Week 11 Flashcards
calcium levels in acute pancreatitis
Hypocalcemia (calcium is consumed during saponification in fat necrosis)
complications of acute pancreatitis
Shock-due to peripancreatic hemorrhage and fluid sequestration
DIC and ARDS
Major risk factors of pancreatic adenocarcinoma?
Major risk factors are smoking and chronic pancreatitis.
what should you think of in a super skinny older lady with late onset DM that has epigastric pain?
pancreatic adenocarcinoma
what is the special boards fodder sign that is seen in ppl with pancreatic adenocarcinoma?
Migratory thrombophlebitis (Trousseau sign); presents as swelling, erythema, and tenderness in the extremities (seen in 10% of patients)
tumor marker for pancreatic adenocarcinoma
Serum tumor marker is CA 19-9.
what are the features of chronic cholecystitis
Characterized by herniation of gallbladder mucosa into the muscular wall
(Rokitansky-Aschotf sinus)
Presents with vague right upper quadrant pain, especially after eating
Porcelain gallbladder is a late complication
Shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification
how does gallbladder carcinoma present? what are the major risk factors?
Gallstones are a major risk factor, especially when complicated by porcelain
gallbladder.
C. Classically presents as cholecystitis in an elderly woman
why is urine dark in extravascular hemolysis
eventually all this UC will get conjugated –> as the liver eventually conjugates it –> you get eventually get a lot of conjugated bilirubin in the bile–> increases the amount of urobilinogen –>reabs into blood –> goes through kidney–> THIS is what makes the urine dark
consequences of a biliary tract obstructions/obstructive jaundice
Dark urine (due to bilirubinuria) and pale stools
Pruritus due to plasma bile acids
Hypercholesterolemia with xanthomas
Steatorrhea with malabsorption of fat-soluble vitamins (because we don’t have bile)
what is seen on histology in regards to alcoholic hepatitis
Acetaldehyde (metabolite of alcohol) mediates damage.
Characterized by swelling of hepatocytes with formation of Mallory bodies (damaged cytokeratin filaments), necrosis, and acute inflammation
Presents with painful hepatomegaly and elevated liver enzymes (AST > ALT); may result in death
what is primary biliary cirrhosis?
Autoimmune granulomatous destruction of intrahepatic bile ducts
Classically arises in women (average age is 40 years)
Associated with other autoimmune diseases
Etiology is unknown; antimitochondrial antibody is present.
Presents with features of obstructive jaundice
Cirrhosis is a late complication.
what is primary sclerosing cholangitis?
Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts
Periductal fibrosis with an ‘onion-skin’ appearance
Uninvolved regions are dilated resulting in a “beaded” appearance on contrast imaging.
Etiology is unknown, but associated with ulcerative colitis; p-ANCA is often positive.
Presents with obstructive jaundice; cirrhosis is a late complication.
Increased risk for cholangiocarcinoma
what is the complication of a hepatic adenoma?
Risk of rupture and intraperitoneal bleeding, especially during pregnancy
1. Tumors are subcapsular and grow with exposure to estrogen.
what are the features of hepatocellular carcinoma?
Malignant tumor of hepatocytes
B. Risk factors include
1. Chronic hepatitis (e.g., HBV and HCV)
2. Cirrhosis (e.g., alcohol, nonalcoholic fatty liver disease, hemochromatosis,
Wilson disease, and A1AT deficiency)
3. Aflatoxins derived from Aspergillus (induce p53 mutations)
C. Increased risk for Budd-Chiari syndrome
1. Liver infarction secondary to hepatic vein obstruction
2. Presents with painful hepatomegaly and ascites
D. Tumors are often detected late because symptoms are masked by cirrhosis; poor prognosis
E. Serum tumor marker is alpha-fetoprotein.
