Pathoma Exocrine pancreas, gallbladder, liver Flashcards Preview

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Flashcards in Pathoma Exocrine pancreas, gallbladder, liver Deck (25)
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1
Q

acute pancreatitis pathophysiology

A

autodigestion of pancreas by its own enzymes to pre-activation of enzymes by trypsin.

2
Q

types of nectosis in pancreatitis

A
  • liquefactive necrosis of the pancreas itself

- fat necrosis of the peripancreatic fat

3
Q

alcoholic pancreatitis pathophysiology

A
  • alcohol causes contraction of the sphincter of oddi
4
Q

Common causes of acute pancreatitis and other causes of acute pancreatitis

A

common: alcohol and gallstones
other:
- scorpion bite
- hypercalcemia, hypelipidemia
- drugs
- mumps
- rupture of posterior duodenal ulcer
- trauma

5
Q

clinical features of pancreatitis

A

epigastric pain radiating to the back
nausea/vomiting
periumbilical/flank hemorrhage
elevation of serum lipase and amylase
–> lipase more specific, could also be from the salivary gland
hypocalcemia
–> calcium taken up as part of fat necrosis, saponification

6
Q

clinical features of chronic pancreatitis

A
epigastric pain radiating to the back 
pancreatic insufficiency 
fat soluble vitamin deficiency
secondary diabetes
dystrophic calcification of the pancreas 
increased risk of pancreatic carcinoma
7
Q

pancreatic carcinoma
cell of origin
major risk factors
clinical presentation

A

adenomcarcinoma arising from the pancreatic ducts.

major risk factors - smoking and chronic pancreatitis

obstructive jaundice and pale stools
palpable gall bladder
double duct sign on imaging
CAN PRESENT WITH SECONDARY DIABETES if the tumor is in the body or tail due to destruction of pancreatic islet cells.

additionally signs/symptoms

  • migratory thrombophlebitis
  • CA19-9 is the serum tumor marker
8
Q

Rokitansky-Aschoff sinuses

A

–> hallmark of chronic cholecystitis, gall bladder mucus pouches into the smooth muscle of the gallbladder wall.

9
Q

gallbladder carcinoma

A

risk factor is gallstones, long standing. especially with porcelain gallbladder.

This malignancy arises from epithelium of the gallbladder wall.

–> classically presents as acute cholecystitis in elderly women.

10
Q

Gilbert syndrome

A

autosomal recessive MILD DECREASE in UGT conjugating activity. Increase in unconjugated bilirubin. Jaundice during stress or severe infection, otherwise not clinically significant.

11
Q

Crigler-Najar

A

ABSENCE of UGT, increased unconjugated bilirubin. kernicterus, often fatal.

12
Q

Dubin-Johnson

A

autosomal recessive deficiency of bilirubin canalicular transport protein. increased in CB. Black liver. not clinically significant.

13
Q

Rotor syndrome

A

similar to dubin johnson, but does not have liver discoloration.

14
Q

HEV infection in pregnancy

A
  • can lead to fulminant hepatitis (liver failure with massive liver necrosis)
15
Q

Hep B chart page 120

A

page 120

16
Q

Hep D

co-infection vs super infection

A

Hep is dependent on Hep B for infection.

infection at the same time (coinfection) is less severe than super infection.

17
Q

Cirrhosis mediated by which cell?

A

the stellate cell which is beneath the endothelium and lines the sinusoids.
–> secretes TGF-beta

18
Q

Mallory bodies

A

DAMAGED INTERMEDIATE FILAMENTS in the hepatocytes seen with alcoholic hepatitis
–>swollen hepatocytes with mallory bodies.

19
Q

Hemochromatosis pathophysiology

A

Enterocyte will take up almost all of iron that is in the gut, but monitors blood level and will only dump iron in to the blood when it is a required, the key regulatory step in the human body for iron. We do not really have a way to get rid of iron.

  • -> in this disorder, this regulation is lost.
  • -> in primary hemochromatosis there is mutation in HFE gene, C282Y.

–> damage is caused by excess iron in the tissue generating free radicals.

  • prussian blue stain will stain the iron blue in liver cells distinguishes the brown in the cells from lipofuscin.
20
Q

hemochromatosis treatment

A

phlebotomy

21
Q

Reye syndrome

A

fulminant liver failure and encephalopathy in a child with viral illness taking aspirin.

22
Q

Reye syndrome presentation

A

–> hypoglycemia, elevated liver enzymes, nauseau/vomiting. can progress to coma and death.

23
Q

Hepatic adenoma

A
  • -> related to orla contraceptive use. resolves with discontinuing the medication.
  • -> benign tumor, risk of rupture though.
24
Q

how do aflatoxins lead to hepatocellular carcinoma?

A

–> induce p53 mutations.

25
Q

serum tumor marker for hepatocellular carcinoma

A

alpha fetoprotein