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Quiz 5 Flashcards

1
Q

With congenital biliary atresia, where is the most common site affected?

A

common bile duct between liver and SI is blocked/absent

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2
Q

What is one of the principal forms of chronic rejection of a transplanted liver allograft?

A

acquired biliary atresia

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3
Q

What do we call congenital cystic dilations of the bile ducts?

A

choledochal cysts

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4
Q

When is a cheledochal cyst most likely to be detected?

A

before 10 yo

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5
Q

What does choledocholithiasis mean?

A

a gallstone that has migrated into the ducts of the biliary tract

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6
Q

What is it called when a choledocholithiasis leads to an acute infection of the biliary tree?

A

ascending cholangitis

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7
Q

What may result if a gallstone within the ampulla of Vater obstructs the exocrine pancreas?

A

pancreatitis

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8
Q

Which two organism species are most likely to be involved in a acute cholangitis case?

A

E. coli

Bacteroides

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9
Q

What causes acute cholecystitis?

A

cholelithiasis

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10
Q

What do you call cholecystitis when not caused by cholelithiasis?

A

acute acalculous cholecystitis

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11
Q

Who is a greater risk for acute acalculous cholecystitis?

A

CAD pt.s.
trauma
immunosuppression

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12
Q

This condition microscopically shows extensive ulceration of the mucosa, hemorrhage, edema and a dense transmural infiltrate of neuts and inflammatory cells.

A

acute cholecystitis

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13
Q

What are the three types of gallstones?

A

cholesterol stones
pigment stones
mixed stones

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14
Q

This stone is light-yellow to dark green or brown often with dark central spot. They are oval.

A

cholesterol

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15
Q

what percentage of the stone much be cholesterol to be deemed a cholesterol stone?

A

80%

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16
Q

What three factors are important in gallstone formation?

A

high cholesterol concentration
the ability of the gallbladder to empty its contents
the presence of proteins and salts in the bile

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17
Q

What percentage of cholesterol is found in mixed stones?

A

20-80%

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18
Q

What other compounds are found in mixed stones?

A

calcium carbone
bilirubin
bile pigments

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19
Q

What is the cholesterol content of pigment stones?

A

<20%

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20
Q

Which two types of stones may be visible on xray?

A

mixed and pigment, depending on calcium content

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21
Q

What is happening with cholesterolosis? What is it’s other name?

A

abnormal deposition of cholesterol and triglyceride filled macrophages in the lamina propria of the gallbladder

strawberry gallbladder

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22
Q

What condition is cholesterolosis often associated with?

A

chronic cholecystitis

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23
Q

If the gallbladder is opened and reveals hundreds of tiny bight yellow dots, what is the condition and what are the dots?

A

cholesterolosis/strawberry gallbladder

cholesterol filled macrophages

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24
Q

T/F. cholesterolosis predisposes a person to develop cholelithiasis and cholecystitis.

A

false

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25
What does the gallbladder look like, grossly, with chronic cholecystitis?
thickened wall is hallmark shaggy, rough mucosal surface (inflammation, ulceration, necrosis) m/b white and fibrous interior surface
26
What does chronic cholecystitis look like microscopically?
increase in fibrous tissue mild chronic inflammation of lamina propria Rokitansky-Aschoff sinuses seen in muscularis
27
Where is the gallstone in choledocholithiasis?
in the common bile duct
28
What is the main cause of ascending cholangitis?
secondary infection due to obstruction of the bile duct | 70-90% involve gallstones
29
T/F. ascending cholangitis has a mortality rate >50%
false. not anymore. now 10-30%
30
what does ascending cholangitis look like histologically?
concentric/onion skin-like periductal fibrosis | looks like PSC
31
What populations are most at risk of adenocarcinoma of the gall bladder?
those with gall stone disease males ~70yo
32
T/F. The majority of gallbladder carcinomas are well differentiated.
true
33
Are women or men more likely to have gall stone related pancreatitis?
women
34
What causes the majority of acute pancreatitis in men and is also the overall main cause of chronic pancreatitis?
alcohol
35
What is the possible complication of acute pancreatitis?
abcess formation
36
What is the single most common etiology of acute pancreatitis?
gallstones
37
The pancreas is shrunken and fibrotic and the main duct is filled with calcified secretions. What is going on?
chronic pancreatitis
38
What are the histologic findings of chronic pancreatitis?
enzymic fat necrosis hemorrhage inflammatory infiltrate
39
What is a pseudo-cyst?
a complication of pancreatitis defined as: a peri-pancreatic fluid collection containing high concentrations of pancreatic enzymes within a fibrous wall and WITHOUT AND EPITHELIAL LINING
40
What does infected necrosis mean?
bacterial contamination of necrotic pancreatic tissue without abscess formation
41
What are pancreatic abscesses most commonly associated with?
infected pseudocysts
42
What percentage of pts. with recurrent pancreatitis with develop an abscess?
3-5%
43
What is the mortality rate of pancreatic abscesses?
can exceed 20%
44
What are the three types of benign tumors of the exocrine pancreas?
pseudopapillary tumor serous cystademona mucinous cytadenoma
45
What are the two types of malignant tumors of the exocrine pancreas?
pancreatic adenocarcinoma | mucinous cytadenocarcinoma
46
What do pseudopapillary tumors look like grossly?
round, well-demarcated solid cyst areas often with hemorrhage
47
What do pseudopapillary tumors look like microscopically?
sheets of cells uniform nuclei eosinophilic/clear cytoplasm PAS positive eosinophilic cytoplasmic inclusions
48
What are the most frequent cystic tumors of the pancreas?
mucinous cystadenoma
49
T/F. Borth serous cystadenomas and mucinous cystadenomas may become malignant if left untreated.
False. Only mucinous cystadenomas are likely to become malignant.
50
What sex and age range are most at risk for mucinous cystadenoma?
females | 49-59 yo
51
What is the second most common cystic tumor of the pancreas?
serous cystadenoma
52
What is the characteristic appearance of a serous cystadenoma?
honeycombed on CT
53
What is condition is serous cystadenoma associated with?
von Hippel-Lindau syndrome
54
What is von Hippel-Lindau syndrome?
genetic condition cysts develop in the pancreas, liver and kidney hemangioblastomas are found in different organs including cerebellum, spinal chord, kidney, retina
55
What is the characteristic histology finding for serous cystadenoma?
small cysts in pancreas lined by ciliated cuboidal epithelium
56
What is the most common type of pancreatic CA?
pancreatic adenocarcinoma
57
From where in the pancreas does adeoncarcinoma arise?
exocrine component | primarily the pancreatic ducts
58
What characterizes pancreatic tumors as neuroendocrine tumors?
when they arise from islets cells
59
T/F. Pancreatic CA has a 1 and 5 year survival rate of 25% and 6%
true.
60
What do you call microscopic lesions within the pancreas and intraductal papillary mucinous and mucinous cystic neoplasms?
pancreatic intraepithelial neoplasia (PIN)
61
What is the most common liver tumor?
hepatic hemangioma
62
What is the most frequent form of primary liver cancer?
hepatocellular carcinoma
63
T/F. Most liver CAs arise from another tissue (are secondary).
true
64
Where is the most common site of the primary CA that metastasizes to the liver?
GI, esp colon
65
What is a cavernous hemangioma? Are they bad?
dilated vascular spaces filled with blood | not usually but prone to bleed
66
Who is at risk for cavernous hemangiomas and hepatic adenomas?
young women on OCPs
67
What is a hepatic adenoma?
a benign glandular tumor of the liver
68
Cells that closely resemble normal hepatocytes but are disorganized and are without normal lobular architecture. They are also slightly smaller, with less abundant cytoplasm and less eosinophilic. What are you looking at?
hepatic adenoma
69
What are the two main types of primary carcinoma of the liver?
hepatocellular carcinoma | cholangiocarcinoma
70
What cells do hepatocellular carcinomas (HCC) arise from compared to choangiocarinomas?
hepatocellular carcinoma: hepatocytes | cholangiocarcinoma: bile duct epithelium
71
Which Hepatitis virus is associated with hepatocellular carcinoma?
HBV
72
T/F. Globally, hepatocellular carcinoma is the most common visceral tumor.
true
73
What is the most common cause of HCC globally vs. in the US?
globally: HBV US: cirrhosis from alcohol or HCV
74
Histological findings: collagen fibrosis, loss of normal liver architecture, nuclear atypia. What is it?
HCC
75
T/F. Infants who contract HBV at birth have a 100 fold risk of developing HCC.
False. 200x the risk
76
What serum values may rise with HCC?
serum alpha-fetoprotein | m/b alk phos with an obstruction
77
What are the risk factors for developing cholangiocarcinoma?
long standing inflammation | chronic injury of the biliary epithelium
78
How are cholangiocarcinomas classified?
intrahepatic/extrahepatic | peripheral/hilar
79
What is the most common form of cholangiocarcinoma and where does it develop?
peripheral cholangiocarcinoma | interlobular ducts of the liver
80
What are the two tumor markers that are positive cholangiocarcinoma and often negative for HCC?
CA 19-9 | CA-50
81
Where is angiosarcoma found and from what cells does it arise?
skin and soft tissue organs such as breast and heart | endothelium
82
What toxic exposure is associated with increase risk of hepatic angiosarcoma?
arsenic (plastics industry workers)
83
Are transaminases usually elevated with mets to the liver?
no

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