GI, Liver, Pancreas pathology (6)

Question 1

What is hepatitis

Answer 1

inflammation of hepatocytes

Question 2

What are the forms of transmission for Hep A, B, and C

Answer 2

A - fecal-oral

B and C - parenteral

Question 3

Which type of Hepatitis is most commonly chronic

Answer 3

C

Question 4

what is fulminant hepatitis

Answer 4

massive hepatocyte necrosis and liver failure

Question 5

Which type of Hepatitis can lead to carcinomas

Answer 5

type B and C

Question 6

What is the most common reason for liver transplant

Answer 6

Hep C

Question 7

What is the prognosis for the three types of hepatitis

Answer 7

A - benign, self limiting
B - most recover, small % die
C - almost 10% die

Question 8

Which viruses cause the types of hepatitis

Answer 8

A - Picornovirus
B - Hepadnavirus
C - Flavivirus
D - Defective virus
E  - Herpevirus

Question 9

which type of hepatitis (acute or chronic) has apoptotic cells

Answer 9

acute

Question 10

What is the progression of Fatty Liver Disease

Answer 10

1. Steatosis - fatty liver
2. Nonalcoholic steatohepatitis (NASH) - fatty and inflamed
3. NASH and fibrosis - scarred
4. cirrhosis - scarred and inflamed
5. cancer

Question 11

What are the two types of fatty liver disease

Answer 11

alcoholic - classic (ingestion of 5 beers/day)

non-alcoholic - Diet related, most common

Question 12

how are obesity, NASH, and insulin resistance related

Answer 12

Obesity and insulin resistance have a strong correlation to NASH

Question 13

What is the best treatment for NASH

Answer 13

improved insulin sensitivity

diet, weight loss, metformin

Question 14

What can hepatitis, and Fatty liver disease lead to

Answer 14

Cirrhosis
Portal hypertension
jaundice

Question 15

What is cirrhosis

Answer 15

irreversible inflammatory disease that disrupts liver function and structure

Question 16

what are the manifestations of cirrhosis

Answer 16

decreased hepatic function due to fibrosis
portal hypertension (blood is shunted away from the liver)
this leads to hypoxic necrosis

Question 17

what are the three types of hepatic portal hypertension

Answer 17

1. prehepatic - narrowing of vessels preceding liver
2. intrahepatic - cirrhosis (most common)
3. post hepatic - right heart disorders

Question 18

what are consequences of hepatic portal hypertension

Answer 18

hepatic encephalopathy - CNS disturbance
varices - distended veins (esopahgeal bleeding)
splenomegaly
ascites - fluid accumulation in the peritoneal cavity

Question 19

how does hepatic portal hypertension cause hepatic encephalopathy

Answer 19

liver dysfunction causes toxins to remain in the blood, then they are absorbed and circulate to the brain, those cells are vulnerable to those toxins

Question 20

What does hepatic portal hypertension cause

Answer 20

impaired cognitive function, tremors, and EEG changes

Question 21

what is ascites

Answer 21

fluid accumulation in the peritoneal cavity that almost always accompanies liver cirrhosis. It leads to increased hepatic vessel hydrostatic pressure and decreased oncotic pressure

Question 22

What are the products of RBC recycling in the spleen and liver

Answer 22

globin - AA
Heme - Iron
bilirubin

Question 23

what happens to the bilirubin from RBC recycling

Answer 23

1. Unconjugated bilirubin is toxic
2. conjugated in the liver via glucoronyl transferase
3. conjugated bilirubin is excreted with bile into the small intestine then in feces
4. some bilirubin is converted to urobilinogen in the small intestine by bacteria
5. some is excreted, some is reprossed by the liver and excreted, some is excreted in urine

Question 24

What are the causes of jaundice

Answer 24

1. bilirubin production in excess of the livers ability to conjugate (lots of RBC destruction)
2. decreased bilirubin excretion

Question 25

what can cause decreased bilirubin excretion

Answer 25

1. reduced hepatic uptake (hepatitis, cirrhosis) 2. decreased conjugation (hepatitis, cirrhosis, enzyme deficiency) 3. bile duct obstruction

Question 26

What is jaundice

Answer 26

excessive bilirubin accumulated in the body, leads to yellowing of skin, nail beds, and whites of the eyes. bilirubin is also very toxic to brain cells

Question 27

how is jaundice treated

Answer 27

treat cause of condition blood transfusion sun

Question 28

how do you determine the site of the problem causing jaundice

Answer 28

color and feces of urine light feces and dark urine = extrahepatic obstructive jaundice light feces and light urine = damaged hepatocytes dark feces and dark urine = hemolytic anemia

Question 29

what is cholestasis

Answer 29

a condition where bile can't flow from the liver to the gut that can lead to xanthomas

Question 30

how do you test urine function

Answer 30

test albumin levels (reduced levels in blood with liver problems) Transaminases (elevated in blood with liver problems)

Question 31

What are oral manifestations of liver failure

Answer 31

hematomas, gingival bleeding glossitis (alcoholic hepatitis) reduced healing after surgery

Question 32

What is Hemochromatosis

Answer 32

autosomal recessive disease that increases iron in the body. this results in cirrhosis, skin pigmentation, liver carcinoma

Question 33

what is wilson disease

Answer 33

autosomal recessive disease that increases body copper. this results in liver disease, neurological disruption, and kayser-fleischer rings in cornea

Question 34

What is hepatocellular carcinoma

Answer 34

carcinoma of the liver strongly associated with hep B and C and aflatoxin exposure. the median survival is 7 months, death from bleeding, liver failure, and cachexia

Question 35

what is metastatic carcinoma in the liver

Answer 35

common malignancy from the colon, lung, breast, pancreas and stomach

Question 36

What is cholelithiasis

Answer 36

gall stones (cholesterol and bilirubin)

Question 37

What are the risk factors for cholelithiasis

Answer 37

female, fat, fertile, forty, fair

Question 38

how does insulin affect cholelithiasis

Answer 38

insulin leads to increased cholesterol production, which causes gallstones

Question 39

how can weight loss lead to gall stones

Answer 39

if you are calorie restricted, your body won't empty the gall bladder often enough

Question 40

what are the exocrine diseases of the pancreas

Answer 40

pancreatitis cystic fibrosis tumors

Question 41

what are the endocrine diseases of the pancreas

Answer 41

diabetes | tumors

Question 42

what are the exocrine functions of the pancreas

Answer 42

digestive enzymes

Question 43

what are the endocrine functions of the pancreas

Answer 43

alpha cells - glucagon - insulin antagonist beta cells - insulin - glucose into cells - anabolism gamma cells - somatostatin - inhibits insulin and glucagon

Question 44

What are the two types of pancreatitis

Answer 44

acute and chronic

Question 45

what are the characteristics of acute pancreatitis

Answer 45

- reversible destruction and inflammation of the pancreas - symptoms = abdominal pain radiating to back - lab = elevated serum amylase and lipase - main cause = alcoholism and gallstones - most people recover, few die in a week.

Question 46

what are the characteristics of chronic pancreatis

Answer 46

- longstanding irreversible pancreatic destruction - cause = most are alcohol related - symptoms = none, or bouts of jaundice and pain - prognosis = poor (50% mortality over 20 years)

Question 47

what is the biggest risk factor for carcinoma of the pancreas

Answer 47

smoking

Question 48

is carcinoma of the pancreas deadly

Answer 48

yes, its highly invasive, and has no symptoms until late. 5% last 5 years.