Week 3 review Flashcards
Acetampinophen overdose
centrilobular coagulative necrosis WITHOUT significant inflammatory cell infiltrate
Hep E in pregnancy
Causes increased mortality!!!
Findings in Autoimmune Hep
Elevated IgG
Anti-smooth muscle Ab
Plasma cell rich interface and centrilobular hepatitis
Female predominance
Findings in alpha-1- antitrypsin deficiency
PAS-positive, diastase resistant globules in hepatocytes (misfolded)
Emphysema
Findings in PBC
Elevated IgM Anti-mitochondria Ab (AMA) Mostly middle-aged women Female predominance Granulomatous lymphocytic cholangitis/ florid duct lesion Can lead to osteopenia and osteoporosis
Usually itching is first sign
Findings in PSC
Ulcerative Colitis
Choleangiography with large bile duct strictures
Male predominance
Cholangiocarcinoma word associations
Tumor of bile ducts
Malignant
Gland-forming tumor with marked desmoplasia
Associated with PSC
Hepatocellular carcinoma associations
Tumor of hepatocytes Malignant Thickened hepatic plates/trabeculae with unpaired arteries Almost exclusively pts with cirrhosis Hep B Most common primary malignant tumor
Hepatocellular adenoma associations
Tumor of hepatocytes Benign Female predominance Birth control- reproductive age Normal hepatic plate thickness with unpaired arteries
Hemangioma associations
Tumor of blood vessels
Benign
Most common hepatic tumor
Focal Nodular Hyperplasia associations
Tumor of hepatocytes Benign Proliferation/hyperplasia/non-neoplastic Central scar and malformed blood vessels Vascular malformation/anomaly etiology
What’s the big risk factor for esophageal adenocarcinoma?
Barrett esophagus
Definition of esophageal varices
tortuous and dilated submucosal blood vesels
Features of steatohepatitis
Can be due to alcohol, metabolic syndrome, and drug related liver injury
If due to alcohol, AST is usually twice ALT
Steatosis
Ballooning degeneration
Include Mallory bodies
Plasma cells in liver think what?
Autoimmune hepatitis
Grade vs stage
Grade= Amount of inflammation and injury Stage= fibrosis
TIPS and mesocaval shunt
TIPS- portal vein to hepatic vein shunt
mesocaval shunt- works to shunt blood from the portal vein to the IVC to circumvent the liver
Decrease pressure in the portal vein system but increase the effects of toxic compounds on the system (would worsen encophalopathy, may shock heart with increased flow to right side of heart, also causes hepatic ischemia due to loss of blood flow)
Lab values of a cholestatic pattern
Normal ALT AST, elevated bili and Alk Phos
What is ERCP used for?
stones in the duct
Bactram
(trimethoprim-sulfamethoxazole) is hepatotoxic and usually has cholestatic pattern
What slows the progression of fibrosis in PBC?
Ursodeoxycholic acid
Causes of encephalopathy
bleeding, drugs/alcohol, SBP (infection), Renal failure (creatinine level)
Which of the viral heps (a-e) have vaccines?
A and B
Which hep (a-e) is replication incompetent and requires co-infection with another hep virus?
D requires co-infection with B
What sequesters iron to suppress bacterial overgrowth?
lactoferrin
released during cephalic phase of digestion
lysozyme
pore forming antimicrobial enyzme
released during cephalic phase of digestion
Stimulation of pancreatic release of digestive enzymes via the ENS is mediated primarily by what?
ACh
What causes increased acinar cell secretion and vasodilation of blood vessels surrounding the acini (results in protein rich & fluid/ion rich solution)?
Parasympathetic NS
What causes increased acinar cell secretion (results in high protein/low fluid solution)
Sympathetic NS
DEGLUTITION
swallowing
Protease enzymes
Secreted from acinar cells to break down proteins into amino acids
Amylase
breaks down the α1-4 bond of amylose and amylopectin yielding maltose, maltotriose and glucose
What produces bicarbonate solution to liquify and neutralize the chyme in the duodenum that has a low pH?
ductal cells
secretin
Decreased intestinal pH stimulates release of the enzyme secretin which in turn drives bicarbonate release from the pancreas
CCK release
Fats and amino acids in the intestine compete for the enzyme trypsin allowing for signaling by CCK-RF and monitor peptide to increase the release of CCK from duodenal I cells
CCK actions
acts back on the pancreas to increase release of digestive enzymes into the duodenal lumen via relaxation of the sphincter of Oddi
This also causes contraction of the gallbladder to facilitate the release of bile acid which aids digestion and absorption of fat
It also has a negative effect on gastric motility and gastric emptying
What are primary bile acids are produced in the liver from?
cholesterol
What are secondary bile acids are formed by?
bacteria in the intestine and colon
How are bile salts made?
Bile acids are complexed with glycine or taurine
What breaks down dietary fats?
lingual and gastric lipase
What hydrolyses trigylcerides into FFAs?
pancreatic lipase
Na+ absorption
Mostly absorbed in the jejunum
often linked with the transport of other dietary components
What two ions compete for absorption into enterocytes?
Ca2+ and Mg2+
TAENIA COLI
Muscles that run along the colon but are shorter than it.
Semilunar folds
allow expansion while supporting the weight of the digesta
Haustra
small pouch that give the colon its segmented appearance
What causes relaxation of the internal anal sphincter
intrinsic neuron derived VIP and NO
