Pancreas/Gallbladder/Liver Flashcards
1
Q
What is annular pancreas?
A
when pancreas forms ring around duodenum
2
Q
What two types of necrosis occur during Acute Pancreatitis?
A
liquefactive of pancreas
fat necrosis of peripancreatic fat
3
Q
What are the two most common causes of acute pancreatitis?
A
alcohol and gallstones
4
Q
Which two serum enzymes are elevated during acute pancreatitis? Which one is more specific?
A
Amylase and Lipase
Lipase = more specific
5
Q
Why can acute pancreatitis present with hypocalcemia?
A
calcium is consumed during peripancreatic fat necrosis
6
Q
What enzyme is persistently elevated during a pancreatic pseudocyst?
A
amylase
7
Q
What bacteria is the most common cause for pancreatic abscess? What enzyme is persistently elevated?
A
E. coli
serum amylase
8
Q
What is the most common cause of chronic pancreatitis in adults?
A
alcohol
9
Q
What is the most common cause of chronic pancreatitis in children?
A
cystic fibrosis
10
Q
How are the markers different between chronic and acute pancreatitis?
A
amylase and lipase are not elevated in chronic pancreatitis
11
Q
What is the pathological process of chronic pancreatitis?
A
dystrophic calcification
12
Q
In what patient population is pancreatic adenocarinoma most often present?
A
elderly
13
Q
What are the two risk factors for pancreatic cancer?
A
smoking and chronic pancreatitis
14
Q
What are the three findings on physical exam that may suggest chronic pancreatitis involving the head of the pancreas?
A
obstructive jaundice
palpable gallbladder
pale stools
15
Q
Pancreatic adenocarcinoma causing diabetes mellitus are likely to arise in what two locations?
A
body or tail
16
Q
What is the serum marker for pancreatic cancer?
A
CA 19-9
17
Q
What four things are removed during a Whipple Procedure?
A
head/neck of pancreas
proximal duodenum
gall bladder
18
Q
What two substances are most commonly found in gallstoes?
A
cholesterol
bilirubin
19
Q
What are the most common types of gall stones?
A
cholesterol
20
Q
What is the more common gender to present with gallstones? Why?
A
women
HMG-CoA reductase is activated by estrogen
21
Q
What drug can cause gallstones? Why?
A
clofibrate
reduces activity of HMG-CoA Reductase
22
Q
What type of ancestry can predispose to forming gall stones?
A
Native American Ancestry
23
Q
Which GI tract disease can produce gall stones?
A
Crohns
24
Q
Are bilirubin or cholesterol gall stones radiolucent?
A
Cholesterol
25
Are bilirubin or cholesterol gall stones radio-opaque?
bilirubin
26
What are the three infectious risk factors for developing bilirubin gallstones
E. coli, Ascaris lumbricoides, Clonorchis Sinesis
27
What causes biliary colic?
gall bladder contracting against lodged stone
28
What are the two primary causes of Acute Cholecystisis?
pressure ischemia
E. coli over-growth
29
Where does acute cholecystitis pain often radiate?
right scapula
30
What is the main serum marker for acute cholecystitis?
increased ALP
31
What is Chronic Cholecystitis marked by? What is another name for this?
herniation of mucosa into muscular wall
Rokitansky-Aschoff Sinus
32
What is the informal name for the appearance of the gall bladder during chronic pancreatitis?
porcelain gallbladder
33
What is ascending cholangitis?
bacterial inflammation of the bile ducts
34
What is the main reason behind ascending cholangitis?
gram-negative infection
35
Why does a gallstone ileus happen?
fistula formation between gall bladder and small bowel
36
What are the two most common factors of gall bladder carcinoma?
gallstones
porcelain gall bladder
37
How does gallbladder carcinoma clasically present?
cholecystitis in an elderly women
38
What does serum bilirubin have to be higher than to cause jaundice?
greater than 2.5 mg/dL
39
What part of the brain does kernicterus effect?
basal ganglia
40
What is defective during Gilbert Syndrome?
mildly low UGT activity
41
What is the problem during Crigler-Najjar?
absence of UGT
42
What is the deficiency of Dubin-Johnson Syndrome?
defective bilirubin transport out of bile canaliculi
43
What syndrome is similar to Dubin-Johnson? What is the only difference?
Rotor Syndrome
liver is not black in rotor syndrome
44
Would a biliary tract obstruction have an increase in conjugated or unconjugated bilirubin?
increase in conjugated
45
What are the three lab findings of biliary tract obstruction?
increase conjugated bilirubin
increased ALP
decrease urine urobilinogen
46
What would the urine look like during a bile duct obstruction? Why?
dark urine
conjugated bilirubin in urine
47
What would the stool look like during a bile duct obstruction?
pale stool
48
Why would a bile duct obstruction present with pruritis?
increased plasma bile acids cause itching
49
What two labs would increase during viral hepatitis?
conjugated and unconjugated bilirubin
50
How would viral hepatitis present in regards to a patients urine? Why?
dark urine
high conjugated bilirubin in urine
51
How is Hepatitis A usually contracted?
traveling
52
What are the two methods to how Hepatitis E usually contracted?
contaminated water
undercooked seafood
53
What two hepatitis viruses only produce acute hepatitis?
Hepatitis A
Hepatitis E
54
Which immunoglobulin marks active hepatitis viral infection?
IgM
55
Which immunoglobulin marks prior hepatitis infection or immunization?
IgG
56
How is HBV transmitted?
parenterally
57
Infection with what hepatitis virus can cause fulminant hepatitis in pregnant women?
HEV
58
How many cases of HBV result in chronic hepatitis?
20%
59
What test confirms HCV infection?
HCV RNA test
60
What does decreasing HCV-RNA indicate?
recovery
61
HDV is dependent on previous exposure with what other hepatitis virus?
HBV
62
What is hepatitis superinfection?
HBV infection before HDV
63
What is the first Hepatitis B serological marker to arise?
HBsAG
64
What serological marker defines the existence of chronic HBV infection? For how long?
HBsAG
longer than 6 months
65
The presence of what two markers incidate hepatitis infectivity?
HBeAG or HBV DNA
66
Other than hepatitis, what two viruses can infect the liver?
EBV and CMV
67
What is the pattern of liver enzymes during acute hepatitis?
ALT > AST
68
What structure develops on gross appearance during liver cirrhosis?
nodules
69
What cytokine mediates liver cirrhosis?
TGF-β
70
What cell is responsible for liver cirrhosis?
stellate cell
71
What hormone cant the liver degrade when it is failing?
estrogen
72
What are three signs of hyper-estrinism during liver failure?
spider angioma
gynecomastia
palmar erythema
73
What does liver failure produce edema?
hypoalbuminemia
74
Would liver failure have an increased or decreased PT?
increased
75
What metabolite of alcohol mediates alcoholic liver damage?
acetylaldehyde
76
What are Mallory bodies composed of? What structure accompanies Mallory Body formation?
cytokeratin
swelling of hepatocytes
77
Which liver enzymes are elevated during alcohol induced liver damage?
AST > ALT
78
Which liver enzymes are elevated during non-alcohol induced liver damage?
ALT > AST
79
What gene is implicated during hematochromatosis?
HFE
80
What is the amino acid mutation of hematochromatosis? Mode of inheritance?
C282Y
autosomal recessive
81
What is the triad of hematochromatosis?
cirrhosis, diabetes mellitus and bronze skin
82
What organ can atrophy during primary hemochromatosis?
testicle
83
What is the stain used for primary hemochromatosis?
prussian blue
84
What specific constituent is lipofuscin made of?
peroxidized lipids
85
What would the ferritin and TIBC measurements be during hematochromatosis?
↑ ferritin and ↓ TIBC
86
What gene is defective during Wilson Disease?
ATP7B
87
Wilsons disease results in lack of what two things?
copper transport into bile
copper incorporation into ceruloplasmin
88
Where does copper deposit in the brain?
basal ganglia
89
What is the treatment of Wilsons disease? Why?
D-penicillamine
chelates copper
90
What type of destruction is Primary Biliary Cirrhosis?
autoimmune GRANULOMATOUS destruction of intrahepatic bile ducts
91
In what patient group does Primary Biliary Cirrhosis often present? What other types of diseases arise?
women of childbearing age
Autoimmune
92
What type of liver disease can present with an antibody? What is the antibody against?
Primary Biliary Cirrhosis
mitochondrial
93
What is primary sclerosing cholangitis?
inflammation of INTRAhepatic and EXTRAhepatic bile ducts
94
What are the two histological appearances of Primary Sclerosing Cholangitis?
onion skin
beaded
95
What disease is primary Sclerosing Cholangitis associated with? What antibody?
Ulcerative Colitis
p-ANCA
96
What is the likely cause for the destruction produced during Reye Syndrome?
mitochondrial damage of hepatocytes
97
What are the three classic symptoms of Reye Sydrome?
hypoglycemia
elevated liver enzymes
nausea/vomiting
98
Hepatic Adenoma is associated with what medication?
oral contraceptives
99
What type of liver cancer is produced by aflatoxins? By what mechanism?
Hepatocellular carcinoma
induce p53 mutations
100
Hepatocellular carcinoma increases the liklihood of developing what other disease?
Budd-Chiari syndrome
101
What is the tumor marker for hepatocellular carcinoma?
alpha-fetoprotein
102
What four cancers like to metastisize to the liver?
colon, pancreas, lung, breast
103
What type of growth is seen during liver metastasis?
multiple nodules
104
What is the first enzyme to be involved during acute pancreatitis?
trypsin
105
What is a common board presentation for pancreatitis in children?
trauma/auto accident
106
What ion disturbance can cause acute pancreatitis?
hypercalcemia
107
A scorpion bite can cause what GI issue?
acute pancreatitis
108
Other than the parotid gland, what gland can be infected by mumps virus?
pancreas
109
An ulcer in the anterior or posterior duodenum can result in acute pancreatitis?
posterior
110
Rupture of a pancreatic pseudocyst can result in what two pathological happenings?
DIC and ARDS
111
Where does the pain from chronic pancreatitis radiate?
back
112
A thin, elderly patient with diabetes in suggestive of what malignancy?
pancreatic adenocarcinoma
113
Over what age is the most common for the diagnosis of pancreatic cancer?
70
114
Migratory thrombophlebitis is suggestive of what GI malignancy?
pacreatic cancer
115
How would a patient with biliary atresia present?
conjugated bilirubinemia
116
What drug can commonly produce cholelithiasis?
cholestyramine
decreased recirculation of bile acids makes cholesterol less soluble
117
Other than bile acids, deficiency of what can lead to cholesterol cholelithiasis? Which one specifically?
phospholipids
lecithin
118
Why can stasis increase formation of cholesterol cholelithiasis?
bacteria can deconjugate bilirubin
119
What hormone increases the activity of HMG-CoA Reductase?
estrogen
120
Why can oral contraceptives increase the risk for cholesterol gallstones?
estrogens increase the risk of HMG-CoA Reductase
121
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
122
Why can cirrhosis produce gall stones?
decreased production of bile salts
123
What is almost the only way to produce a bilirubin gallstone?
extravascular hemolysis
124
Why can a bacterial infection increase the risk of a bilirubin gallstone?
deconjugate bilirubin
125
What two helminths infect the biliary tree?
Clonorchis sinesis
Ascaris lumbricoides
126
What is gallstone ileus?
when a gall stone enters and obstructs small bowel
127
How does a gallstone ileus happen?
fistula between gallbladder and mucosal wall of intestine
128
Does hemolytic anemia result in high or low UCB? Why?
high
splenic destruction overwhelms liver conjugating ability
129
What does the urine look like in hemolytic anemia? Why?
dark
excess production of urobilinogen by intestinal flora
130
What type of gall stone would present during extravascular hemolysis?
bilirubin
131
Why does hemolytic disease of the newborn happen? Which enzyme?
infant liver has low conjugating ability
UGT
132
Why does UV light aid in hemolytic disease of the newborn?
makes UGT more water soluble
133
Would Gilbert Syndrome present with an increase or decrease in unconjugated bilirubin?
increase in unconjuated
134
Would Criggler-Najjar Syndrome present with an increase or decrease in unconjugated bilirubin?
unconjugated
135
Would Dubin-Johnson Syndrome present with an increase or decrease in unconjugated bilirubin?
conjugated
136
A surgeon goes in and sees a black liver, what is the Dx?
Dubin-johnson
137
What is the only difference between Dubin-Johnson and Rotor Syndrome?
Rotor does not have dark liver
138
What color would the urine be in a patient with biliary tract obstruction? Stool?
dark urine
pale stool
139
Why is urine dark in a patient with biliary tract obstruction? Why is stool pale?
cojugated bilirubin in urine
lack of stercobilin in stool
140
How would urine urobilinogen levels be in viral hepatitis?
low to normal
141
Where does inflammation occur during acute hepatitis?
lobule and portal tract
142
Where does inflammation occur during chronic hepatitis?
mostly portal tract
143
Which two hepatitis viruses produce acute hepatitis w/o a chronic state?
HAV and HEV
144
How often does HBV progress to chronic hepatitis?
20%
145
How often does HCV progress to chronic hepatitis?
almost always
146
What part of the HBV virus will be present during the window phase?
HBcAB
147
Will IgG develop against HBV during the chronic state?
no
148
What does HBV envelope antigen indicate?
envelope = infectivity
149
What does dropping levels of HCV RNA indicate? What do persistent levels indicate?
dropping levels = recovery
persistent levels = chronic state
150
What does HDV require for infection?
previous HBV infection
151
What is hepatitis co-infection?
HBV and HDV simultaneously
152
What is worse, superinfection or co-infection?
super
153
Why can portal HTN lead to anemia of thrombocytopenia?
congested spleen can consume RBCs or platelets
154
Would PT, PTT or both rise during liver failure? Which one is used to follow liver failure?
both
PT
155
Other than Mallory bodies, what is the key histological finding of alcoholic hepatitis?
swelling of hepatocytes
156
Mallory bodies are damaged what?
intermediate filaments
157
Hemochromatosis increases liklihood of developing what cancer?
hepatocellular carcinoma
158
At what age does Wilsons disease present?
Childhood
159
What are the three labs of Wilson disease?
increased urinary copper
decreased ceruloplasmin
increased copper on liver biopsy
160
What are the three common presentations of Wilsons Disease in children?
Liver cirrhosis
neurological issues
Kayser-Fleischer Rings
161
What cancer does primary sclerosing cholangitis increase the risk of?
Cholangiocarcinoma
162
How does ascending cholangitis present?
sepsis and jaundice
163
What does UGT stand for?
Uridine Glucoronyl Transferase
164
What haplotype does HLA-DR52-A correspond to?
primary sclerosing cholangitis
165
What two organs are destroyed during Reye Syndrome?
liver and brain
166
What is a pancreatic pseudocyst?
fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes
167
Is DM an early or late complication of chronic pancreatitis?
late
168
What product of heme metabolism is converted into unconjugated bilirubin?
Protoporphyrin
169
Is urobilin or urobilinogen normally present in the urine?
urobilin
170
Is urobilin or urobilinogen in the urine during extraascular hemolysis?
urobilinogen
171
Which specific free radical is created during Wilson Disease?
hydroxyl free radical
172
What does alcohol do to the Sphincter of Oddi?
contraction
173
Which structure in the pancreas does adenocarcinoma rise from?
ducts
174
Are stellate cells above or below endothelial cells?
below
175
What is hypersplenism?
congestion of RBCs by an enlarged spleen
