GI 2 and liver, 4th quiz W2015 Flashcards Preview

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Flashcards in GI 2 and liver, 4th quiz W2015 Deck (109)
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1
Q

Looking at all age groups, what is the most common cause of viral enteritis?

A

Norwalk

2
Q

Among infants and young children, what is the most common cause of severe diarrhea?

A

Rotovirus

3
Q

What micro-organism causes “picnic food poisoning”?

A

Staphylococcus aureus

4
Q

What microorganism that causes food poisoning is associated with Chinese food?

A

Bacillus cereus

5
Q

What microorganism that causes food poisoning is associated with saltwater crabs and shrimp?

A

Vibrio (cholera and non-cholera)

6
Q

What microorganism that causes food poisoning is associated with improperly prepared home canned fruits and vegetables?

A

Clostridium botulinum

7
Q

What microorganism is the number one cause of foodborne illness in the U.S.? Second?

A

1st: Norovirus
2nd: Salmonella

8
Q

What microorganism causes bloody diarrhea?

A

Campylobacter

9
Q

What are toxins associated with gram-negative bacteria that are usually released after lysis of the bacteria?

A

Endotoxins

10
Q

What are chromosomally encoded exotoxins that are produced and secreted by several bacterial organisms?

A

Enterotoxins

11
Q

Enterotoxins are often heat-stable and frequently cytotoxic, killings cells by doing what?

A

Altering the apical membrane permeability of the mucosal cells of the intestinal wall

12
Q

What may be secreted or, similar to endotoxins, may be released during lysis of the cell?

A

Exotoxins

13
Q

What destroys most exotoxins?

A

Heating

14
Q

What are two common exotoxins?

A

Botulinum

Corynebacterium diphtheriae

15
Q

What condition is primarily seen in premature infants, where portions of the bowel undergo necrosis?

A

Necrotizing enterocolitis

16
Q

What illness is characterized by offensive smelling diarrhea, fever, and abdominal pain?

A

Pseudomembranous enterocolitis

17
Q

What is a cause of antibiotic-associated diarrhea that is often caused by clostridium difficile?

A

Pseudomembranous enterocolitis

18
Q

In pseudomembranous enterocolitis, what is the pseudomembrane made of?

A

inflammatory cells, necrotic epithelium, and mucus in which the overgrowth of microorganisms takes place

19
Q

Although colonoscopy and sigmoidoscopy are still employed, what is now the first-line diagnostic approach for pseudomembranous enterocolitis?

A

Stool testing for the presence of C. difficile toxins

20
Q

What is a condition in which inflammation and injury of the large intestine occur as a result of inadequate blood supply?

A

Ischemic colitis

21
Q

What region of the intestine is rarely affected by ischemic colitis and why?

A

The recturm because it received blood from both the inferior mesenteric artery and the internal iliac arter

22
Q

What are the most common types of benign small bowel tumors?

A
Hyperplastic polyp
Adenomas
Stromal tumors - leiomyomas
Lipomas
Hamartomas
23
Q

Describe the histological appearance of a leiomyoma.

A

Smooth muscle cells with elongated spindle cells containing cigar-shaped nuclei and no evidence of increased mitotic activity is seen.

24
Q

What condition is an autosomal dominant disorder characterized by mucocutaneous pigmentation and benign GI hamartomas.

A

Peutz-Jeghers syndrome

25
Q

Where do you find the lesions of Peutz-Jeghers syndrome?

A

Mucocutaneous pigmentation on the face, lips and buccal mucosa.
Benign hamartomas - small bowel (90%), stomach and large bowel.

26
Q

What is the histological appearance of a lesion of P-J syndrome?

A

Frond-like appearance with a stromal/smooth muscle core that is covered by acinar glands and normal mucosa. Nuclear atypia is absent.

27
Q

How common is primary cancer of the small intestine?

A

Relatively rare, accounting for only 2% of all GI cancers

28
Q

What is the most common type of small bowel malignancy in the U.S.?

A

Adenocarcinoma

29
Q

What is the most common type of cancer found in the small bowel? From where?

A

Metastatic disease

Melanoma, and colon, breast, ovary, pancreas and stomach cancers.

30
Q

Carcinoid tumors arise from what? What do they usually secrete?

A

Neuroendocrine cells

Serotonin

31
Q

What is the histological appearance of a carcinoid tumor?

A

Typical endocrine appearance with collections of small round cells containing nuclei that are consistent in size and shape and surrounded by cytoplasm which stains pink to pale blue.

32
Q

What is a fleshy growth occurring on the lining of the colon or rectum? What is it a risk of developing into?

A

Colorectal polyp

Colorectal cancer

33
Q

What is the most common type of polyp found in the colon?

A

Hyperplastic polyps

34
Q

What can be described as rice grains on the colonic mucosa, with minimal epithelial atypia, where the cells display normal differentiation and maturation?

A

Hyperplastic polyps

35
Q

What does a adenomatous polyp look like and what is it also known as?

A

Small, smooth, rounded.

AKA tubular adenoma because of the rounded nature of the neoplastic glands that form it.

36
Q

What is the gross appearance of a villous adenoma?

A

Sessile, larger than a tubular adenoma.

37
Q

The majority of the polyps found in this condition are non-neoplastic, hamartomatous, self-limiting and benign, but there is an increased risk of developing adenocarcinoma.

A

Juvenile polyposis syndrome

38
Q

Histologically, a slide shows edematous stroma, eroded surface and cystic epithelial elements. What is the condition?

A

Juvenile polyposis syndrome

39
Q

What condition is inherited and consists of hundreds to thousands of polyps formed mainly in the epithelium of the large intestine? What happens if it goes untreated?

A

Familial adenomatous polyposis

The polyps start out benign, but untreated there is malignant transformation into colon cancer

40
Q

What is the combination of polyposis, osteomas, fibromas, and sebaceous cysts?

A

Gardner’s syndrome

41
Q

What condition has a gross appearance of the mucosal surface of the colon being a carpet of small adenomatous polyps?

A

Familial adenomatous polyposis

42
Q

What does adenocarcinoma look like microscopically?

A

Still glandular configuration, but the glands are irregular and are very crowded. Many of them have lumens containing bluish mucin. Hyperchromatism and pleomorphism are seen.

43
Q

How is LeiomyoSARCOMA different from LeiomyoMA?

A

Both have increased cellularity, but leiomyosarcoma greater cell density and cells have more mitotically active nuclei.

44
Q

What do non-Hodgkin’s lymphoma cells look like?

A

They have prominent clumped chromatin and nucleoli with occasional mitotic figures. They can be seen infiltrating through the mucosa.

45
Q

While moderate hepatocyte swelling is reversible, more severe damage has irregularly clumped cytoplasmic organelles and large clear spaces. These may not be reversible. What is this process known as?

A

Ballooning degeneration

46
Q

A dying (apoptotic) hepatocyte may shrink down to form what? What condition(s) is it associated with?

A

An eosinophilic councilman body

Viral hepatitis, yellow fever, other viral syndromes

47
Q

What is iron overload in hepatocytes?

A

Hemochromatosis

48
Q

What is copper overload in hepatocytes?

A

Wilson’s disease

49
Q

What is triglyceride fat droplet accumulation in hepatocytes?

A

Steatosis

50
Q

What is the most common cause of fatty change in developed nations?

A

Alcoholism

51
Q

What category of liver disease involves quiescent lymphocytes collecting in the portal tracts which may migrate into specific areas of the periportal parenchyma as activated lymphocytes?

A

Viral hepatitis

52
Q

What is a sign of very recent hepatocyte destruction?

A

Apoptotic hepatocytes

53
Q

Apoptotic hepatocytes usually don’t incite a diffuse inflammatory reaction. However, scavenger macrophages (also known as what?) engulf the apoptotic cell fragments within a few hours, generating localized clumps of inflammatory cells which does what?

A

Kupffer cells and circulating monocytes

Activates a cascade of multiple cytokines

54
Q

Unlike other responses which are reversible, what points toward a state of generally irreversible hepatic damage?

A

Fibrosis

55
Q

Ongoing liver damage with liver cell necrosis followed by fibrosis and hepatocyte regeneration results in what?

A

Cirrhosis (nodular)

56
Q

With cirrhosis, what do you see microscopically?

A

The regenerative nodules of hepatocytes are surrounded by fibrous connective tissue that bridges between portal tracts.

57
Q

What type of disorders is by far the most frequent concerning the liver?

A

Inflammatory

58
Q

Other than hepatitis A, B, C, D, and E, what viruses effect the liver?

A

Epstein-Barr
Cytomegalovirus
Yellow fever virus

59
Q

How serious is HAV?

A

Benign, self-limited

60
Q

Which hepatitis virus can involve (1) acute hepatitis with resolution (2) chronic hepatitis > mb cirrhosis (3) fulminant hepatitis w/massive liver necrosis and (4) the backdrop for HDV?

A

Hepatitis B

61
Q

Which hepatitis virus is most widespread, globally?

A

Hepatitis B

62
Q

What makes HBV so hardy?

A
  • Prolonged incubation period
  • Remains in the blood up to and during active episodes of acute and chronic hepatitis
  • Present in all physiologic and pathologic body fluids except stool
  • Withstands extremes of temp and humidity
63
Q

What is the most common chronic blood-borne infection in the U.S. and accounts for almost half of all patients in the U.S. with chronic liver disease?

A

Hepatitis C

64
Q

How is HBV transmitted?

A

Inoculations(IV drug use 60%) and blood transfusions. Risk of sexual transmission is low.

65
Q

Which hepatitis virus is the highest risk perinatally?

A

HBV

66
Q

What is generally the course of HCV?

A

Often undetected clinically. Once symptomatic it is indistinguishable from HAV/HBV, although it is often milder.

67
Q

What is a characteristic clinical feature of chronic HCV infection?

A

Episodic elevations in serum aminotransferases.

68
Q

What is the only way to prevent HDV and why?

A

Prevent HBV because the D virus is “replication defective” and requires genetic information from the B virus to replicate.

69
Q

Where is HDV common?

A

Mediterranean, Middle East, Northern Africa. It is uncommon in the U.S.

70
Q

Hepatitis E symptoms resolve over the course of 6 weeks. However, who should be worried about HEV?

A

Pregnant women; it can lead to fulminant hepatic necrosis and death (15-25%)

71
Q

Which hepatitis virus is termed an “innocent bystander” virus?

A

Hepatitis G; no known pathogenic activity.

72
Q

What is a liver parenchymal cell with a characteristic hazy staining appearance to the cytoplasm on light microscopy?

A

Ground glass hepatocyte

73
Q

The classic ground glass appearance is associated with what condition and occurs as a result of what abundant substance?

A

Chronic hepatitis B; hepatitis B antigen in the endoplasmic reticulum.

74
Q

What is the term used when hepatic insufficiency progresses from onset of symptoms to hepatic encephalopathy within 2 to 3 weeks?

A

Fulminant hepatitis

75
Q

What may reactivate a latent HBV infection with fulminant hepatitis as a possible outcome?

A

HAV or non-heptotropic virus, drugs (acetominophen) or chemical toxicity.

76
Q

Transection of a fulminant liver will reveal what?

A

Necrotic areas with a muddy, red appearance with blotchy bile staining.

77
Q

What does Fulminant hepatitis look like microscopically?

A

Complete destruction of hepatocytes in contiguous lobules leaving only a collapsed reticulum framework and preserved portal tracts.

78
Q

If a patient survives more than a week with a fulminant hepatitis, the liver can recover, potentially completely. Under what circumstances is the parenchymal framework preserved and what is this compared to?

A

With centrilobular zonal necrosis caused by direct hepatotoxins or by ischemia. With more massive destruction of confluent lobules, regeneration is disorderly.

79
Q

What does alcohol impaired hepatic metabolism of methionine lead to?

A

Decreased intrahepatic glutathione (GSH) levels thus sensitizing the liver to oxidative injury.

80
Q

Induction of what increases break down of alcohol in the endoplasmic reticulum and increases the conversion of acetaminophen to toxic metabolites (especially what)

A

Cytochrome P-450

NAPQI - N-acetyl-p-benzoquinone-imine

81
Q

What is the antidote for acetaminophen poisoning?

A

N-acetyl-cysteine (NAC)

82
Q

What is the leading cause of liver disease in most Western countries?

A

Excessive alcohol consumption

83
Q

What three conditions are collectively referred to as alcoholic liver disease?

A

Hepatic steatosis
Alcoholic hepatitis
Cirrhosis

84
Q

Describe the process of hepatic steatosis (fatty liver)?

A

The intake of alcohol causes microvesicular droplets of lipids to accumulate in hepatocytes. Chronic intake causes these globules to compress and displace the nucleus to the periphery.

85
Q

What is the major intermediate metabolite of alcohol en route to acetate production that induces lipid peroxidation and subsequent oxidative damage?

A

Acetaldehyde

86
Q

Hepatocytes may accumulate keratin and other proteins, which become visible as eosinophilic cytoplasmic inclusions. What is this called? What are they characteristic of?

A

Mallory bodies

Alcoholic liver disease

87
Q

What is almost always accompanied by prominent activation of fibroblasts which give rise to fibrosis? What generally signals an irreversible stage of the disease process?

A

Chronic alcoholic hepatitis

The appearance of fibrotic bands

88
Q

How many grams of daily ethanol intake is associate with significant risk? Severe injury?

A

80 gm

160 gm for 10 to 20 years

89
Q

How does alcoholic hepatitis contrast to steatosis?

A

Acutely, usually following a bout of heavy drinking

90
Q

What is a syndrome characterized by central nervous system dysfunction in association with liver failure including portal-systemic shunts?

A

Hepatic encephalopathy

91
Q

What is one of the most common findings with portal hypertension? (what other organ is affected?)

A

Splenomegaly

92
Q

What liver condition is strongly associated with obesity, dyslipidemia, hyperinsulinemia, insulin resistance and type 2 diabetes?

A

Nonalcoholic fatty liver disease (NAFLD)

93
Q

What is presumed to be the most likely explanation for the elevated serum aminotransferases and/or GGT values documented in 24% of the the general U.S. adult population?

A

Nonalcoholic fatty liver disease (NAFLD)

94
Q
What condition reveals the following on biopsy?: 
steatosis
multifocal parenchymal inflam.
Mallory hyaline bodies
hepatocyte death
sinusoidal fibrosis
A

Nonalcoholic steatohepatitis NASH

95
Q

What are the usual primary and secondary causes of hemochromatosis?

A

Primary - genetic defect causing excessive iron absorption

Secondary - excessive administration of iron

96
Q

What condition is an autosomal recessive disorder marked by the accumulation of toxic levels of copper in many tissues and organs, principally the liver, brain, and eyes?

A

Wilson’s disease

97
Q

What sign in the eye is pathognomonic for Wilson’s disease?

A

Kayser-Fleischer’s ring

98
Q

What is an autosomal recessive disorder marked by abnormally low serum levels of this protein that inhibits proteases which are normally released from neutrophils at sites of inflammation?

A

Alpha 1-antitrypsin deficiency

99
Q

A1AT deficiency is more likely to cause disease where in the body in children vs. adults?

A

Liver in children

Lung in adults

100
Q

Microscopically, periportal red hyaline globules with periodic acid-schiff (PAS) stain are characteristic of what condition?

A

A1AT deficiency

101
Q

What condition is an autoimmune disease in which there are T cell mediated destruction of the bile ducts of the liver?

A

Primary biliary cirrhosis

102
Q

What is the primary histologic feature of primary biliary cirrhosis?

A

Granulomatous destruction of medium sized intrahepatic bile ducts

103
Q

What condition has hepatomegaly, xanthomas and xanthelasmas with later development of jaundice and severe pruritus?

A

Primary biliary cirrhosis

104
Q

What is an important identifying lab for PBC? (95% sensitivity)

A

Positive anti-mitochondrial antibody test

105
Q

What condition is associated with the bile ducts initially becoming inflamed, with segmental stricture and dilatation?

A

Primary sclerosing cholangitis

106
Q

What do you expect to see with a barium swallow in a patient with primary sclerosing cholangitis?

A

Beaded appearance of intra-hepatic ducts

107
Q

What condition do patients with primary sclerosing cholangitis also have 70% of the time?

A

Ulcerative colitis

108
Q

What do the bile ducts look like histologically on biopsy for a patient with primary sclerosing cholangitis?

A

Onion skin pattern

109
Q

What cancer is a primary sclerosing cholangitis patient at an increased risk for?

A

cholangiocarcinoma