Exam 2 - Liver, Gallbladder, Exocrine pancreas Flashcards Preview

PTH560 Pathology > Exam 2 - Liver, Gallbladder, Exocrine pancreas > Flashcards

Flashcards in Exam 2 - Liver, Gallbladder, Exocrine pancreas Deck (43):
1

unconjugated bilirubin (UCB)

-end product of heme degradation
-lipid soluble -> indirect bilirubin

2

Conjugated bilirubin (CB)

UCB combines with albumin in blood
-blah conjugated to glucuronic acid

water soluble -> direct bilirubin

-secreted into bile ducts. stored in gallbladder. enters duodenum

3

urobilinogen (UBG)

-intestinal bacteria convert CB to urobilinogen (UBG)
-UBG oxidized to urobilin (gives poo color)

-recycled 90% to liver, 10% kidney - give pee color

4

Jaundice

-due to inc in UCB and/or CB
-first noticed in sclera
-classified based on percentage of CB

5

Causes of jaundice

-viral hepatitis = most common!
-other stuff, defects, cancers, etc

6

Hepatitis classifications and transmission routes

-Hep A: oral-fecal, sexual
-Hep B: oral-fecal, sexual, blood
-Hep C: sexual, blood
-Hep D: sexual , blood
-Hep E: oral-fecal
***these are caused by a virus

can have autoimmune, neonatal, alcoholic hepatitis

7

Viral hepatitis

acute phases:
-prodrone (initial part of infectious disease. liver gets bigger, inc enzymes, and enzymes peak before jaundice

-jaundice phase
-recovery phase

8

Microscopic findings of viral hepatitis

-lymphocytic infiltrate (invade when there is a viral infection)

9

Fulminant hepatic failure

-has to include encephalopathy within 8 weeks of liver being screwed up.

causes:
reye syndrome (liver failure due to ASA)
-wilson disease = cant handle copper in body

10

Cirrhosis

irreversible diffuse fibrosis of liver with formation of regenerative nodules

11

Cirrhosis causes

-alcoholic liver disease (most common)
-postnecrotic cirrhosis
-autoimmune disease
-metabolic disease

12

Cirrhosis complications

-liver failure
-ascites (excess fluid)
-hepatorenal syndrome (back up into kidney)
-hyperestrinism

13

Ascites

tap the belly and see if the fluid moves to the other side

14

Primary biliary cirrhosis

-cirrhosis due to granulomatous destruction of bile ducts
-more common in females
-autoimmune

treatment: liver transplant. treat symptoms

15

Cavernous hemangioma

-most common benign liver tumor
-danger for hemorrhage

16

Hepatic cell adenoma

- benign tumor of liver cells
-causes: oral contraceptives and steroids.
-if you stop taking the stuff it can get smaller

-tendency to rupture during pregnancy

17

What is the most common liver cancer?

Metastasis*******

18

Hepatocellular Carcinoma (HCC)

-malignant
-most common primary liver cancer (came from this organ)

causes: due to Hep B or C. lots of others

gross findings: focal, multifocal, or diffusely infiltrating
Micro findings: presence of bile in neoplastic cells

Lab:-liver enzymes will increase
*radiation/chemo not helpful

19

Angiosarcoma (in liver)

-caused by exposure to vinyl chloride (plastic pipes) = most common

20

Cholelithiasis

-medical word for gallstone
-2 types (cholesterol and pigmented -black or brown)

due to: saturation of bile with cholesterol or decreased bile salts/acids

-risk factors: "Fs"
Female, Forty, fertile, fat

21

Cholelithiasis complications

-cholecystitis (most common)
-common bile duct obstruction
-gallbladder cancer
-acute pancreatitis

22

Choledocholithiasis

gallstone in the common bile duct

23

What is Acute cholecystitis? who gets it more?

-inflammation of gallbladder
-more common in females in 5th and 6th decades
-inc incidence in native americans

24

Acute cholecystitis pathogenesis

Typically
-lodging of a stone
-everything behind it backs up
-over growth of bacteria in area (E.coli)
-perforation possible

atypical: CMV in AIDS, volume depletion

25

Acute cholecystitis clinical findings

-pain in epigastric, RUQ (murphy sign) and it radiates to R arm.

L arm pain you think heart.
R arm pain you think gallbladder possibly

Lab: inc WBC and enzymes
imaging: Most common = UltraSound

26

Chronic cholecystitis

-most common symptomatic disorder of gallbladder
-Cholelithiasis with repeated attacks

27

Gallbladder cancer

-Adenocarcinoma
-elderly women
-treat: surgery
-very poor prognosis

28

Porcelain gallbladder

-due to calcification
-50% lead to cancer
-Remove it!

29

Primary sclerosing Cholangitis

-*70% males!
-fibrosis of bile duct (in or outside of liver)
-genetic predisposition
-associated with IBD

30

Annular pancreas

-embryological buds form ring around duodenum

-results in SBO (small bowel obstruction)

31

Aberrant pancreatic tissue

Pancreatic tissue is in a different place in body.

locations: stomach =most common. duodenum, jejunum, meckel diverticulum

32

There are variations to the location of the major pancreatic duct. Why is this important?

-major pancreatic duct empties into terminal CBD

-an obstruction could block both depending on the variation

33

Pancreatitis

inflammation of the pancreas
-autodigestion (eats itself)
-acute vs chronic

34

Acute pancreatitis

-**most common cause = alcohol (can be from binge drinking)
-pathogenesis: activation of proenzymes (many ways). releases proteases, lipases, and elastases.

35

What enzyme causes the proenzymes to be activated in acute pancreatitis?

Trypsin

36

If someone feels a stabbing pain in their back what it is?

Acute pancreatitis

37

What are some complications of acute pancreatitis?

-pancreatic necrosis
"" pseudocyst
"" abscess

38

Acute pancreatitis Lab stuff

-serum amylase (salavery)
-serum lipase (pancreas)

-****increase "SIT" serum immunoreactive tyrpsin
(decreased SIT in chronic)

39

What is the treatment for acute pancreatitis?

-NPO = nothing per oral
-fluids
-pain control
-NG tube to suction

40

Acute pancreatitis: ranson criteria

Prognostic indicator of mortality

>7 = 100% death
5-6 = 40%
3-4 = 15%
<3 = 1%

41

Chronic pancreatitis

-majority idiopathic

Pathogenesis
-repeated attacks of acute
-*calcified concretions

Labs: decreased "SIT"!***

42

Pancreatic pseudocyst

-collection of digested pancreatic tissue around pancreas
-have elevated amylase even if it is under control

Treatment: watch it. or if big drain it

43

Pancreatic cancer

7th or 8th decade
-smoking is most common cause

Pathogenesis:
-gene mutations

clin find: virchow node (left supraclavicular), sister mary joseph node (belly button)

REMOVE IT! whipple procedure