
sepsis and jaundice
What does UGT stand for?
Uridine Glucoronyl Transferase
What haplotype does HLA-DR52-A correspond to?
primary sclerosing cholangitis
What two organs are destroyed during Reye Syndrome?
liver and brain
What is a pancreatic pseudocyst?
fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes
Is DM an early or late complication of chronic pancreatitis?
late
What product of heme metabolism is converted into unconjugated bilirubin?
Protoporphyrin
Is urobilin or urobilinogen normally present in the urine?
urobilin
Is urobilin or urobilinogen in the urine during extraascular hemolysis?
urobilinogen
Which specific free radical is created during Wilson Disease?
hydroxyl free radical
What does alcohol do to the Sphincter of Oddi?
contraction
Which structure in the pancreas does adenocarcinoma rise from?
ducts
Are stellate cells above or below endothelial cells?
below
What is hypersplenism?
congestion of RBCs by an enlarged spleen
