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Pathoma > Pancreas/Gallbladder/Liver > Flashcards

Pancreas/Gallbladder/Liver Flashcards

1
Q

What is annular pancreas?

A

when pancreas forms ring around duodenum

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2
Q

What two types of necrosis occur during Acute Pancreatitis?

A

liquefactive of pancreas

fat necrosis of peripancreatic fat

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3
Q

What are the two most common causes of acute pancreatitis?

A

alcohol and gallstones

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4
Q

Which two serum enzymes are elevated during acute pancreatitis? Which one is more specific?

A

Amylase and Lipase

Lipase = more specific

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5
Q

Why can acute pancreatitis present with hypocalcemia?

A

calcium is consumed during peripancreatic fat necrosis

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6
Q

What enzyme is persistently elevated during a pancreatic pseudocyst?

A

amylase

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7
Q

What bacteria is the most common cause for pancreatic abscess? What enzyme is persistently elevated?

A

E. coli

serum amylase

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8
Q

What is the most common cause of chronic pancreatitis in adults?

A

alcohol

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9
Q

What is the most common cause of chronic pancreatitis in children?

A

cystic fibrosis

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10
Q

How are the markers different between chronic and acute pancreatitis?

A

amylase and lipase are not elevated in chronic pancreatitis

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11
Q

What is the pathological process of chronic pancreatitis?

A

dystrophic calcification

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12
Q

In what patient population is pancreatic adenocarinoma most often present?

A

elderly

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13
Q

What are the two risk factors for pancreatic cancer?

A

smoking and chronic pancreatitis

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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

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15
Q

Pancreatic adenocarcinoma causing diabetes mellitus are likely to arise in what two locations?

A

body or tail

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16
Q

What is the serum marker for pancreatic cancer?

A

CA 19-9

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17
Q

What four things are removed during a Whipple Procedure?

A

head/neck of pancreas

proximal duodenum

gall bladder

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18
Q

What two substances are most commonly found in gallstoes?

A

cholesterol

bilirubin

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19
Q

What are the most common types of gall stones?

A

cholesterol

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20
Q

What is the more common gender to present with gallstones? Why?

A

women

HMG-CoA reductase is activated by estrogen

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21
Q

What drug can cause gallstones? Why?

A

clofibrate

reduces activity of HMG-CoA Reductase

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22
Q

What type of ancestry can predispose to forming gall stones?

A

Native American Ancestry

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23
Q

Which GI tract disease can produce gall stones?

A

Crohns

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24
Q

Are bilirubin or cholesterol gall stones radiolucent?

A

Cholesterol

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25
Q

Are bilirubin or cholesterol gall stones radio-opaque?

A

bilirubin

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26
Q

What are the three infectious risk factors for developing bilirubin gallstones

A

E. coli, Ascaris lumbricoides, Clonorchis Sinesis

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27
Q

What causes biliary colic?

A

gall bladder contracting against lodged stone

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28
Q

What are the two primary causes of Acute Cholecystisis?

A

pressure ischemia

E. coli over-growth

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29
Q

Where does acute cholecystitis pain often radiate?

A

right scapula

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30
Q

What is the main serum marker for acute cholecystitis?

A

increased ALP

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31
Q

What is Chronic Cholecystitis marked by? What is another name for this?

A

herniation of mucosa into muscular wall

Rokitansky-Aschoff Sinus

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32
Q

What is the informal name for the appearance of the gall bladder during chronic pancreatitis?

A

porcelain gallbladder

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33
Q

What is ascending cholangitis?

A

bacterial inflammation of the bile ducts

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34
Q

What is the main reason behind ascending cholangitis?

A

gram-negative infection

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35
Q

Why does a gallstone ileus happen?

A

fistula formation between gall bladder and small bowel

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36
Q

What are the two most common factors of gall bladder carcinoma?

A

gallstones

porcelain gall bladder

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37
Q

How does gallbladder carcinoma clasically present?

A

cholecystitis in an elderly women

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38
Q

What does serum bilirubin have to be higher than to cause jaundice?

A

greater than 2.5 mg/dL

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39
Q

What part of the brain does kernicterus effect?

A

basal ganglia

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40
Q

What is defective during Gilbert Syndrome?

A

mildly low UGT activity

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41
Q

What is the problem during Crigler-Najjar?

A

absence of UGT

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42
Q

What is the deficiency of Dubin-Johnson Syndrome?

A

defective bilirubin transport out of bile canaliculi

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43
Q

What syndrome is similar to Dubin-Johnson? What is the only difference?

A

Rotor Syndrome

liver is not black in rotor syndrome

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44
Q

Would a biliary tract obstruction have an increase in conjugated or unconjugated bilirubin?

A

increase in conjugated

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45
Q

What are the three lab findings of biliary tract obstruction?

A

increase conjugated bilirubin

increased ALP

decrease urine urobilinogen

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46
Q

What would the urine look like during a bile duct obstruction? Why?

A

dark urine

conjugated bilirubin in urine

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47
Q

What would the stool look like during a bile duct obstruction?

A

pale stool

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48
Q

Why would a bile duct obstruction present with pruritis?

A

increased plasma bile acids cause itching

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49
Q

What two labs would increase during viral hepatitis?

A

conjugated and unconjugated bilirubin

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50
Q

How would viral hepatitis present in regards to a patients urine? Why?

A

dark urine

high conjugated bilirubin in urine

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51
Q

How is Hepatitis A usually contracted?

A

traveling

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52
Q

What are the two methods to how Hepatitis E usually contracted?

A

contaminated water

undercooked seafood

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53
Q

What two hepatitis viruses only produce acute hepatitis?

A

Hepatitis A

Hepatitis E

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54
Q

Which immunoglobulin marks active hepatitis viral infection?

A

IgM

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55
Q

Which immunoglobulin marks prior hepatitis infection or immunization?

A

IgG

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56
Q

How is HBV transmitted?

A

parenterally

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57
Q

Infection with what hepatitis virus can cause fulminant hepatitis in pregnant women?

A

HEV

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58
Q

How many cases of HBV result in chronic hepatitis?

A

20%

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59
Q

What test confirms HCV infection?

A

HCV RNA test

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60
Q

What does decreasing HCV-RNA indicate?

A

recovery

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61
Q

HDV is dependent on previous exposure with what other hepatitis virus?

A

HBV

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62
Q

What is hepatitis superinfection?

A

HBV infection before HDV

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63
Q

What is the first Hepatitis B serological marker to arise?

A

HBsAG

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64
Q

What serological marker defines the existence of chronic HBV infection? For how long?

A

HBsAG

longer than 6 months

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65
Q

The presence of what two markers incidate hepatitis infectivity?

A

HBeAG or HBV DNA

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66
Q

Other than hepatitis, what two viruses can infect the liver?

A

EBV and CMV

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67
Q

What is the pattern of liver enzymes during acute hepatitis?

A

ALT > AST

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68
Q

What structure develops on gross appearance during liver cirrhosis?

A

nodules

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69
Q

What cytokine mediates liver cirrhosis?

A

TGF-β

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70
Q

What cell is responsible for liver cirrhosis?

A

stellate cell

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71
Q

What hormone cant the liver degrade when it is failing?

A

estrogen

72
Q

What are three signs of hyper-estrinism during liver failure?

A

spider angioma

gynecomastia

palmar erythema

73
Q

What does liver failure produce edema?

A

hypoalbuminemia

74
Q

Would liver failure have an increased or decreased PT?

A

increased

75
Q

What metabolite of alcohol mediates alcoholic liver damage?

A

acetylaldehyde

76
Q

What are Mallory bodies composed of? What structure accompanies Mallory Body formation?

A

cytokeratin

swelling of hepatocytes

77
Q

Which liver enzymes are elevated during alcohol induced liver damage?

A

AST > ALT

78
Q

Which liver enzymes are elevated during non-alcohol induced liver damage?

A

ALT > AST

79
Q

What gene is implicated during hematochromatosis?

A

HFE

80
Q

What is the amino acid mutation of hematochromatosis? Mode of inheritance?

A

C282Y

autosomal recessive

81
Q

What is the triad of hematochromatosis?

A

cirrhosis, diabetes mellitus and bronze skin

82
Q

What organ can atrophy during primary hemochromatosis?

A

testicle

83
Q

What is the stain used for primary hemochromatosis?

A

prussian blue

84
Q

What specific constituent is lipofuscin made of?

A

peroxidized lipids

85
Q

What would the ferritin and TIBC measurements be during hematochromatosis?

A

↑ ferritin and ↓ TIBC

86
Q

What gene is defective during Wilson Disease?

A

ATP7B

87
Q

Wilsons disease results in lack of what two things?

A

copper transport into bile

copper incorporation into ceruloplasmin

88
Q

Where does copper deposit in the brain?

A

basal ganglia

89
Q

What is the treatment of Wilsons disease? Why?

A

D-penicillamine

chelates copper

90
Q

What type of destruction is Primary Biliary Cirrhosis?

A

autoimmune GRANULOMATOUS destruction of intrahepatic bile ducts

91
Q

In what patient group does Primary Biliary Cirrhosis often present? What other types of diseases arise?

A

women of childbearing age

Autoimmune

92
Q

What type of liver disease can present with an antibody? What is the antibody against?

A

Primary Biliary Cirrhosis

mitochondrial

93
Q

What is primary sclerosing cholangitis?

A

inflammation of INTRAhepatic and EXTRAhepatic bile ducts

94
Q

What are the two histological appearances of Primary Sclerosing Cholangitis?

A

onion skin

beaded

95
Q

What disease is primary Sclerosing Cholangitis associated with? What antibody?

A

Ulcerative Colitis

p-ANCA

96
Q

What is the likely cause for the destruction produced during Reye Syndrome?

A

mitochondrial damage of hepatocytes

97
Q

What are the three classic symptoms of Reye Sydrome?

A

hypoglycemia

elevated liver enzymes

nausea/vomiting

98
Q

Hepatic Adenoma is associated with what medication?

A

oral contraceptives

99
Q

What type of liver cancer is produced by aflatoxins? By what mechanism?

A

Hepatocellular carcinoma

induce p53 mutations

100
Q

Hepatocellular carcinoma increases the liklihood of developing what other disease?

A

Budd-Chiari syndrome

101
Q

What is the tumor marker for hepatocellular carcinoma?

A

alpha-fetoprotein

102
Q

What four cancers like to metastisize to the liver?

A

colon, pancreas, lung, breast

103
Q

What type of growth is seen during liver metastasis?

A

multiple nodules

104
Q

What is the first enzyme to be involved during acute pancreatitis?

A

trypsin

105
Q

What is a common board presentation for pancreatitis in children?

A

trauma/auto accident

106
Q

What ion disturbance can cause acute pancreatitis?

A

hypercalcemia

107
Q

A scorpion bite can cause what GI issue?

A

acute pancreatitis

108
Q

Other than the parotid gland, what gland can be infected by mumps virus?

A

pancreas

109
Q

An ulcer in the anterior or posterior duodenum can result in acute pancreatitis?

A

posterior

110
Q

Rupture of a pancreatic pseudocyst can result in what two pathological happenings?

A

DIC and ARDS

111
Q

Where does the pain from chronic pancreatitis radiate?

A

back

112
Q

A thin, elderly patient with diabetes in suggestive of what malignancy?

A

pancreatic adenocarcinoma

113
Q

Over what age is the most common for the diagnosis of pancreatic cancer?

A

70

114
Q

Migratory thrombophlebitis is suggestive of what GI malignancy?

A

pacreatic cancer

115
Q

How would a patient with biliary atresia present?

A

conjugated bilirubinemia

116
Q

What drug can commonly produce cholelithiasis?

A

cholestyramine

decreased recirculation of bile acids makes cholesterol less soluble

117
Q

Other than bile acids, deficiency of what can lead to cholesterol cholelithiasis? Which one specifically?

A

phospholipids

lecithin

118
Q

Why can stasis increase formation of cholesterol cholelithiasis?

A

bacteria can deconjugate bilirubin

119
Q

What hormone increases the activity of HMG-CoA Reductase?

A

estrogen

120
Q

Why can oral contraceptives increase the risk for cholesterol gallstones?

A

estrogens increase the risk of HMG-CoA Reductase

121
Q

Which GI disease can increase the risk for cholesterol gallstones? Why?

A

Crohns

damages terminal ileum where bile acids are recycled –> decreased solubility of cholesterol stones

122
Q

Why can cirrhosis produce gall stones?

A

decreased production of bile salts

123
Q

What is almost the only way to produce a bilirubin gallstone?

A

extravascular hemolysis

124
Q

Why can a bacterial infection increase the risk of a bilirubin gallstone?

A

deconjugate bilirubin

125
Q

What two helminths infect the biliary tree?

A

Clonorchis sinesis

Ascaris lumbricoides

126
Q

What is gallstone ileus?

A

when a gall stone enters and obstructs small bowel

127
Q

How does a gallstone ileus happen?

A

fistula between gallbladder and mucosal wall of intestine

128
Q

Does hemolytic anemia result in high or low UCB? Why?

A

high

splenic destruction overwhelms liver conjugating ability

129
Q

What does the urine look like in hemolytic anemia? Why?

A

dark

excess production of urobilinogen by intestinal flora

130
Q

What type of gall stone would present during extravascular hemolysis?

A

bilirubin

131
Q

Why does hemolytic disease of the newborn happen? Which enzyme?

A

infant liver has low conjugating ability

UGT

132
Q

Why does UV light aid in hemolytic disease of the newborn?

A

makes UGT more water soluble

133
Q

Would Gilbert Syndrome present with an increase or decrease in unconjugated bilirubin?

A

increase in unconjuated

134
Q

Would Criggler-Najjar Syndrome present with an increase or decrease in unconjugated bilirubin?

A

unconjugated

135
Q

Would Dubin-Johnson Syndrome present with an increase or decrease in unconjugated bilirubin?

A

conjugated

136
Q

A surgeon goes in and sees a black liver, what is the Dx?

A

Dubin-johnson

137
Q

What is the only difference between Dubin-Johnson and Rotor Syndrome?

A

Rotor does not have dark liver

138
Q

What color would the urine be in a patient with biliary tract obstruction? Stool?

A

dark urine

pale stool

139
Q

Why is urine dark in a patient with biliary tract obstruction? Why is stool pale?

A

cojugated bilirubin in urine

lack of stercobilin in stool

140
Q

How would urine urobilinogen levels be in viral hepatitis?

A

low to normal

141
Q

Where does inflammation occur during acute hepatitis?

A

lobule and portal tract

142
Q

Where does inflammation occur during chronic hepatitis?

A

mostly portal tract

143
Q

Which two hepatitis viruses produce acute hepatitis w/o a chronic state?

A

HAV and HEV

144
Q

How often does HBV progress to chronic hepatitis?

A

20%

145
Q

How often does HCV progress to chronic hepatitis?

A

almost always

146
Q

What part of the HBV virus will be present during the window phase?

A

HBcAB

147
Q

Will IgG develop against HBV during the chronic state?

A

no

148
Q

What does HBV envelope antigen indicate?

A

envelope = infectivity

149
Q

What does dropping levels of HCV RNA indicate? What do persistent levels indicate?

A

dropping levels = recovery

persistent levels = chronic state

150
Q

What does HDV require for infection?

A

previous HBV infection

151
Q

What is hepatitis co-infection?

A

HBV and HDV simultaneously

152
Q

What is worse, superinfection or co-infection?

A

super

153
Q

Why can portal HTN lead to anemia of thrombocytopenia?

A

congested spleen can consume RBCs or platelets

154
Q

Would PT, PTT or both rise during liver failure? Which one is used to follow liver failure?

A

both

PT

155
Q

Other than Mallory bodies, what is the key histological finding of alcoholic hepatitis?

A

swelling of hepatocytes

156
Q

Mallory bodies are damaged what?

A

intermediate filaments

157
Q

Hemochromatosis increases liklihood of developing what cancer?

A

hepatocellular carcinoma

158
Q

At what age does Wilsons disease present?

A

Childhood

159
Q

What are the three labs of Wilson disease?

A

increased urinary copper

decreased ceruloplasmin

increased copper on liver biopsy

160
Q

What are the three common presentations of Wilsons Disease in children?

A

Liver cirrhosis

neurological issues

Kayser-Fleischer Rings

161
Q

What cancer does primary sclerosing cholangitis increase the risk of?

A

Cholangiocarcinoma

162
Q

How does ascending cholangitis present?

A

sepsis and jaundice

163
Q

What does UGT stand for?

A

Uridine Glucoronyl Transferase

164
Q

What haplotype does HLA-DR52-A correspond to?

A

primary sclerosing cholangitis

165
Q

What two organs are destroyed during Reye Syndrome?

A

liver and brain

166
Q

What is a pancreatic pseudocyst?

A

fibrous tissue surrounding liquefactive necrosis and pancreatic enzymes

167
Q

Is DM an early or late complication of chronic pancreatitis?

A

late

168
Q

What product of heme metabolism is converted into unconjugated bilirubin?

A

Protoporphyrin

169
Q

Is urobilin or urobilinogen normally present in the urine?

A

urobilin

170
Q

Is urobilin or urobilinogen in the urine during extraascular hemolysis?

A

urobilinogen

171
Q

Which specific free radical is created during Wilson Disease?

A

hydroxyl free radical

172
Q

What does alcohol do to the Sphincter of Oddi?

A

contraction

173
Q

Which structure in the pancreas does adenocarcinoma rise from?

A

ducts

174
Q

Are stellate cells above or below endothelial cells?

A

below

175
Q

What is hypersplenism?

A

congestion of RBCs by an enlarged spleen

Pathoma (19 decks)

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