Pancrease/Gallbladder/Liver 2 Flashcards
What is Kernicterus?
UCB (unconjugated bilirubin) depositing in the basal ganglia leading to neurological defects or death.
Usually seen in physiologic jaundice of newborns.
What is urobilinogen?
What bile is turned into by intestinal floura
what makes stool brown
reabsorbed into blood, processed by kidney, making urine yellow
What is Gilbert Syndrome? Crigler-Najjar syndrome?
Gilbert: low UGT activity (autosomal recessive), Uridine Glucoronyl Transferase, which conjugates Bilirubin.
Crigler-Najjar: Absence of UGT -> kernicterus, fatal
Lab finding of Conjugated Bilirubin can have what 3 causes:
Dubin-Johnson Syndrome: lack of Bilirubin Canalicular transport protein (moves CB into gall bladder)
Biliary Tract obstruction (gallstones, carcinoma, parasites)
Viral hepatitis (increase in both CB and UCB)
Pitch Black liver suggestive of
Dubin-Johnson syndrome
Xamthomas
are, seen in
Benign tumors made of foam cells (macrophages with lipids inside)
found on skin
Seen in obstructive jaundice
Why does acute hepatitis cause both CB and UCB?
CB: bile ductules are destroyed, and CB leaks out of gall bladder
UCB: destroys hepatocytes, so conjugating ability is reduced
Dark urine seen in
Conjugated Bilirubin
because it is water soluble, and can be excreted in urine
Hepatitis E in pregnant women associated with
Fulminant hepatitis with massive liver necrosis leading to failure
HBsAG
what it represents
Surface antigen
First serologic marker to rise
Presence >6 months = chronic state
What is window phase of hepatitis infection
When only IgM against the core (HBcAB) is present.
This essentially means that HBsAG, HBeAG, and HBV DNA is gone.
This precedes IgG against surface (HBsAB) which indicates protection.
Serologic sign for protection against HBV.
IgG against HBs (HBsAB)
Serologic indicator for infective HBV
Envelope antigen (need an envelope to mail a letter) HBeAG
Cirrhosis mediated by what cells
Stellate cells secrete TGF-Beta causing fibrosis.
These cells are beneath the endothelial cells that line sinusoids.
Excess estrogen from Cirrhosis produce what symptoms?
Gynecomastia, spider angiomata, palmar erythema
Alcoholic Hepatitis damage mediated by what molecule?
Acetaldehyde (C2H4O)
This is what alcohol is broken down into from ethanol
What are mallory bodies?
Damaged intermediate filliments in the hepatocytes
Why is AST>ALT in alcoholic damage to the liver?
AST is found in mitochondria, and alcohol is a mitochondrial poison.
Treatment for Wilson’s disease
Give D-penicillamine, which is a copper chelating agent
Copper is usually carried in ______ in body
Ceruloplasmin
Serum ceruloplasmin decreased in Wilson’s disease
Primary Sclerosing Cholangitis
What is it
Appearance
Assocation
Inflammation/Fibrosis of intrahepatic and extrahepatic bile ducts.
Onion skin around bile ducts. Uninvolved regions are dilated, so “beaded” appearance.
Association with Ulcerative Colitis***
Only instance when you would give a child aspirin
Kawasaki syndrome, which is systemic inflammation of the medium sized vasculature resulting in classic strawberry tongue appearance. Can be deadly if it involves the heart. Treatment is usually IV immunoglobulins and Aspirin. Otherwise, salicylates can cause Reye’s syndrome.
Aflatoxin is derived from?
Associated with?
Aspergillus (fungus) - in countries that store grain for a long time, Causes p53 mutaiton
Hepatocellular Carcinoma
