HIGH YIELD LIVER/GALLBLADDER (PATHOMA) -- Leah Flashcards Preview

DT4- Exam 3 > HIGH YIELD LIVER/GALLBLADDER (PATHOMA) -- Leah > Flashcards

Flashcards in HIGH YIELD LIVER/GALLBLADDER (PATHOMA) -- Leah Deck (56):
1

Biliary Atresia:
-age group
-cause
-presentation

-babies
-failure to form/ destruction of EXTRAhepatic biliary tree
-jaundice (conjugated bilirubin) --> cirrhosis

2

Cholelithiasis is the big word for _____.
-three causes
-most common type?

-gallstones
1. supersaturation (cholesterol or bile)
2. decreased bile or phospholipids
3. stasis

**Most common type = cholesterol (90%); bile less common.

3

Cholesterol stones:
-color
-xray appearance
-major risks

-yellow
-radiolucent
-FAT FERTILE FEMALE FORTY
(ALSO-- clofibrate)

4

What does radioLUCENT mean? OPAQUE?

(Sorry, dumb card guys, I know. But I mess these up.)
-Lucent= too "L"ight to be seen
-Opaque= seen on xray

5

Bile stones:
-color
-xray appearance
-2 risk factors

-pigmented (dark)
-radiopaque
-(clonorchiasis, ascaris lumbricoides)

6

Gallstones:
-most common presentation
-possible complications

-usually ASYMPTOMATIC!!!!
-until they cause..... biliary colic, cholecystitis, ascending cholangitis, gallstone ileus, gallbladder cancer

7

Biliary colic:
what is it?

-waxing/ waning RUQ pain caused by gallbladder contracting against a stone in the cystic duct

8

Common bile duct obstruction may lead to?

-acute pancreatitis/ obstructive jaundice

9

What is unexplained jaundice in and older person until proven otherwise?

-PANCREATIC CANCER BECAUSE THIS CAN BLOCK COMMON BILE DUCT.

10

Acute cholecystitis:
-cause?
-how is it different from biliary colic?
-risk?

-stone in cystic duct --> dilation/ pressure ischemia/ bacterial overgrowth of the gallbladder

-more constant RUQ pain, also see that "pericolic --however you say it-- fluid" on U/S (not mentioned in pathoma) ++ fever, N/V, ^^WBC also seen (patient is SICK, not just in pain)

-risk gallbladder rupture

11

Chronic cholecystitis:
-classic histo findings
-classic xray finding + risk
-gross appearance
-cause

-herniation of mucosa into muscular wall (Rokitansky Aschoff sinuses)
-porcelain gallbladder --> risk carcinoma (take it out!!)
-shrunken/ fibrotic gallbladder
-chemical irritation 2ndary to long standing cholelithiasis

12

Ascending cholangitis:
-cause
-presentation
-risk

-bacterial (#1 gram neg) infection of bile ducts
-SEPSIS + abdominal pain +jaundice
-more common with choledocholithiasis

13

Cause of gallstone ileus

-fistula between gallbladder and small bowel --> stone gets stuck in intestine --> obstruction

14

Gallbladder carcinoma
-type
-major risk factor
-presenation

-adenocarcinoma
-stones major risk
-cholecystitis in ELDERLY (DOESNT FIT THE FAT, FERTILE, ***FORTY***, FEMALE) criteria

15

Jaundice
-bilirubin level when icterus (yellow eyes) begins
-most dangerous type?

-2.5 mg/dl
-kernicterus (DEPOSITS IN BABY'S BASAL GANGLIA.)

16

Describe steps of leading up to the synthesis of conjugated bilirubin in a healthy person (4)

1. reticuloendothelial macs break down RBCs
2. Heme --> protoporphyrin --> unconjugated bili
3. unconjugated bili to liver via albumin
4. unconjugated --> conjugated via **uridine glucuronyl transferase** (UGT)

17

How is conjugated bilirubin removed from the body?

Intestinal Flora:
conjugated bili --> stercobilin + urobilin
(sterco goes to stool, uro to urine)

18

What can overwhelm the bilirubin conjugating ability of the liver?
Two assc findings?

-hemolysis/ ineffective erythropoiesis
-jaundice
-dark urine
-pigminted gallstones

19

What causes physiologic jaundice of the newborn?
Treatment?

-ineffective UGT enzyme
-phototherapy makes UCB water soluble

20

Gilbert Syndrome & Crigler- Najjar:
-enzyme effected?
-difference in presenation?
-type of jaundice?

-both effect UGT; low in gilbert but ABSENT in CN
-Gilbert- benign; transient stress induced jaundice
-CN: kernicterus + fatal
-both cause ^^UNconjugated bili *UCB*

21

Dubin Johnson & Rotor Syndromes
-defect
-type of jaundice
-difference in clinical presentation?

-deficient bile canalicular transport protein (AR)
-causes ^^ CB
-DUBIN causes a DARK liver; Rotor does not.

(I think of Dubin Johnson as a black man....)

22

Obstructive Jaundice:
-type?
-two other lab findings?
-stool? urine?
-other symptoms?

-Conjugated
-^^ urine urobilinogen + alk phos
-pale stool, dark urine
-pruritis, xanthomas, fat malabsorption

23

Possible causes of obstructive jaundice:

-stones
-cancers (pancreatic v cholangiocarcinoma)
-parasites/ liver fluke

24

Viral hep:
-type of ^^ bili?
-why?
-urine findings?

-conjugated + unconjugated
-inflammation disrupts BOTH hepatocytes + bile ductules
-dark urine but low --> normal urobilinogen

25

Hepatitis:
-fecal/ oral variants
-ineffective type?
-types spread by blood/ sex?

-A/E = fecal oral (A trAvel, E sEEfood)
-D= "D"ependent in HBV, otherwise ineffective
-B/C= "B"LOOD AND "C"EX

26

Two Hep strains that can cause CHRONIC hep?

-B : 20% cases
-C: most all cases

27

Hep strain that can cause fulminant hep in pregnant women?

-Hep E

28

Ig that marks ACTIVE/NEW disease? Confers IMMUNITY?

-IgM= new/ active
-IgG= protective

29

Serologic markers for ACUTE HEP:

-HBsAG
-HBeAG
-HBV DNA
-HBcAB-IgM

30

Serologic markers during "window" period?

-^^^IgM against HBcAG only.

31

Serologic markers following immunization against hep?

-^^ IgG against HBsAG only.

32

Serologic markers for resolved hep?

-^^ IgG against both HBs and HBc ag's

33

Serologic markers for CHRONIC hep?
What strains cause this?

-HBsAG more than 6 months
-+/- HBeAG/ HB DNA
-IgG against HBcAG

-20% hep C, ~100% hep C

34

Viruses that can cause hepatitis (3)

-hepatits virus
-EBV
-CMV

35

Histo of acute v chronic hep?

-acute: inflammation of TRACTS + LOBULES and hepatocyte apoptosis
-chronic: inflammation of ONLY PORTAL TRACTS + possible cirrhosis progression.

36

Cirrhosis:
two histo features
cells that mediate?
cytokine that mediates?

-bands of fibrosis + regenerative nodules
-Ito/stellate cells, stimulated by TGF-B

37

Four general complications of cirrhosis

-ascites
-HSmegaly
-shunts (i.e. varices)
-hepatorenal syndrome (renal failure)

38

Liver damaged causes decreased detox (NO MORE OF THE EFFING CYPS. I THINK I WANT CIRRHOSIS).

What is the result?

-mental status change, asterixis --> ammonia induced coma
-spider angiomatoma, gynecomastia (^^androgen --> estogen), palmar erythema


**asterixis = flapping tremor

39

Two main results of decreased protein synthesis by the liver?

-hypoalbuminemia --> edema
-coagulopathy

40

#1 cause liver disease in western world?

-Alcohol (AFLD) --> acetaldehyde mediated damage


But.... NON alcoholic fatty liver (obesity related) is quickly on the rise!

41

How to diagnose NAFLD?

-ALT higher than AST; AST higher with alcohol use
-diagnosis of exclusion

42

Alcoholic fatty liver disease
-2 histo findings
-cure?

-mallory bodies
-fat in hepatocytes

-resolves with abstinence UNLESS cirrhosis is reached (occurs in 10-20%)

43

Primary Haemochromatosis
-inheritance pattern
-HLA linkage
-effect on liver?
-risk?
-treatment?


**Also: what causes "secondary" type?

-AR defect in iron absorption
(HFE gene mutation --> ^hepcidin --> ^ iron)
-^^ iron due to transfusions in secondary type

-H(A3)machromatosis= HLA-A3 linkage (MHC1)
-damage by free radicals
-HCC risk ^^
-treat with phlebotomy

44

Haemochromatosis:
classic symptomatic triad?
labs?
two histo findings?

-cirrhosis, DM, bronze skin
-high ferritin, serum iron and %saturation
-low TIBC
-brown pigment in hepatocytes, prussian blue stain +

45

Wilsons Disease
-Whats the mutation?
-Labs? (3)
-Triad of symptoms

-AR mutation in ATP mediated Cu transport --> copper incorporated in ceruloplasmin
-urinary copper, low ceruloplasmin, copper in liver
-kid with neuro maifestations, cirrhosis, & kayser fleisher rings

46

Wilsons Disease:
-assc risk?
-treatment?

-^^ HCC risk (just like haemachromatosis)
-treat with penicillamine chelation

47

Primary "biliary cirrhosis" and "sclerosing cholangitis":
in terms of location, whats the difference?
which causes ^^ risk of cholangiocarcinoma?

-biliary cirrhosis= intrhepatic ducts only
-sclerosing cholangitis= intra + EXTRAhepatic ducts ... so ^^ risk cholangiocarcinoma

48

Primary biliary cirrhosis:
-histo
-assc Ab
-population

-granulomatous inflammation
-antimitochondrial ab
~40 years of age, women

49

Primary sclerosing cholangitis:
-classic histo
-classic CT
-assc disease/ Ab

-periductal fibrosis + onion skinning
-beaded appearance on imaging
-p-ANCA, ulcerative colitis

50

Reyes:
cause + presentation

-kids: viral illness + aspirin
-liver failure, encephalopathy, hypoglycemia, can be FATAL

51

ONLY reason to kid aspirin to kids?

-Kawasaki Disease

52

Hepatic Adenoma:
association?
malignant?

-OCPs, regresses with cessation
-OMA= benign BUT risk rupture + bleeding esp with estrogen exposure

53

Hepatocellular Carcinoma:
three possible causes?
marker?
prognosis?

-cirrhosis, chronic hep B/C, aflatoxins (p53 mutations, think MOLDY PEANUTS!!)
-marker AFP
-poor prognosis

54

What is Budd-Chiari?

-hepatic vein obstruction --> liver infarct --> hsmegaly + ascites

(can be caused by tumor compression i.e. hepatocellular carcinoma)

55

From where are tumor mets most commonly

-Cancer Sometimes Penetrates Benign Liver
-Colon
-Stomach
-Pancreas
-Breast
-Lung

56

How do you diagnose mets?

-HSmegaly, NODULAR FREE EDGE OF LIVER.