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PATH MAGIC > HEPATOBILIARY 2 > Flashcards

HEPATOBILIARY 2 Flashcards

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1
Q

Jaundice, weight loss, epigastric pain

A

Pancreatic cancer

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2
Q

2 major risk factors for pancreatic cacner

A

Smoking

Chronic Pancreatitis

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3
Q

Unique findings in carcinoma of the HEAD of the pancreas

also seen in periampullary cancer

A

Conjugated hyperbilirubemia / Jaundice
Pale Stools
Dark urine (due to CB)
Itching

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4
Q

Serum marker for pancreatic cancer

A

CA 19-9

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5
Q

biliary atresia embryo defect

A

Failure to form the extrahepatic biliary tree

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6
Q

biliary atresia presentaion

A

conjugated hyperbilirubinemia/pale stool

Jaundice and cirrhosis in an INFANT

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7
Q

Risk factors for CHOLESTEROL stone formation

A

Supersaturation of bile
DECREASED bile acid, decreased phosphatidylcholine
GB Stasis, high estrogen, low cck, high progesterone

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8
Q

Cholesterol stone, gross and Xray

A

Radiolucent…may possibly be radiopaque

Yellow/faceted

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9
Q

Bilirubin stones, gross and Xray

A

Radio-opaque

Black (no infection)

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10
Q

Causes of brown pigmented stones

A

Biliary Tree infection

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11
Q

the causative organism of acute cholangitis

A

E.coli

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12
Q

RUQ pain radiating to the shoulder, Nausea and Vomiting

A

Acute Cholecystitis

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13
Q

Acalculous Cholecystitis causes

A

Critically ill patients (burns, sepsis) to develop cholecystitis w/o stones
Also in biliary sludge.

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14
Q

Which type of calcification causes porcelan gallbladder

A

Dystrophic- think carcinoma

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15
Q

Most common pathogens causing ascending cholangitis

A

gram negative enterics

Parasites that target the liver

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16
Q

Triad of symptoms for Acute ascending cholangitis

A

Sepsis
Jaundice
Abdominal pain

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17
Q

Biggest risk factor for ascending cholangitis

A

Choledocolithiasis

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18
Q

RLQ pain, SBO, Xray reveals air in the biliary tree

A

Gallstone illeus

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19
Q

Gallbladder carcinoma arises from

A

glandular epithleium –> Adenocarcinoma

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20
Q

Classic patient with gallbladder cancer is

A

Elderly female with cholecystitis

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21
Q

Unconjugated hyperbilirubinemia labs (hemolysis)

A

Increased UB
Increased urine Urobilinogen (more shunted during enterohepatic cycling)
No urine CB

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22
Q

Conjugated hyperbilirubinemia labs

A

Increased CB
no Urine urobilinogen (no CB made it to the gut to be converted)
Increased Urine CB and bile salts (CB refluxes backward into sinusoids)

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23
Q

Mixed hyperbilirubinemia is a result of

A

Hepatitis (viral or alcoholi)

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24
Q

Physiologic jaundice of newborn defect

A

low UDPgluconyltransferase levels –> high UCB

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25
Physiologic jaundice of newborn tx and mechanism
Phototherapy --> converts UCB to CB
26
Gilbert syndrome
mildly low UDPgluconyltransferase levels
27
Crigler Najjar 1 syndrome
ABSENT UDPgluconyltransferase levels --> high UCB
28
Crigler najjar presentation
neonatal kernicterus
29
Gilbet inheritance
AR
30
Dubin Johnson and Rotor syndrome defect and inheritance
Bilirubin canalicular transport protein defect --> high CB AR
31
Classic 5 symptoms in biliary tract obstruction
``` Dark urine (CB) Pale stool Pruritis Xanthomas Steatorrhea ```
32
Why do hepatitis patients have dark urine
Increased urine CB
33
Pregnant woman develops acute onset Jaundice, ascites, AST, ALT through the roof then dies
Hepatitis E
34
Confirmatory marker for active hepatitis C infection
HCV RNA / IgM
35
markers for chronic hepatitis C
HCV RNA / IgG --> IgG is NOT protective
36
Which hepatitis depends on hepatitis B for infection
Hepatitis D Superinfection is worse than Coinfection
37
3 Indicator of active HepB infection
HBsAg, High AST/AlT, Presence of HBc antibody | HBeAg / HBV DNA
38
what is the only marker present in the window phase?
IgM against the core
39
Markers for a cleared hepB infection
IgG against the surface Ag
40
Markers for hepB vacccination
IgG against the surface Ag/no other antibodies are present
41
Marker for the chronic carrier state
IgG against the core + Surface antigen (>6 months) + or HBV DNA
42
Cell type that mediates liver cirrhosis
Stellate cells that secrete TGFB
43
4 consequenses of hyperesternisim in cirrhosis
Gynecomastia Testicular atrophy Spider angioma Palmar erythema
44
2 consequences of decreased proten synthesis in cirrhosis
hypoalbuminemia --> edema | coagulopathy
45
how to tell if elevated alkaline phosphatase is of liver orgin?
y-glutamyltranspeptidase will also be increased
46
What is the underlying mechanism of tissue damage in hemochromatosis?
Free radical generation via the Fenton Rxn
47
Hemochromaosis defect
Overactivation of HFE gene (C282Y)
48
What does HFE code for?
Hepcidin
49
Hepcidin function
Inhibit the release of iron from cell into blood
50
relationship of hepcidin and ferroportin
indirect. High hepcidin = low ferroportin
51
Iron studies in hemochromatosis (ferritin,TIBC, serum Fe, transferrin, %saturation)
Ferritin high Low TIBC High Serum Fe High %sat
52
How to differentiate between lipofuscin and iron?
Prussian Blue stains iron
53
2 other organs affected in hemochromatosis
Testes and heart (cardiomyopathy)
54
Pt presents with darkening of skin, polyuria and polyphagia
Hemochromatosis (this bronze diabetes)
55
Wilson disease mutation and inheritance
AR ATP7B gene
56
Wilson disease udnerlying defect
Defective ATP mediated hepatocyte/copper transfer --> copper accumulates in liver
57
mechanism of damage in wilson disease
Free radical production
58
Wilson Dz labs (urinary Cu, serum free Cu, TOTAL Cu, cerruloplasmin)
Increased Urinary Cu Increased Free serum Cu Decreased TOTAL Cu (low cerruloplasmin)
59
45y/o female with SLE presents with generalized itching
Primary biliary cirrhosis
60
25 year old male with hx of bloody diarrhea and abdominal pain presents with jaundice
Primary sclerosing cholangitis
61
serum marker for PSC
p-ANCA
62
Baby has fever, mom gives a fever reducer, baby develops jaundice, hypoglycemia, vomiting
Reye Syndrome
63
hepatic adenomas are associated with which 2 substances
Birth control pills | Anabolic steroids
64
Classic case for hepatic adenoma rupture
Healthy girl on birth control pills or male body builder suddenly develops severe RUQ pain, hypotension and death
65
how does aflatoxin induce hepatocellular carcinoma
p53 mutation
66
hepatocellular carcinoma tumor marker
Alpha Fetoprotein
67
5 most common tumors that met to liver
Colon > Stomach > Pancreas > lung / breast "Cancer Sometimes Penetrates Benign Liver"
68
PE signs of 2 most common causes of Obst jaundice
Palpable gallbladder that is non tender- Suggestive of adenocarcinoma of the head of the pancreas Non-palpable gall bladder: Stone in CBD
69
Imaging technique for acute cholecystitis diagnosis
Hepatobiliary iminodiacetic acid scan (HIDA)
70
Effect of estrogen on cholesterol/stones
Increases HMGCoA reductase --> increases risk of stones
71
Well circumscribed liver mass with cystic blood filled spaces, and vascular proliferation
Cavernous Hemangioma
72
hepatolenticular degeneration (AKA)
Wilson Disease
73
Which inflammatory cell mediates alcoholic hepatitis?
Neutrophils
74
cholangiocarcinoma is associated with which other cancer
ulcerative colitis
75
Deficiency of vitamin ADEK
Gallstone, steatorrhea
76
night blindness, squamous metaplasia of resp. epithelium, osteomalacia, bleeding tendency - seen in___
Gallstone, steatorrhea
77
isolated deficiency of Vit D seen in ___________
Uremia/renal failure
78
Casue of renal stone in steatorrhea
Increased oxalate absorption from GIT
79
Casue of gall stone in crohns disease
Decreased reabsorption of BS from GIT/Ilium

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