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Hepatobiliary and pancreatic disorders > Goljan inflammatory and infectious disorders of liver > Flashcards

Goljan inflammatory and infectious disorders of liver Flashcards

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1
Q

pathogen for ascending cholangitis

A

E. coli

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2
Q

pathogen for liver abscess

A

E. coli;
Bacteroides fragilis;
streptococcus faecalis

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3
Q

pathogen for granulomatous hepatitis

A

mycobacterium Tb;

histoplasma capsulatum

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4
Q

pathogen for spontaneous peritonitis

A

E. coli in adults;

strept pneumoniae in children

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5
Q

pathogen for leptospirosis

A

leptospira interrogans

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6
Q

pathogen for amebiasis

A

entamoeba histolytica

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7
Q

pathogen for clonorchiasis

A

clonorchis sinensis (chinese liver fluke)

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8
Q

pathogen for schistosomiasis

A

schistosoma mansoni

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9
Q

pathogen for echinococcosis

A

echinococcus granulosus (sheepherder’s disease)

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10
Q

Define ascending cholangitis

A

inflammation of bile ducts (cholangitis) from concurrent biliary infection and duct obstruction (stone);
life threatening disease

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11
Q

clinical findings of ascending cholangitis

A

fever, jaundice, RUQ pain

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12
Q

What is ascending cholangitis likely to cause?

A

MC cause of multiple liver abscesses

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13
Q

Tx for ascending cholangitis

A

decompression and drainage;

piperacillin-tazobactam

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14
Q

Epidemiology for autoimmune hepatitis

A

type 1 is predominant form in US and worldwide (80%);
type 2 is uncommon in US;
young women

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15
Q

what are the range of autoimmune presentations?

A

symptomatic w/ increased transaminases;
fulminant hepatitis;
cirrhosis

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16
Q

Genetic associations w/ autoimmune hepatitis

A

HLA-D3 and DR4 association

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17
Q

What are autoimmune associations w/ AI hepatitis?

A

Hashimoto’s thyroiditis;

Graves’ disease

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18
Q

clinical findings of AI hepatitis

A

fever;
jaundice;
hepatosplenomegaly

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19
Q

lab findings for type I AI hepatitis

A

positive ANA (>60%);
anti-smooth muscle Ab (>85%);
increased serum transaminases;
decreased serum albumin in severe disease;
prolonged prothrombin time in severe disease

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20
Q

Tx for AI hepatitis

A

initial Tx w/ corticosteroids + azathioprine;

liver transplantation if resistant to Tx

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21
Q

where do a majority of liver abscess occur?

A

right lobe w/ majority being solitary

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22
Q

What are causes of liver abscess?

A 
ASCENDING CHOLANGITIS (MC);
INTRA-ABDOMINAL INFECTION (pathogen spread via portal vein, diverticulitis, bowel perforation);
DIRECT EXTENSION (empyema of gallbladder, subphrenic abscess);
HEMATOGENOUS SPREAD (bacterial endocarditis)
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23
Q

Clinical findings of liver abscess

A

spiking, intermittent fever;
RUQ or right CVA tenderness;
jaundice is uncommon

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24
Q

How is liver abscess diagnosed?

A

ultrasound (least expensive);

CT scan

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25
Tx for liver abscess
percutaneous drainage; | metronidazole + ceftriaxone
26
What does granulomatous hepatitis indicate?
sign of miliary spread
27
When will spontaneous peritonitis occur?
develops in ascities => cirrhosis, nephrotic syndrome
28
Tx for spontaneous peritonitis
cefotaxime
29
Describe the pathogen that causes leptospirosis
G-; tightly wound spirochetes; | crook at end resembles shepherd's staff
30
what are the reservoirs for leptospira interrogans and how it is transmitted?
dogs (MC), rats; spirochetes excreted in urine transmitted by swimming in contaminated water (ponds on farms); farmers, miners, people who work w/ sewage
31
What type of disease is leptospirosis
biphasic disease => Weil's disease
32
Describe the septicemic phase of leptospirosis
fever, jaundice, hemorrhagic diathesis; renal failure (interstitial nephritis); conjunctivitis and photophobia, meningitis; phase terminated by appearance of Ab
33
describe immune phase of leptospirosis
presence of numerous organisms in urine => darkfield micro to confirm
34
Tx of leptospirosis
pen G
35
What is the most common cause of liver abscess worldwide?
amebiasis => entamoeba histolytica
36
What is the common location for amebiasis?
usually produces a right lobe abscess
37
Tx for amebiasis
metronidazole followed by paromomycin
38
What is the life cycle of the pathogen that causes Clonorchiasis?
nonschistosomal=> egg (human) => ciliated miracidial larva => infects snail (1st intermed host) => produces fork-tailed cercarial larvae => infect 2nd intermed host (fish) => form infective metacercariae => man ingests 2nd intermed host => gets disease
39
How is clonorchiasis contracted?
by ingesting encysted larvae in fish; | larvae enter CBD and become adults
40
What is a risk for clonorchiasis?
may produce cholangiocarcioma
41
Tx for clonorchiasis
praziquantel
42
Describe the life cycle of the pathogen causing schistosomiasis
``` egg (human) => ciliated miracidial larva=> infects snail (1st intermed host)=> produces fork-tailed cercarial larvae => penetrate skin in human => gets disease ```
43
How does Schistosoma mansoni cause schistosomiasis in the human? (not the life cycle)
larvae in SMV enter into portal vein => develop into adult worms that deposit eggs=> host develops immune response w/ concentric fibrosis in a "pipestem cirrhosis) in the vessel wall
44
Complications of schistosomiasis
portal HTN; ascites; esophageal varices
45
Tx for schistosomiasis
praziquantel
46
Where is echinococcosis likely to be found?
single or multiple cysts containing larval forms => may be in liver (MC), lungs, brain
47
Life cycle of echinococcus granulosus
eggs develop into larval form only; | larval form only develops into adult that can lay eggs
48
How does echinococcosis pathogen get to the point of infection in human?
``` infected sheep (intermed host w/ larva in liver cyst) dog eats sheep liver (definitive host & larva develops into adult to lay eggs); human eats eggs from dog is intermed host (eggs develop into larvae that penetrate bowel and enter liver => hydatid cyst ```
49
What is a likely way a child may contract echinococcosis?
eating grass contaminated w/ dog excreta
50
What leads to the ultimate infection of echinococcosis?
inner germinal layer of hydatid cysts has protoscolices (larva) in brood capsules => rupture of cysts can produce anaphylaxis
51
Tx of echinococcosis
percutaneous drainage + albendazole
52
Epidemiology of neonatal hepatitis
idiopathic; congenital infections like CMV; inborn errors of metabolism=>a1-antitrypsin def
53
What does biopsy show in neonatal hepatitis?
multinucleated giant cells => "giant cell" hepatitis
54
Triad associated w/ Reye syndrome?
encephalopathy; microvesicular fatty change; transaminase elevation
55
What is the typical cause of Reye syndrome?
aspirin given to young child w/ infection
56
Pathogenesis of reye syndrome
``` mitochondrial damage (virus, salicylates); disruption of urea cycle (increase serum ammonia); defective Beta-oxidation of fatty acids ```
57
What may be the effect of salicylates in Reye syndrome? How is it viewed on micro?
microvesicular fatty change => small cytoplasmic globules w/o nuclear displacement; no inflammatory infiltrate
58
Initial Clinical findings in Reye syndrome
afebrile, quiet, lethargic sleepy, and vomiting => hepatomegaly and liver dysfxn present
59
Clinical findings as Reye syndrome progresses
Signs & Sx related to cerebral edema & pressure increase; 1) sleepy but respond; vomit 2) stuporous, seizures, decorticate rigidity, intact papillary reflexes 3) deepening coma, decerebrate rigidity, fixed pupils 4) coma, loss of deep tendon reflex, fixed dilated pupils, flaccidity/decerebrate 5) death
60
lab findings w/ Reye syndrome
transaminasemia; normal to slight increase in total bilirubin; increased serum ammonia and PT (levels give severity); hypoglycemia; CSF usually normal
61
Tx for Reye syndrome
supportive; | mannitol, glycerol, hyperventilation to reduce cerebral edema
62
mortality rate for Reye syndrome
25-50% mortality rate
63
Pathogenesis of acute fatty liver of pregnancy? risks?
abnormality in Beta-oxidation of fatty acids; | FATAL TO MOTHER AND FETUS UNLESS DELIVERED
64
Define preeclampsia
HTN, proteinuria, dependent pitting edema in 3rd trimester
65
How does preeclampsia damage the liver? what lab will be elevated?
liver cell necrosis around portal triads (zone 1); | increased serum transaminases
66
Define HELLP syndrome
Hemolytic anemia w/ schistocytes; Elevated Liver enzymes Low Platelets (DIC)
67
Define fulminant hepatic failure
acute liver failure w/ encephalopathy w/in 8wks of hepatic dysfxn
68
causes of fulminant hepatic failure
Viral hepatitis (MC overall cause); drugs (acetaminophen MC); Reye syndrome
69
gross and micro findings of fulminant hepatic failure
wrinkled capsular surface due to loss of hepatic parenchyma; | dull red-yellow necrotic parenchyma w/ blotches of green (bile)
70
clinical findings in fulminant hepatic failure
hepatic encephalopathy; | jaundice
71
Lab findings w/ fulminant hepatic failure
``` DECREASE transaminases (liver parenchyma destroyed); INCREASE in PT and ammonia ```

Hepatobiliary and pancreatic disorders (7 decks)

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