Pancreas, Gallbladder, Liver Flashcards
first enzyme activated in acute pancreas
trypsin
what types of necrosis seen in acute pancreas
liquefactive necrosis of pancreas itself
fat necrosis of peripancreatic fat
how does alcohol effect sphincter of Oddi
causes contraction -> blocks pancreas drainiage = pancreatitis!
what can trigger pancreatitis
hypercalcemia, hyperlipidemia (drugs, scorpin stings, mumps), rupture of posterior ulcer
lab values in acute panc
elevated lipase amylase
HYPOCALCEMIA (from fat necrosis and soponification)
persistently elevaed amylase with fever infection
pancreatic abscess (usu. e coli)
two devastating complications of pancreatitis
DIC and ARDS
MCC chronic panc in adults and hcildren
adult - alcohol
children - cystic fibrosis
how does pancreatic insufficiecy present
fat malabsorption (steatorrhea), vitamin deficiency (ADEK), dystrophic calcifcation
secondary DM!!! alte complication
increase risk of pancreatic arcinoma
major risk factors pancreatic carcinoma
smoking
chronic pancreatitis
how does pancreas head tumors present
obstructive jaundice with nontender gallbladder (Courvoisier)
tumor marker pancreatic cancer
CA 19 9
migratory thrombophelibitis
red flag for pancreas cancer!
thin elderly person suddenly develops DM….
suspicious for pancreatic cancer…(this is not the demographic of people who get DM!!!)
decreasd phospholipids and bile acids
increase risk of cholesterol stone (increased risk of preciptating)
what lipid lowering agent can increase risk for cholesterol stones
bile acid resins (cholestyramine, colestipol, colestivam)
where does reuptake of bile acids and bile salts occur
terminal ileum (crohns disease here increase risk of stone)
risk factor for BILIRUBIN/pigented stone
extravascular hemoylsis
where does acute cholecystitis pain occur
RUQ radiating to RIGHT SCAPULA
porcelain gallbladder
chronic cholecystitis causes this….take out gallbaldder for increased risk of cancer
very old woman with cholecytitis (past age dmographic)
gallbladder carcinoma
pitch black liver…discolored
dubinjohnson (problem with transport of conjugated bili)
Gilbert and Crigler Najar
AR deficiency in UGT (uglucouronlytransferase) gilbert is mild crigler najar (EVIL NAME) is almost absent UGT...usually fatal
biliary tract obstruction what will beelevated in blood
conjbili, plasma bile acids, alk phos, dark urine claycolored stool
how are hepatocytes destroyed in hepatitis
cd8 t cell killing
HEV in pregnantwoman?
may progress to fulminant hep (very bad)
what’s worse superinfection of hpD on previous hepb or concurrentinfection of HBV HDV
superimpoed superinfection
what cell mediates fibrosis in liver
TGF beta form stellate cells which lie beneath endothelial cells that line sinusoids
signs and symptoms of excess estrogen
gynecomastia
spider angioma
palmar erythema
histologic hallmark of alcoholic hepatitis
Mallory bodies (intracytoplasmic eosinophilic inclusions of DAMAGED INTERMEDIATE FILAMENTS, KERATIN FILAMENTS)
non alcoholic fatty liver disease associated with…
obesity…ALT>AST
how is hemochromotasis causing damge?
generation of free radicals from iron from fentin reaction
deposits in tissues as hemosiderosis
primary hemochromatosis gene mechanism
HFE gene (c282y) recessive leads to abnormal iron sensing in enterocytes leading to increasd absorption (increased ferriton, increased iron, decreased TIBC, INCREASED TRANSFERRIN, high percent sat)
how can secondary hemochromatosis happen
from transfusions multiple
how to differentiate between iron an lipofuscin in liver
Prussian blue stain!
autosomal recessive defeect in ATP7B gene (ATP mediated hepatocyte copper transport)
wilson dx
lack of copper transport into bile and ceruloplasmin leading to tissue deposition
how does copper cause damage
free fradicals by production of hydroxyl free radicals
rx wilsons
copper chelation with d penicillamine or zinc or trientine
labs on wilsons
increased urinary iron
LOW CERULOPLASMIN
increaed copper in liver
antibody for PBC
antimitochondrial
obstructive jaundice, with late cirrhosis associated with other autoimmune disease, woman
PBC damage to intrahepatic ducts
histology of PSC
concentric “onion skin” bile duct fibrosis with alternating stricture and dilation with “string and bead” apeparnts of both INTRA AND EXTRA hepatic ducts
PSC associated with what disease and what marker
UC
p-anca
child has viral illness and takes asprin…
reye syndrome
fulminant liver failure and encephalopathy… via MITOCHONDRIA DAMAGEL
mitochondria abnormalities, fatty liver, HYPOGLYCEMIA, vomiting, hepatomegaly, coma in child
REY syndrome
decerased b oxidation off reversible inhibition of mitochondrial enzymes
only time u give child aspirin
KAWASAKIS
hepatic adenomas (benign) are assocaited with what medication
oral contracept
what fungus can increase risk of HCC
aflatoxins form aspergillus by inducing p53 mutations
liver infarction secoondary hepatic vein obstruction
budd chairi
presents wiht painful hepatoegaly and ascites
serum tumor marker for HCC
AFP
sources of liver mets
colon pancreas lung, breast
RESULTS IN MULTIPEL NODULES IN LIVER…can feel noduels on physical
MOA duodenal atresia vs jejunal/ileal atresia
duodenal - failure of recanalization at 8-10 weeks gestation, aw Downs
jejunal/ileal - vascular occlusion = ischemia and narrowing/obliteration, apple peel deformity
