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Exam 2 Flashcards

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1
Q

Complications for chronic pancreatitis

A

Diabetes mellitus
Pancreatic cancer
Calcification of pancreas
Multiple cysts

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2
Q

Spreads through contaminated food and water, often causes an acute and self-limiting infection, but (unlike hep A) causes severe intralobular necrosis, acut cholangitis, does not cause chronic hepatitis

A

HEV
+ssRNA
Infectious hepatitis

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3
Q

IgG indicates

A

Chronic case

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4
Q

Hepatic rub, bruit, and abdominal venous hum would suggest that a patient with cirrhosis had developed a

A

Hepatoma

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5
Q

Management of acute cholecystitis

A

Cholecystectomy

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6
Q

Metastases to the liver results from

A

Specific venous blood flow from GI tract to v.porta which brings the blood to the liver for detoxification

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7
Q

Sickle cell anemia

A

RBC abnormal chemical structure - sickle shape

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8
Q

Large amount of meal or fat meal can trigger the pain

A

Acute cholecystitis

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9
Q

Pathogenesis of acute cholecystitis

A

Etiological agents
Decrease gallbladder motility
Delay of bile evacuation
Increase of pressure inside gallbladder, increase of bile concentration, activation of opportunistic bacteria (e.g. E. Coli)
Inflammation of gallbladder wall
Edema of gallbladder wall
Compromising of blood flow and lymphatic drainage in gallbladder wall and surrounding tissue
Ischemia and necrosis of gallbladder wall and surrounding tissue

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10
Q

Treatment pancreatitis

A

Only medical treatment

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11
Q

ERCP

A

Endoscopic retrograde cholangiopancreatography

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12
Q

Signs and symptoms acute pancreatitis

A

Sudden acute, severe pain in upper abdomen, lasts from short time to days, and resolves itself

Pain worsens after food eating

Pain may reach to across the back, level T8-L1 (band-like pain)

Pain could radiate to umbilical, both flanks, left shoulder

Pain worse when lying flat on back

Pain decreases with sitting and flexion forward

Pain is always accompanied by high BP and tachycardia

Positive cullen’s sign

Nausea

Vomiting

Fever

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13
Q

Right shoulder radiation

A

Gallbladder

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14
Q

Indicates inflammation of the gallbladder wall due to bile duct obstruction

A

Elevated ALP

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15
Q

There are three types of blood test for evaluation of patients with hepatitis

A

Liver enzymes aka aminotransferases
Anti-viral antibodies and viral genetic materials
Serum proteins

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16
Q

AST
ALT
GGT
Inc with _____

Bile duct obstruction only ALP increased

A

ALP

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17
Q

Complications cholelithiasis

A 
Gallbladder gangrene
Acute cholecystitis
Chronic cholecystitis
Perforation or rupture of gallbladder
Cholangitis
Acute pancreatitis
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18
Q

Etiology liver cancer

A 
Chronic infectious hepatitis B, C, D
Liver cirrhosis
Aflatoxins
Wilson’s disease
Hemochromatosis
Non-alcoholic fatty liver diseases
Estrogen and anabolic steroids
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19
Q

Cancer that originates from liver cells

A

Primary liver cancer

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20
Q

Cirrhosis signs and symtpoms

A 
Ankle swelling 
jaundice
Palmar erythema
Nail changes and clubbing of fingers
Easy bruising
Abnormal bleeding
Confusion or problems thinking
Hepatic encephalopathy
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21
Q

Most frequent liver cancer, which originates from hepatocytes

A

Hepatocellular carcinoma aka hepatoma

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22
Q

Spreads through blood, body fluids, sexual contacts, tattoos, mothre to child by breast feeding

A

HBV
+dsDNA
Serum hepatitis

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23
Q

Incubation period Hepatitis A

A

28 days (range 15-50 days)

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24
Q

Formation and migration of stones inside the biliary tree or common bile duct

A

Choledocholithiasis

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25
Diagnosis pancreatitis
``` Blood amylase and lipase high Urine amylase significantly increased Blood glucose inc US CT MRI ```
26
Formation of stones in the gallbladder
Cholelithiasis aka gallstone disease
27
Tests for bilirubin
Considerable increase of blood total and conjugated (direct) bilirubin Finding of bilirubin in the urine (which results in dark brown color of the urine, like dark beer) Increased concentration of urobilirubinogen in the urine
28
Cholesterol long time between meals
Only eat 1 or 2 times a day
29
Both cullen’s and grey-turner’s signs can predict
Acute pancreatitis
30
Usually the clinical manifestations of pancreatic cancer come to the clinical attention in ____stage of the disease
Terminal
31
Acute cystitis easy pathogenesis
Quiescent Stone blocks cystic duct. Chemical and bacterial inflammation Stone drops back into gallbladder in 7 days or so Resolution in 2 months or so
32
Acute pancreatitis when the ____ or ___ is obstructed
Hepatopancreatic duct | Pancreatic duct
33
Complications cholecystitis
Perforation or rupture of gallbladder Ascending cholangitis Local abscess Peritonitis
34
Diagnosis pancreatic cancer
Blood CA-19-9 CT Endoscopic ultrasound (EUS) Endoscopic ultrasound with endoscopic needle biopsy
35
Signs and symptoms typical for acute hepatitis in overt stage
``` Hepatomegaly Abdominal discomfort and pain Jaundice - yellowing of the skin and eyes (icterus) Lymphadenopathy Dark colored urine White stool ```
36
Cooleys or mediterranean anemia
Thallassemia major
37
Predisposing factors pancreatic cancer
``` Chronic pancreatitis Smoking Family history Age over 60 Diet with high amount red meat, soft drinks Obestiy Partial gastrectomy as treatment of obesity H. Pylori infection ```
38
Treatment cirrhosis
Liver cirrhosis is an irreversible disease and the treatment usualy focuses on preventing of its progression and complications
39
Hypoalbuminemia and increased prothrombin time are the most specific tests for
Liver destruction
40
For determination of biochemical activity of the organ and cancer stage
PET-CT (positron-emission tomography-computer tomography)
41
Risk factors for cholesterol gallstones
``` Decreased gallbladder motility with bile stasis Obesity Family history (genetic predisposition) Rapid weight loss Long intervals between meals ```
42
Murphy’s sign is positive in cholelithiasis only when
It complicated with cholecystitis
43
Tumor marker frequently elevated in pancreatic or liver cancer
CA-19-9
44
Spherocytosis
Small eccinocytes, present with dec amount of lip
45
MRI is used for diagnosis of stones at
Any level of bile tree and gallbladder
46
Acute pancreatitis
Reversible disease, if does NOT turn into chronic pancreatitis
47
Presence of paget’s disease with osteoblastic activity, or metastatic prostate cancer
High ALP
48
Complications cholelithiasis
Acute cholecystitis when cystic duct is obstructed Chronic cholecystitis when long-term presence of gallstones leads to fibrosis of gallbladder wall with further its calcification
49
Beta-cell tumor generally benign is characterized by overproduction of insulin, which can result in hypoglycemia
Insulinoma
50
Calculous cholecystitis
When stones in the gallbladder are formed 90%
51
Zollinger-Ellison syndrome causes multiple
Peptic ulceration not only in stomach and duodenum but also in jejunum
52
Etiology of acalculous cholecystitis
``` Critical illness (HIV, diabetes mellitus, myocardial infarction) Major surgery or severe trauma/burns Sepsis Long-term total parenteral nutrition Prolonged fasting Salmonella infection ```
53
Don’t forget that liver cirrhosis is the major cause of
Esophageal varicies
54
Virus etiology hepatitis aside from Hep a, b, etc.
Cytomagalovirus Epstein-Barr virus Yellow fever virus Ebola virus and Marburg virus
55
Blood tests diagnosis cholelithiasis
Inc WBC Inc common bilirubin content Inc alkaline phosphatase
56
Signs and symptoms of hepatitis depend on the
Form of hepatitis (acute or chronic) and its etiological factor
57
Incubation period Hepatitis B
90 days (range 30-150 days)
58
Autoimmune diseases etiology hepatitis
Sjogren’s sydnrome
59
Increased alfa-fetoprotein
Is normal for infants before 1 year old | Aften 1year it decreases and is low during the entire life
60
Alkaline phosphatase (ALP) is an enzyme presenting in all tissues of the body, but is particularly concentrated in
``` Liver Bile duct Kidneys Bones Placenta ```
61
Recommendations by chiropractor for hepatitis
Rest to minimize energy demands Avoid alochol and other hepatotoxic drugs (tylenol) Small amount, high-calorie meal
62
Pain in upper abdomen that typically radiates to the back when carcinoma located in the body or tail of the pancreas
Pancreatic cancer
63
Acute gastritis and duodenitis Internal bleeding with development of hypovolemic shock Lung problems (enzymes may affect lung tissue causing it’s inflammation)
Acute pancreatitis
64
Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
Acute peritonitis positive cullen’s sign
65
Metastases to the liver
Major sources of metastases to the liver are the ones from the GI tract organs
66
Cirrhosis etiology alcoholism
Alocholic steatosis | Non-alcoholic steatohepatitis
67
2 forms of cholecystitis
Calculous | Acalcolous
68
Most common causes chronic hepatitis, cirrhosis, liver cancer
Hepatitis C
69
Most common type of pancreatic cancer
Adenocarcinoma - 95%
70
Only small stones are the ___ dangerous
More
71
The ____ the calculi, the less likely they are to enter the cystic or common ducts to produce obstruction
Larger
72
Cholesterol gallstones genetic
Predominantly young spanish population
73
Signs and symptoms of chronic cholecystitis
``` First symptoms are bitter taste adn taste of metal in mouth in the morning Abdominal discomfort after meals Complaints of gas accumulation Nausea Chronic diarrhea Presence of skin xanthomas ```
74
Poisons produced by the plant mold aspergillus, that grows on wheat, rice, corn, and peanuts
Aflatoxins
75
Usually blood test liver panel is abnormal with liver cancer because a patiente had
A previous liver disease
76
Etiology for chronic pancreatitis
Alcoholism Cystic fibrosis Pseudocysts Idiopathic
77
Pain when pressuring between edges of Right SCM muscle
Georgievskiy-Myussi’s sign
78
Xanthomas represent
Focal accumulation of cholesterol
79
Most common cause of toxic hepatitis
Alcohol
80
ALT is normally most concentrated within ____ and in ____
Liver cells | Heart muscle cells, kidneys, pancreas
81
Irreversible disease characterized by atrophy, fibrosis, and calcification of pancreatic parenchyma
Chronic pancreatitis
82
Unexplained thrombophelbitis (Trousseau sign) of superficial veins anywhere in the body, portal vein or deep veins of the extremities
Pancreatic cancer
83
Represents the dilation of periumbilical collateral veins and is an important sign of portal hypertension
Caput medusae
84
Treatment pancreatic cancer
Surgery Radiation therapy Chemotherapy
85
Chronic hepatitis usually results from ___ form of hepatitis but sometimes develops insidiously, with ____ initial clinical manifestations
Acute Non-sepcific Weakness Fatigue
86
Incubation period Hepatitis D
60-90 days (range 30-180 days)
87
Parasites hepatitis etiology
Echinococcus Toxocara Schistosoma
88
3 types of gallstones
Cholesterol stones Pigment stones Mixed stones
89
Primary liver cancer
When the tumor originates from liver cells
90
Serum proteins diagnosis hepatitis
IgM IgG Hypoalbuminemia Increased prothrombin time
91
Obesity etiology hepatitis
Non-alcoholic steatosis
92
Protozoa etiology hepatitis
Toxoplasma | Leishmania
93
Accumulation of fat in the hepatocytes, may results altered fat metabolism in the liver and increase synthesis of fatty acids and triglycerides. Enlargement of the liver is accompanied by symptoms that may include anorexia, nausea and jaundice. At this point the fatty changes are generally reversible if alochol consumption ceases
Alocholic steatosis - fatty liver
94
The most aggressive form, with high mortality rate, cannot exist without B virus, spreads through the blood, typical for IV drug users and hemophilia patients
HDV -ssRNA Serum delta hepatitis
95
Causes chronic hepatitis, can cause cirrhosis and cancer
Hepatitis B
96
IgM
Indicates acute case
97
Tenderness when hand taps the end of right costal arch
Ortner’s sign
98
AST is presented not only in the liver but also in
``` Skeletal muscles Heart muscle Brain Lungs Pancreas ``` Can be released from these tissues in the case of their destruction
99
Classification of primary liver cancer
Hepatocellular carcinoma Cholangiocarcinoma Angiosarcoma
100
Risk factors for calculous cholecystitis
``` Female Obesity Rapid weight loss Pregnancy Increasing age Ethnic groups (hispanic, scandinavian) Drugs (esp hormonal therapy in women) ```
101
Alpha-1-antitrypsin deficiency
Abnormal accumulation of the protein within liver cells
102
More sensitive for diagnosis of porcelain gallbladder characterized by calcification of gallbladder wall, developing usually in cholelithiasis complicated by ____
Describing cholelithiasis Chronic cholecystitis
103
Signs and symptoms in choledocholithiasis
Acute constant pain in upper part of abdomen Obstructive jaundice Murphy’s sign negative Charcot triad
104
Pain worse when lying flat on bakc
Acute pancreatitis
105
An eosinophilic cytoplasmic inclusion, alocholic hyaline, found in liver cells
Mallory bodies
106
Long-term presence og gallstones
Silent stones
107
Initial manifestations of hepatitis may start and get better quickly = ______ or cause long-term disease = _____
Typical for acute hepatitis | Chronic hepatitis
108
Charcot triad
Indicates ascending cholangitis Severe right upper quadrant pain Jaundice Fever
109
Treatment hepatitis
Medical, depends on the cause
110
Arises in the duodenum, pancreas, and peripancreatic soft tissue
Sollinger-Ellison syndrome
111
The most common type of pancreatic cancer is adenocarcinoma arising from the ___ component, from the cells that line the ducts of the pancreas
Exocrine
112
Aspartate aminotransferase (AST) aka serum glutamic oxaloacetic tranaminase (SGOT) is
Intracellular enzymes
113
AST blood concentration is significantly increased in
Acute toxic hepatitis Acute viral hepatitis Alcoholic liver disease
114
The major danger of gallstones is their ability
To move to the bile ducts resulting in duct obstruction
115
Diagnosis cirrhosis imaging
CT of abdomen MRI of abdomen Upper endoscopy for esophageal varicies Ultrasound of the abdomen
116
CT-scan is used for diagnosis of _____ stones Aka ____
Distal common bile duct stones Porcelain gallbladder
117
Normal gallbladder wall vs inflamed
1 inch | 2 inches
118
Cirrhosis etiology
``` Alocholism Chronic hepatitis B, C, D, F Autoimmune hepatitis Some medicines (corticosteroids) Genetic diseases (genetic hemochromatosis, Wilson’s disease) ```
119
Signs and symptoms of acute cholecystitis
Acute pain in right upper abdomen that is severe and constant, may last for days Pain is increased with breathing Pain radiates to right shoulder, or right scapula, or right mid back (T8-9 level) Changing position and passing gas do NOT relieve pain Large amount of meal or fat meal can trigger the pain Pain occurs several hours after eating and awakens the pt during the night Fever and chills Nausea nad vomiting Vomiting does NOT relieve pain (unlike peptic ulcer)
120
Ischemic hepatitis (shock liver) most often associated with
Heart failure Shock Sepsis
121
Gastrinoma
Zollinger-Ellison syndrome
122
Alanine aminotransferase (ALT) aka serum glutamic pyruvic tranaminase (SGPT) is
Intracellular enzymes
123
Pathogenesis of chronic cholecystitis
Occurs after repetitive mild exacerbations of acute cholecystitis and is characterized by mucosal atrophy and fibrosis of gallbladder wall
124
Toxic hepatitis could be caused by
Medications (tylenol, birth control pills, Lipitor, etc) Mushroom poison Alcohol
125
Metastases from the liver
To local veins and then to lungs Advanced cases are characterized by metastases to the bone (including spine) and brain
126
Acalcolous cholecystitis
Without formation of stones 10%
127
When cholelithiasis becomes symptomatic the following signs and symptoms develop
``` Murphy’s sign? Tachycardia Nausea, vomiting (vomiting does NOT relieve pain) Increased production of gas Fat intolerance ```
128
As liver function worsens, symptoms may include
Ascites | Ascites with caput medusae
129
In acute cholecystitis vomiting ____ relive the pain
Does not
130
Differential diagnosis for chronic cholecystitis
Peptic ulcer Hiatal hernia Colitis Chronic pancreatitis
131
Gold standard for diagnosis of cirrhosis is
Liver biopsy
132
Decreased gallbladder motility - mixed gallstones
Severe trauma (e.g. car accidents) Severe burns Paralysis
133
X-ray in cholelithiasis
15% sensitivity for radioopaque stones (pigment and mixed stones)
134
Spreads through sexual contacts and hemotransfusions, cross the placenta
HCV +ssRNA Serum non-A, non-B hepatitis
135
Cholelithiasis signs and symptoms - gallstone attack
Sudden acute pain in right upper quadrant lasts 30 minutes to several hours, until gallbladder relaxes Pain radiates to back, between blades, right shoulder, behind sternum Change of posture, defecation do NOT relieve pain
136
Risk factors for mixed gallstones - what part of ilium
Distal portion
137
This is a new discovered hepatitis virus, spreads by blood and sexual contact. Does not appear to replicate primarily in the liver, its characteristics are in the process of study
HGV | GB virus C
138
Phrenic nerve sign
Georgievskiy-Myussi’s sign
139
More sensitive than ultrasound in diagnosis of pericholecystitic inflammation
CT-scan
140
Signs and symptoms of liver cancer Clinical manifestations appear only in the late stages, and worsen with a progression of the disease
Loss of weight Loss of appetite Upper abdominal discomfort and pain
141
Liver size can be ___ in cirrhosis
Normal Enlarged Shrunken
142
Incubation period Hepatitis E
40 days (range 14-60 days)
143
Comlpications hepatitis
``` Liver cirrhosis (hep b,c,d,f, toxic, autoimmune, genetic) Hepatic failure Hepatocellular carcinoma (hepatoma) ```
144
Zollinger-Ellison syndrome diagnosis
Blood testing to detect inc gastrin levels Upper GI endoscopy Imaging tests to look for gastrinoma Measurement of stomach acid - gastric pH less than 2.0; large gastric volume greater than 140mL
145
Thalassemia
Absence of globulin or alpha or 2beta | Physical or morphological structure
146
Diagnosis liver cancer
``` Blood test US CT MRI Liver biopsy PET-CT ```
147
Gastric pH less than 2.0 Large gastric volume >140mL
ZES (Zollinger-Ellison syndrome)
148
Gamma-glutamyltransferase (GGT) is found predominately in the ___ but also is present in the cell membrance of other tissues (e.g. kidneys, heart, brain)
Hepatobiliary cell membrances
149
Bacteria cause hepatitis
Staphylococci and streptococci - toxic shock syndromes Leptospira (gram-negative spirochete) Listeria (gram positive, non spore-forming rods)
150
Radioopaque stones
Pigment and mixed stones
151
Diagnosis cirrhosis
CBC - thrombocytopenia, leukopenia, neutropenia Inc prothrombin time Hypoalbuminemia Aminotrasferases - AST, ALT, GGT elevated; AST usually > ALT, GGT typically much higher in alcoholic cirrhosis ALP elevated Bilirubin elevated
152
Increased prothrombin tmie indicates the
Decreased production of clotting factors
153
Risk factors for pigement gallstones
Young population Hemolytic conditions (sickle cell anemia, hereditary spherocytosis, thalassemia) Liver cirrhosis Intraductal stasis (choledochole cyst, postsurgical biliary stricture)
154
Zollinger-Ellison syndrome can mmetastasize to ____leading to a significantly short life
The liver
155
Blood tests for acute cholecystitis
Elevated WBC Elevated alkaline phosphatase Elevated C-reactive protein
156
In men signs and symptoms cirrhosis
Impotence Hypogonadism (shrinking of the testicles) Gynecomastia (breast swelling)
157
ALT blood elevation is significantly increased in case of
Acute hepatocyte destruction or severe kidneys, pancreas damage
158
Cirrhosis etiology
Alocholism is major etiological factor
159
GGT blood concentration is significantly increased in liver diseases associated with
Hepatocyte necrosis Cirrhosis Alcoholic liver disease
160
Pain decreases with sitting and flexion forward (unlike to pain in ___ and ____)
Acute pancreatitis Cholelithiasis Acute cholecystitis
161
Spreads through fecal contamination of food and water, causes an acute and self-limiting infection, does NOT cause chronic hepatitis
HAV (hepatitis A) +ssRNA Infectious hepatitis
162
One of the real treatment options today is
Liver transplantation
163
Signs and symptoms liver cirrhosis
There may be no symptoms or symptoms may come on slowly, depending on how well the liver is working
164
Etiology hepatitis
``` Viral Toxic Bacteria Protozoa Parasites Fungi Autoimmune diseases Obesity Genetic Ischemic hepatitis ```
165
Risk factors for mixed gallstones
Crohn’s disease Partial removal of ilium Decreased gallbladder motility
166
Originates from the blood vessel cells in the liver
Angiosarcoma aka hemangioendothelioma
167
Most liver transplant recipients recieve immunosuppressive drugs (corticosteroids) for
Prevention of the graft rejeciton
168
Tumor markers found only in primary liver cancers as well as in other cancers and certain other disorders
Carbohydrate antigen 19-9 (CA19-9) Carcinoembryonic antigen (CEA) Cancer antigen 125 (CA125)
169
Anti-viral antibodies and viral genetic materials
Anti-HAV (for Hep A) Anti-HBV (for Hep B) Anti-HCV (for HEp C)
170
Decreased gallbladder motility with bile stasis
Age over 40 Female Some drugs (statins, estrogen therapy) Multiple pregnancies
171
Hepatitis exists in 2 forms
Acute - less than 6 months | Chronic - more than 6 months
172
Specific for cholecystitis but is non-sensitive especially in geriatric patients
Murphy’s sign
173
Pancreatitis blood amylase and lipase are ____ than normal variations Which is better indicator
4-6 times hight | Lipase
174
Use for differential diagnosis between acute and chronic cholecystitis
HBS - hepatobiliary scintigraphy
175
Fungi etiology hepatitis
Aspergillus Histoplasma capsulatum Candida
176
Pain occurs several hours after eating and awakens pt at night
Acute cholecystitis
177
Lateral clinical manifestations of cirrhosis
``` Jaundice Esophageal varicies Ascites Hepatomegaly Splenomegaly Hemorrhoids Edema Peripheral neuropathy Changes in mental responsiveness and memory Spider angiomas. Face, neck, shoulders Anemia Thrombocytopenia Coagulation disorders Collateral veins visible on abdominal wall Palmar erythema Sexual characteristics Changes Gynecomastia Hirsuitism ```
178
Initial manifestations of acute hepatitis for first 2-4 days are NON-specific and characterized by flu-like signs and symptoms
``` Fever Malaise Joint aches Headache Nausea, vomiting Diarrhea ```
179
Managment of chronic cholecystitis
Diet modification Antibiotics Restriction of physical activity
180
The first symptoms of cholecystitis
Bitter taste and taste of metal in mouth in the mornings
181
Hemochromatosis
Iron accumulate in multiple body sites, including the liver
182
Pulmonary embolism because the pancreatic cancer produces
Blood clotting chemicals
183
Splenomegaly is often found regardless of
Liver size
184
Cholelithiasis diagnosis
``` Blood tests US CT MRI ERCP X-ray ```
185
Ankle swelling (non-pitting, non-pedal edema) due to
Hypoalbuinemia
186
Cholangitis when the common bile duct is obstructed before jointing the
Pancreatic duct
187
Gold standard examination for diagnosis of gallbaldder stones and stones in the cystic duct is
Ultrasound examination
188
Occupies 3rd position in frequency among the most common cancer mortality
Liver cancer
189
Treatment cholelithiasis
Just medical treatment including surgery
190
Fibrosis of gallbladder wall with further calcification
Porcelain gallbladder
191
A consequence of chronic liver diseases characterized by replacement of liver tissue by scarring tissue leading to loss of liver function
Liver cirrhosis
192
Jaundice develops when pancreatic cancer is located in
The head of the pancreas
193
Treatment recommendations by chiropractor cirrhosis
Avoiding alcohol consumption Eating healthy diet that is low in salt Vitamin and nutritional supplements
194
Cholesterol stones
Radiolucent | 80%
195
Liver enzymes
``` Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Gamma glutamyltransferase (GGT) ```
196
Complications for acute pancreatitsi
``` Pancreonecrosis Pancreatic abscess Acute gastritis and duodenitis Internal bleeding with development of hypovolemic shock Lung problems ```
197
Causes chronic hepatitis, cirrhosis, liver cancer
Hepatitis D
198
Tumor markers blood test most important is increased
Alfa-fetoprotein
199
Tumor originates from the bile duct cells
Cholangiocarcinoma
200
Blood tests for chronic cholecystitis
Frequently shows normal values
201
Inflammation of the pancreas when certain enzymes that normally do not become active until they reach the small intestine, become active in the pancreas digesting this gland itself
Pancreatitis
202
Non-specific signs and symptoms pancreatic cancer
``` Clinical depression - sometimes presenting before caner is diagnosed Unexplained weight loss Anorexia Nausea, vomiting Steatorrhea ```
203
Murphy’s sign is negative with the stone in the
Bile duct - choledocholithiasis
204
Radiologic exam can be used for differential diagnosis between
Gallbladder | Kidney stones
205
Autoimmune, parasites, protozoa, obesity, genetic, ischemic etiological agents usually result in
Progression to chronic hepatitis
206
Increased neutrophils for acute
Cholecystitis
207
Metastases pancreatic cancer
1. To regional lymphatic nodes 2. Liver 3. Lungs and pleura
208
High ALP can show
``` Liver disease Bile duct obstruction Presence of paget’s disease with osteoblastic activity Presence of pregnancy Presence of celiac disease ```
209
Xanthomas result from
Cholestasis and/or hyperlipidemia
210
Complications cirrhosis
Bleeding disorders Esophageal varicies Hepatocellular carcinoma Hepatic encephalopathy
211
Etiology for acute pancreatitis
``` Alcohol use Gallstones Trauma of the abdomen Viral infections (mumps) Pseudocysts Medications (corticosteroids, estrogen, statins) ```
212
Anit-viral antibodies and viral genetic materials can be helpful in diagnosis of both
Acute and chronic viral hepatitis
213
Spreads through blood transfusion or oral fecal route Causes chronic hepatitis
HFV | Serum, mutated B-virus
214
Diagnosis cholelithiasis
Blood tests are infomative in the cases of exacerbation
215
Cancer that begins in another area of the body (colon, breast, stomach) and then spreads to the liver
Secondary (metastatic)
216
Hypoalbuminemia indicates
A decreased function of hepatocytes
217
Measures of liver homeostasis High concentrations develop as a result of destruction or inflammation not only in the liver, but in other tissues as well
Liver enzymes aka aminotransferases
218
Malignant neoplasm originating from transformed cells of the pancreas
Pancreatic cancer
219
Left shoulder radiation
Heart | Pancreas
220
This pain is ALWAYS accompanied by high blood pressure and tachycardia
Acute pancreatitis
221
Perforation or rupture of gallbladder with development of
Bile peritonitis and high level of mortality
222
Characterized by overproduction of gastrin which stimulates extreme HCl secretion
Zollinger-Ellison syndrome
223
Incubation period Hepatitis C
50 days (range 15-160 days)
224
Types of pancreatitis
Acute | Chronic
225
The enzyme ____ plays teh most important role in pancreatitis process
Trypsin
226
Pigment stones
Contain bilirubin and calcium | Radioopaque
227
Liver cancer - forms
Primary | Secondary - metastatic
228
On lateral lumbar x-ray film Gallstones are located : Kidney stones :
In front of lumbar spine Overlap L2 or locate posterior to it
229
Changing position and passing gas do NOT relieve pain
Acute cholecystitis
230
Signs and symptoms liver cancer
``` Nausea, vomiting General weakness, fatigue Jaundice with skin itching Hepatosplenomegaly Sudden ascites Back pain ```
231
Early symptoms liver cirrhosis
Fatigue and loss of energy Poor appetite and weight loss Nausea and upper abodminal discomfort Small, red, spider-like blood vessels on the skin (telangiectasia, spider angioma)
232
Early pancreatic cancer often does not cause symptoms or symptoms are _____
Silent disease Non-specific
233
Differential diagnosis for acute cholecystitis
Acute peptic ulcer Perforated peptic ulcer Acute pancreatitis Ureteral colic
234
Viral, bacterial, fungal, and toxic etiological agents usually result in
Acute hepatitis until further progression to chronic hepatitis EXCEPT HAV and HEV
235
Signs and symptoms pancreatic cancer
Painless jaundice, may be associated with itching
236
Signs and symptoms typical for all forms and etiologies of hepatitis in overt stage
Weight loss Easy bruising Encephalopathy Hepatosplenomegaly
237
Inflammation of the gallbladder wall
Cholecystitis
238
During the physical exam the ___ can be found with liver cancer It develops because hepatocarcinoma has a lot of blood vessels with turbulent blood flow
Hepatic bruit
239
Treatment liver cancer
Cryotherapy in early stage Chemoembolisation Radiotherapy Liver transplantation
240
Diagnosis hepatitis
``` Tests for bilirubin Liver enzymes Anti-viral antibodies and viral genetic materials Serum proteins Ultrasound Liver biopsy ```
241
Increased sensitivity below the right scapula (also due to phrenic nerve irritation)
Boas’ sign
242
Inflammation of the liver with change of its function
Hepatitis
243
The gallstones may be present for ____ before symptoms develop, and ___ of patients remain asymptomatic throughout their lives
Decades | 70-80%
244
Brusing of the flank, which may be indicative of pancreatic necrosis with retro peritoneal or intraabdominal bleeding
Acute pancreatitis positive Grey-Turner’s sign Ecchymosis of the flanks
245
Genetic causes of hepatitis
Alpha-1-antitrypsin deficiency Hemochromatosis Wilson disease Glycogen storage disorders
246
The signs and symptoms of pancreatic cancer depend on
Size, location, and tissue type of tumor
247
Wilson disease
Copper accumulate in the liver and brain
248
Cholecystitis divides into
Acute | Chronic
249
Endocrine pancreatic tumors
Insulinoma | Zollinger-ellison syndrome
250
Diagnosis cholecystitis
``` Ortner’s sign Georgievskiy-Myussi’s sign Murphy’s sign Boas’ sign Blood tests US MRI CT HBS ```
251
Signs and symptoms for chronic pancreatitis
``` Acute pain is NOT resolved itself Nausea Severe vomiting Fatty stool Signs of diabetes mellitus: thirst, polyuria Weight loss Pain increases after eating and drinking ``` Change of position does NOT relive the pain Band-like pain
252
Increased alfa-fetoprotein is found not only in primary liver cancer but also in
Cancer of testicles and ovaries | Metastatic cancer to the liver
253
Acute pain is NOT resolved itself Pain increases after eating and drinking Change in position does NOT relieve the pain Band-like pain
Chronic pancreatitis

GE (5 decks)

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