Liver And Pancreas Flashcards by emily todd

Define: icterus

Jaundice

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What is jaundice?

Yellowing of the skin caused by increased levels of bilirubin (usually related to increased lysis of RBCs)

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How much bilirubin before jaundice appears?

Usually bilirubin levels must reach close to double normal concentration before yellowing is evident.

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How is bilirubin transported? Why?

Unconjugated bilirubin is water insoluble and must be transported with an albumin chaperone

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What happens to conjugated bilirubin?

It is water-soluble and should be included in the bile. When elevated, may appear in urine.

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What is the difference between indirect and direct bilirubin? Relationship to urine?

Indirect = unconjugated / insoluble / prehepatic. Cannot appear in urine.

Direct = conjugated / soluble / posthepatic. Can appear in urine when elevated?

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What is hemolytic anemia and what is it’s relationship to jaundice?

Accelerated degradation of RBCs leading to excessive release of bilirubin

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Define: cholestasis

Obstructive jaundice caused by biliary obstruction —> bile spills over into the tissues when the bile cannot move into the intestines normally due to obstruction

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Define: hepato-cellular jaundice

Jaundice associated with liver damage

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Which of these result in bilirubin in the urine?

cholestasis
hepatocellular jaundice
hemolytic anemia
choluric jaundice
acholuric jaundice

Why??

Choluric jaundice = elevated conjugated or direct BR

Cholestasis is the only one that results in urinary bilirubin —> the problem is bile duct obstruction, which is post-conjugation

Acholuric jaundice = elevated unconjugated or indirect BR

Hemolytic anemia and liver failure both result in free unconjugated bilirubin —> not water soluble and therefore not in the urine.

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Review: which are the fat-soluble vitamins?

A
D
E
K

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What are the ingredients of bile?

Water 
Cholesterol 
Bile acids 
Bile salts 
Lecithin 
Bile pigments
Inorganic ions

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What is the van den Bergh reaction? What does it test for?

Tests for the presence of bilirubin in the blood. Distinguishes between direct and indirect.

[Mix serum and sulfanilic acid —> if turns red —> conjugated bilirubin is present

Serum, sulfanilic acid and alcohol —> if turns red —> unconjugated bilirubin is present]

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Define: kernicterus

Brain damage in an infant due to jaundice

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Define: cirrhosis

Diffuse scarring / fibrosis of the liver. Irreversible disruption of function with nodular hyperplasia (from past repair attempts)

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Review: define ascites

Abdominal fluid due to accumulation of fluid (most often related to portal HTN)

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Manifestations of cirrhosis

Portal HTN leading to:

circulatory obstruction
ascites
esophageal varicosities
splenomegaly

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Review: most common varicosities?

esophageal
pampiniform plexus
saphenous veins (lower leg)
hemorrhoids

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What are the 3 stages of cirrhosis?

Fatty liver
Alcoholic hepatitis
Cirrhosis (fibrosis)

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What are the characteristics of fatty liver?

asymptomatic
universal in heavy drinkers
reversible with lifestyle changes
normal function
enlarged with greasy appearance

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What are the characteristics of alcoholic hepatitis?

Inflammation and necrosis of hepatocytes

- inclusion of Mallory bodies (hyaline deposits)

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What are the symptoms of alcoholic hepatitis?

Possible sx include: 
Vomiting 
Anorexia 
Hepatomegaly 
Pain 
Jaundice

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What are the characteristics of cirrhosis?

Necrosis of hepatocytes
Collagenous scarring
slow progression
irreversible

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Threshold for risks associated with drinking?

36% of caloric intake

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What is accumulating in pigment cirrhosis?

Iron

What is hemosiderin?

Complex of protein and ferric ions that is deposited in macrophages (liver, spleen, marrow) and hepatocytes —> formed when iron is in excess

What is bronze diabetes?

Hemochromatosis

What is the diagnostic triad for hemochromatosis?

- bronzed skin (jaundice) - cirrhosis - pancreatic fibrosis (eventually leads to Type II DM)

Hepatolenticular degeneration is the medical name for what condition?

Wilson’s disease

What is Wilson’s disease and what are the dominant features?

Dysfunction in copper regulation, resulting in copper accumulation in liver, kidneys, brain, eyes. Causes: - cirrhosis - lentiform nucleus degeneration (Parkinson like sx) - Kayser Flesher ring

Define: cholelithiasis

Gallstones

What are gall stones made of?

Mostly cholesterol

Can gall stones be seen on imaging?

Sometimes. Rarely calcify, so not likely to show up on plain films

Who is at highest risk for gallstones?

The 4 F’s: - female - fat - fertile - 40+ (age)

What are “pure” gall stones?

Stones in the gall bladder made of all cholesterol. Large, oval, and only a few. May be pigmented with bilirubinate, giving them a blackberry appearance.

What are “mixed” or “combined” gall stones made of?

A combination of cholesterol and bilirubin. Tend to be many, faceted and variable in size.

Are pure or mixed gall stones more common?

Mixed - 80% to 90% (only about 10% are pure cholesterol)

What are the symptoms of gall stones?

Tend to be asymptomatic - 80% are silent unless they cause: - biliary obstruction - biliary colic

What is biliary colic?

Painful spasms associated with the passage of gall stones into the biliary tract

Define: cholecystitis

Inflammation of the gallbladder, acute or chronic

What are the 3 main causes of cholecystitis?

1. Hyperconcentrated bile 2. Bacterial infection, which usually follows concentration of bile (which causes mucosal injury, allowing bacteria to enter) 3. Pancreatic reflux (mixing of pancreatic digestive enzymes into bile may cause mucosal damage)

What are the features of acute cholecystitis?

- right upper quadrant pain (DDX with appendicitis) - bacteria present (80%) - enlarged gallbladder - edematous & hyperemic (red) - mucosal ulceration - biliary colic

What is the danger of severe acute cholecystitis?

Necrosis and gangrene of the gallbladder leading to peritonitis

What are the features of chronic cholecystitis?

- fibrotic - either reduced in size or distended - calcification may be present

What is “porcelain gallbladder”?

Calcification of the gallbladder

What are the most common tumors of the liver?

Metastasis of GI tumors via portal drainage

What infections affect the pancreas most?

- mumps | - hepatitis

What is the primary cause of acute pancreatitis?

Activation of pancreatic enzymes leading to “auto-digestion” via inappropriate trypsin activity

What is the dominant symptom of acute pancreatitis?

Severe pain with sudden onset, may refer to upper back. Usually follows meal or alcohol ingestion.

What are the causes of acute pancreatitis?

- chronic biliary disease - chronic alcohol abuse - obstruction (biliary stones) - disturbed sphincter of Oddi allowing mixing of duodenal and pancreatic contents

What is chronic or relapsing pancreatitis?

Multiple episodes of pancreatic attacks, more mild than the acute form. Lead to: - fibrosis - atrophy - pancreatic failure

Which is more common: acute or chronic pancreatitis?

Chronic

Chronic pancreatitis may be associated with what conditions?

- chronic liver disease | - alcoholism

Chronic pancreatitis may lead to what condition?

Type II DM - due to destruction of beta cells

What are the risk factors for pancreatic carcinoma?

- smoking - high fat diet - chemicals - diabetes

What are the symptoms of pancreatic carcinoma?

None. Usually silent, and metastasizes early. If adjacent nerves are affected, pain may be present

Review: what is Trousseau’s sign?

Spontaneous, migratory thrombosis

What are the most common pancreatic tumors? What do they cause?

Benign beta cell tumors Cause hypoglycemia

What is the Zollinger Ellison syndrome? (Triad)

- gastrin producing tumor of islet cells - gastric hyperacidity - intractable peptic ulcers *multiple ulcers is most important sign

What is the 7th most common cause of death in the US?

Diabetes mellitus

What are common sites of organ damage due to diabetes?

Heart - cardiovascular disease - atherosclerosis Kidney - glomerular sclerosis - renal atherosclerosis Eyes - retinopathy - cataracts - glaucoma Peripheral nerves

What is the distribution pattern for DM-induced peripheral neuropathy?

Glove and stocking

Define: pyelonephritis

Urinary tract infection

Liver And Pancreas Flashcards

(63 cards)