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P&T Block 3 Pulm & GI > L74 > Flashcards

Flashcards in L74 Deck (32):
1

What is biliary atresia?
- Pt pop
- Dx

Narrowing of biliary tract
NEWBORNS: most common cause of liver disease in infants
Treat
1. Kasai procedure
- Act quickly b/c cirrhosis faster in infants
2. Transplant

2

Biliary atresia histo

See proliferation of ducts around the native duct -> liver trying to find a way out for excess bile

3

What is a choledochal cyst?
Treat

Cystic dilation of bile duct
Present early in life - obstructive jaundice
Treat = resection

4

2 complications of bile stones?

Choledocholithiasis = stones in common bile duct
Cholangitis = bacterial infection of bile ducts
- Can ascend from pt of obstruction

5

Cholangitis histo

Seen in liver biopsy (don't biopsy the bile duct itself)
- Obstruction
- Pus = PMNs in lumen
- Liver parenchyma might be inflammed

6

Symptoms of cholangitis

Jaundice due to obstruction
Maybe ↑AST/ALT

7

Acute cholecystitis usually due to stones. What is the other rare cause?

Acalculous cholecystitis
Aka hosp pts who have systemic issues
Tree doesn't move bile correctly
Stagnant bile in GB = inflammation

8

How does the GB change with chronic cholecystitis?

Thick
Fibrotic
Healing response due to repeated injury

9

Main GB cancer

GB adenocarcinoma
- Gland formation
Thickened GB wall around mass
May migrate w/ nerves

10

GB carcinoma
- Pt pop
- Prognosis
- Symptoms

Old women
Bad prognosis b/c detected late
Asymptomatic or pain (behaves like cholecystitis)

11

Carcinoma of extrahepatic bile ducts
- 3 risk factors
- Looks like

1. PSC - primary sclerosing cholangitis
2. Choledochal cyst
3. Inflammatory states - parasites

12

What is pancreas divisum

Ducts don't form to primarily drain out the papilla of Vater
Instead, most drains via minor papilla
↑risk chronic pancreatitis

13

What is pancreatic heteropia?

Normal pancreatic tissue elsewhere in GI
Clinically irrelevant to pts life
Slight ↑risk -> tumor

14

What is annular pancreas?

Pancreas forms as a ring around duodenum
↑risk pancreatitis

15

3 main outcomes of acute pancreatitis

Inflam
Fat necrosis (as inflam damages acinar cells so they release enzymatic contents)
Hemorrhage

16

Are exocrine or endocrine pancreatic fxns lost first in chronic pancreatitis?

Exocrine goes 1st

17

Histo of chronic pancreatitis

Fibrosis
Maybe loss of acini
Duct dilation
Pseudocysts

18

What are serous pancreatic cysts?

Benign - sponge like and can get big but won't kill

19

What type of cells line serous cysts?

Cleared out cells (glycogen)

20

What pancreatic cyst has malignant potential? Name 2 subtypes.

Mucinous cysts
1. Mucinous cystic neoplasms
2. Intraductal papillary mucinous neoplasms
**On a spectrum:
Benign --> borderline --> malignant parts within 1 tumor

21

Pt pop + describe mucinous cystic neoplasms

Young women
Ovarian type cyst @ body or tail of pancreas
Mucinous lining epithelium

22

Describe intraductal papillary mucinous neoplasms

Pancreatic HEAD
Interfere w/ main duct
Look like have papillae
See mucin oozing out ampulla from camera in duodenum

23

Solid pseudo-papillary tumor
Pt pop
Solid or cystic?
Mutation
Malignant or benign

MALIGNANT but more likely to die from treatment complications
Mutation to beta-catenin / APC pathway
Solid AND cystic regions
Strongly young female

24

What type of cancer is traditional pancreatic cancer?

Ductal adenocarcinoma

25

Describe development of pancreatic cancer

Cyst that might progress to cancer
Benign -> low grade -> high grade -> invasion
More likely to be ductal

26

Ductal adenocarcinoma
Pt pop
Presentation
Location in pancreas
Prognosis

Older pts - associated w/ SMOKING
Most = head = jaundice
- If body/tail -> pain due to neural invasion
High MORTALITY b/c present at high stage

27

Ductal adenocarcinoma histo

Looks like cholangiocarcinoma - won't need to tell difference

28

Treat pancreatic adenocarcinoma

Surg
- Head - take out some SI (Whipple)
- Body/take - take out spleen
+ Adj chemo/radiation

29

3 types of pancreatic endocrine neoplasms (fxnal classification)

Insulinomas (benign) will present as hypoglycemia
Gastinomas (malignant)
Glucagonomas (malignant)

30

Stain for pancreatic endocrine neoplasms

Chromogranin // synapthophysin

31

What do you need to know about acinar cell carcinoma?

It's rare

32

What is pancreatoblastoma

Kids pancreatic tumor
Look for undifferentiated cells w/ squamoid nests