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Gastrointestinal - step > Pathology - biliary tree > Flashcards

Pathology - biliary tree Flashcards

1
Q 
pruritus
jaundice
dark urine
light coloured stools
hepatosplenomegaly
A

biliary tract disease

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2
Q

presentation of biliary tract disease lab style please

A

cholestatic pattern of LFTs:

  • increased conjugated bilirubin
  • increased cholesterol
  • increased ALP
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3
Q

what is the pathos of secondary biliary cirrhosis

A

extrahepatic biliary obstruction – increases pressure in intrahepatic ducts – injury fibrosis and bile stasis

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4
Q

who gest secondary biliary cirrhosis

A

patietsn with known OBSTRUCTIVE lesiosn ie gallstones, biliary strictures, pancreatic carcinoma

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5
Q

what are the complications of secondary biliary cirrhosis

A

asecndong cholangitis

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6
Q

how to differentiatl secondary from primary biliarly cirrhosis vai blood work

A

no increased IgM in secondary; yes in primary

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7
Q

what is the pathology of primary biliary cirrhosis

A

an autoimmune reaction – lymphocytic infiltrate and granulomas – desctruction of intralobular bile ducts

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8
Q

typical patient with primary biliary cirrhosis

A

women in 40-50s with another autoimmuencondigion CREST, sjuogren, RA, celiacl dsiease

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9
Q

typical co presentined pathos with primary biliary cirrhosis

A

rheumatoid arthritis
sjogren
CREST
celiac disease

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10
Q

anti mitochondrial abs and increased IgM

A

primary biliary cirrhosis

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11
Q

what can be increased risk by primary biliary cirrhosis

A

HCC

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12
Q

labs of primary biliarly sclerosis please

A 
increased cholesterol
increased conjugated bilirubin
increased ALP
increased GGT
increased igM
positive anti-mitochondrial antibodies
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13
Q

describe the pathos of primary sclerosign cholangitis

A

unkno cause of concentric onion skin bild duct fibrosis - alternating strictures and dilation fo BEADING of intra and extrahepatic bild ducts on ERCP, or magnetic resonance cholangiopancreatography

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14
Q

typical patient with primary sclerosing cholangitis

A

young man with UC

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15
Q

pbilterative fibrosis of intrahepatic and extrahepatic bile ducts

A

primary sclerosing cholangitis

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16
Q

cirroses due to granulomatous desctruction of bile ducts and portal triad

A

primary biliary cirrhosis

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17
Q

labs in primary sclerosing cholangitis

A 
increased cholesterol
increased conjugated bilirubin
increased ALP
increased GGT
increased IgM
MPO-ANCA/p-ANCA positive
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18
Q

what is associated with MPO-ANCA/p-ANCA positiviti

A

primary sclerosing cholangitis/UC
microscopic angitis
chrug strauss (granulomatous polyangiits with eosinophilia or something like that. good try brain)

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19
Q

what are consequences of primary sclerosing cholangitis

A

secondary biliary cirrhosis (ascending cholangitis)

cholangiocarcinoma

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20
Q

biliary tract disease with increased risk of a) cholangiocarcinoma and b) hepatocellular carcinoma

A

cholangiocarcinoma - primary sclerosing cholangitis

hepatocellular carcinoma - primary biliary cirrhosis

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21
Q

what causes cholangiocarcinoma

A

primary sclerosing cholangitis
clonorchis sinuses
thorium dioxide
choledochal cyst

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22
Q

obstructive jaundice
palpable gallbladder Courvorsier sign
hepatmegaly

A

cholangiocarcinoma

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23
Q

what can cause gallbladder stones?

A

increased cholesterol
increased bilirubin
decreased bile salts
gall bladder stasis

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24
Q

which type of stones are radiolucent?

A

cholesterol if no calcium

brown pigmented

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25
Q

which type of stones are radiopaque

A

cholesterol if calcium

black pigmented

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26
Q

causes of cholesterol stones please

A 
chron disease
fat
female
fertile - pregos
native American
old
clofibrate
estropgen therapy
multiparity
rapid weight loss
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27
Q

RF and name the stone: fat

A

cholesterol

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28
Q

RF and name the stone: multiparity

A

cholesterol

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29
Q

RF and name the stone: native american

A

cholesterol

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30
Q

RF and name the stone: rapid weight loss

A

cholesterol

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31
Q

RF and name the stone: estrogen therapy

A

cholesterol

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32
Q

RF and name the stone: clofibrate use

A

cholesterol

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33
Q

RF and name the stone: chron disease

A

cholesterol

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34
Q

RF and name the stone: SCD

A

black pigment

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35
Q

RF and name the stone: asian

A

brown pigment

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36
Q

RF and name the stone: hereditary spherocytosis

A

black pigment

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37
Q

RF and name the stone: alcoholic cirrhosis

A

black/brown pigment

38
Q

RF and name the stone: total parenteral nutrition

A

black/brown pigment

39
Q

charcots triad

A

jaundice
fever
RUQ

40
Q

jaundice
fever
RUQ

A

cholelithiasis

41
Q

what complicatiosn come from cholelithiasis

A

cholecystits
cholangitis
acute pancreatitis
bile stasis

42
Q

what is biliary colic

A

cholelithiasis can cause biolary colic = neurohormonal activation of gall bladder contractions via CCK after a fatty meal ( stimulated by protein and fatty acids) forcitn a stone into the cystic dcut

can be painless in diabetics ** watch out

43
Q

what is gallstone ileus

A

fistula between gallbladder and small intestine - air in biliary tree and passage of gallstone into the intestinal tract - usually at ileocecal valve

44
Q

diseases associated with air where they aren’t suppseo to be

A

duodenal PUD anterior perforation - under diaphragm
diverticulitis - pneumaturia
necrotizing enterocolitis - air in portal vein, pneumatosis intestinalis, free air in abdomen
gallstone ileus - in biliary tree

45
Q

how to dx gallstones

A

u/c (cholesterol and black pigmented are ragiopague and some cholesterol and brom are radiolucent)

46
Q

what is cholecystits

A

acute or chornic inflammation of the gallbaldder

47
Q

what causes cholecystits

A

gallstones blockgin the cystic duct

48
Q

pathogenesis of cholecystitis

A

stone into cystic duct – biliary colic - impacts in cystic uct with bacterial proliferation - bacteria invade wall - perforation

49
Q

diffuse mid epigastric colicky pain - RUQ constant pain dull achey - positive murphys sign

A

cholecystits

50
Q

who is most likely to get cholecystitis

A

females in 5th to 6th decade in North America

51
Q 
fever
stage dependent pain localization
PMn above 12 000
bilirubin above 4 
palpable GB
jaundice
vomiting
increased/not increased amylase
A

obstruction at cbd
cholecystis
with out without acute pancreatitis

52
Q

what tis a porcelain gallbladder

A

dystrophic calcification fo the gall bladder

must be removed – gallbladder carcinoma – very poor prognosis <2 % 5 year survival

53
Q

what causes porcelain gallbladder

A

chronic cholecystitis

54
Q

who presents with porcelain gallbladder

A

elderly women

55
Q

what is acute pancreatitsi

A

autodigestion of the panrease by pancreatic enzymes

56
Q

GET SMASHED

A 
gallstones
ethanol
trauma
scorpion bite
mumps
autoimmune disease
steroids
hypercalcemia, hyperTAGemia
ercp
drugs: sulfa drugs, NRTIs, protease inhibitors
57
Q 
epigastric abdominal pain radiating to back
anorexia
nausea
increased amylase
increased lipase
hypocalcemia
A

acute pancreatitsi

58
Q

what causes acute pancreatitis

A

hypertriglyceridemia, hypercalcemia, scorpions, sulfa drugs, NRTIs, protease inhibitos, gallsontes, alcohol, truma, steroids, mumps, autoimmune diseases, ercp

59
Q

drugs that can cause acute pancreatitis

A

NRTIs, protease inhibitors sulfas

60
Q

what are complications of acute pancreatitis

A 
pseudocyst
DIC
ARDS
difuse fat necrosis - hypocalcemia (collects in pancreatic soap deposits)
hemorrhage
infection
multi organ system failure
61
Q

what causes ARDS in acute pancreatitis

A

phospholipases degrade surfactant

62
Q

what casues hypovolemia in acute pancreatitis

A

pancreatic fluid build up - increased third space fluid

63
Q

what causes hypoxemia in acute pancreatitis

A

phospholipase degrade surfactant - ARDS

64
Q

what is ARDS?

A

acute onset of respiratory failure with bilateral lung opacities with no heart failure. can be cacused by trauma, sepsis shock, gastric aspiration uremia, acute pancreatitis, AF embolism
diffuse alveolar damage - increased alveolar capillary permeability and protein rish leakage into alveoli and noncardiogenic pulmonary edema with normal PCWP.
intraalveolar hyaline membranes - initial damge due to relase from PMNs that are toxic to alveolar wall - activates coagulation cascades and ROS

65
Q

what can cause ARDS

A 
trauma
sepsis
shock
gastric aspiration
uremia
acute pancreatitis
AF embolism
66
Q

what is a pseudocyst

A

abdominal mass of pancreatic enzymes that is surrounded by granulation tissue not epithelium.

67
Q

what is most common cause of acute pancreatits in children

A

seatbelt trauma

68
Q

what viruses can cause acute pancreatitsi due to damge to alveolar celsl

A

CMV
mumps
coxsackie viruses

69
Q

what causes hemorrhage in acute pancreatitsi

A

elastases going to town on bvs

70
Q

what is chronic pancreatits

A

chornic inflammation, atrophy and calcification fo the pancreas

71
Q

what are the major causes of chronic pancreatitis?

A

OH
idiopathy
CF

72
Q

what is major cause of chronic pancreatitis in developing countries

A

malnutrition

73
Q

steathorrhoea
vitamin ADEK, folate B12 deficiencies
diabetes mellitus

A

chornic pancreatitis

74
Q

dxtic tools for chronic pancreatitis please

A

amylase and lipase may or may not be elevated
asses with secretin stimulation test
and bentromidefert test - ability of pancreatic chymotrypsin fto cleave orally administered wahterver to PAH and then assesses levels in urine.

75
Q

what is the prognosis of pancreatic adenocarcinoma

A

average survival is one year after diagnosis

76
Q

histoathos of pancreatic adenocarcinoma

A

of the exocrine pancrease

very aggressive tumoru arising from pancreatic ducts - disorganized glandular structure with cellular infiltration

77
Q

what is common when pancreatic adenocarcinoma presents

A

mets already :(

78
Q

tumour marker of pancreatic adenocarcinoma please

A

CA 19-9 and sometimes CEA, can also look at genes KRAS, p16 and p53

79
Q

what genes are associated with pancreatic adenocarcinoma

A

KRAS
p16
p53

80
Q

risk factors for pancreatic adenocarcinoma please

A 
MOST COMMON - SMOKING
chronic pancreatits for more than 30 years
diabetes
> 50 years old
jweish and African america
81
Q

nationality most likely to get pancreatic adenocarcinoma

A

jewish

African americans

82
Q 
abdominal pain radiating to back
weight loss
light stools
jaundice
palpable gallbladder
redness and tenderness on palpation of extremities
A

pancreatic adenocarcinoma
weight loss - malabsoprtion and anorexia
obstructive jaundice - at head = light stools, jaundice and palpable gallbladder
redness and tenderness on palpation of extremities - migratory thrombophlebitis

83
Q

what is trousseaus syndrome

A

migratory thrombophlebitis - redness and tenderness on

84
Q

migratory thrombophlebitis - redness and tenderness on palpation of extremities

A

pancreatic adenocarcinoma

85
Q

acanthosis nigricans

A

gastric adeocarcinoma

86
Q

dermatitis herpetiformis

A

celiac

87
Q

seborrhoeic keratosis

A

gastric adenocarcinoma

88
Q

list the associated pathology:

a) acanthosis nigricans
b) dermatitis herpetiformis
c) seborrhoeic keratosis
d) migratory thrombophlebitis

A

a) acnathosis nigricans - gastric adenocarcinoma
b) dermatitis nigricans - celiac disease
c) seborrhoeic keratosis - gastric adenocarcinoma
d) migratory thrombophlebitis - pancreatic adenocarcinoma

89
Q

how to treat pancreatic carcinoma

A

whipple - take out head and neck leave tail
chemo
radiation

90
Q 
epigastric pain
weight loss
jaundice
light coloured stools
palpable gallbladder
red and tenderness on palpation fo extremities
vichows node
sister mary joseph
A

pancreatic adenocarcinoma

remember virchows: gastric adenocarcinoma, squamous (weird…. maybe my brain si wrong and is adeon that does this) esophageal, cervical, pancreatic do this but GASTRIC is MOST COMMON

Gastrointestinal - step (10 decks)

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