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Gastrointestinal - step > Pathology - biliary tree > Flashcards

Pathology - biliary tree Flashcards

1
Q 
pruritus
jaundice
dark urine
light coloured stools
hepatosplenomegaly
A

biliary tract disease

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2
Q

presentation of biliary tract disease lab style please

A

cholestatic pattern of LFTs:

  • increased conjugated bilirubin
  • increased cholesterol
  • increased ALP
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3
Q

what is the pathos of secondary biliary cirrhosis

A

extrahepatic biliary obstruction – increases pressure in intrahepatic ducts – injury fibrosis and bile stasis

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4
Q

who gest secondary biliary cirrhosis

A

patietsn with known OBSTRUCTIVE lesiosn ie gallstones, biliary strictures, pancreatic carcinoma

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5
Q

what are the complications of secondary biliary cirrhosis

A

asecndong cholangitis

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6
Q

how to differentiatl secondary from primary biliarly cirrhosis vai blood work

A

no increased IgM in secondary; yes in primary

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7
Q

what is the pathology of primary biliary cirrhosis

A

an autoimmune reaction – lymphocytic infiltrate and granulomas – desctruction of intralobular bile ducts

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8
Q

typical patient with primary biliary cirrhosis

A

women in 40-50s with another autoimmuencondigion CREST, sjuogren, RA, celiacl dsiease

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9
Q

typical co presentined pathos with primary biliary cirrhosis

A

rheumatoid arthritis
sjogren
CREST
celiac disease

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10
Q

anti mitochondrial abs and increased IgM

A

primary biliary cirrhosis

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11
Q

what can be increased risk by primary biliary cirrhosis

A

HCC

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12
Q

labs of primary biliarly sclerosis please

A 
increased cholesterol
increased conjugated bilirubin
increased ALP
increased GGT
increased igM
positive anti-mitochondrial antibodies
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13
Q

describe the pathos of primary sclerosign cholangitis

A

unkno cause of concentric onion skin bild duct fibrosis - alternating strictures and dilation fo BEADING of intra and extrahepatic bild ducts on ERCP, or magnetic resonance cholangiopancreatography

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14
Q

typical patient with primary sclerosing cholangitis

A

young man with UC

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15
Q

pbilterative fibrosis of intrahepatic and extrahepatic bile ducts

A

primary sclerosing cholangitis

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16
Q

cirroses due to granulomatous desctruction of bile ducts and portal triad

A

primary biliary cirrhosis

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17
Q

labs in primary sclerosing cholangitis

A 
increased cholesterol
increased conjugated bilirubin
increased ALP
increased GGT
increased IgM
MPO-ANCA/p-ANCA positive
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18
Q

what is associated with MPO-ANCA/p-ANCA positiviti

A

primary sclerosing cholangitis/UC
microscopic angitis
chrug strauss (granulomatous polyangiits with eosinophilia or something like that. good try brain)

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19
Q

what are consequences of primary sclerosing cholangitis

A

secondary biliary cirrhosis (ascending cholangitis)

cholangiocarcinoma

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20
Q

biliary tract disease with increased risk of a) cholangiocarcinoma and b) hepatocellular carcinoma

A

cholangiocarcinoma - primary sclerosing cholangitis

hepatocellular carcinoma - primary biliary cirrhosis

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21
Q

what causes cholangiocarcinoma

A

primary sclerosing cholangitis
clonorchis sinuses
thorium dioxide
choledochal cyst

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22
Q

obstructive jaundice
palpable gallbladder Courvorsier sign
hepatmegaly

A

cholangiocarcinoma

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23
Q

what can cause gallbladder stones?

A

increased cholesterol
increased bilirubin
decreased bile salts
gall bladder stasis

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24
Q

which type of stones are radiolucent?

A

cholesterol if no calcium

brown pigmented

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25
which type of stones are radiopaque
cholesterol if calcium | black pigmented
26
causes of cholesterol stones please
``` chron disease fat female fertile - pregos native American old clofibrate estropgen therapy multiparity rapid weight loss ```
27
RF and name the stone: fat
cholesterol
28
RF and name the stone: multiparity
cholesterol
29
RF and name the stone: native american
cholesterol
30
RF and name the stone: rapid weight loss
cholesterol
31
RF and name the stone: estrogen therapy
cholesterol
32
RF and name the stone: clofibrate use
cholesterol
33
RF and name the stone: chron disease
cholesterol
34
RF and name the stone: SCD
black pigment
35
RF and name the stone: asian
brown pigment
36
RF and name the stone: hereditary spherocytosis
black pigment
37
RF and name the stone: alcoholic cirrhosis
black/brown pigment
38
RF and name the stone: total parenteral nutrition
black/brown pigment
39
charcots triad
jaundice fever RUQ
40
jaundice fever RUQ
cholelithiasis
41
what complicatiosn come from cholelithiasis
cholecystits cholangitis acute pancreatitis bile stasis
42
what is biliary colic
cholelithiasis can cause biolary colic = neurohormonal activation of gall bladder contractions via CCK after a fatty meal ( stimulated by protein and fatty acids) forcitn a stone into the cystic dcut can be painless in diabetics ** watch out
43
what is gallstone ileus
fistula between gallbladder and small intestine - air in biliary tree and passage of gallstone into the intestinal tract - usually at ileocecal valve
44
diseases associated with air where they aren't suppseo to be
duodenal PUD anterior perforation - under diaphragm diverticulitis - pneumaturia necrotizing enterocolitis - air in portal vein, pneumatosis intestinalis, free air in abdomen gallstone ileus - in biliary tree
45
how to dx gallstones
u/c (cholesterol and black pigmented are ragiopague and some cholesterol and brom are radiolucent)
46
what is cholecystits
acute or chornic inflammation of the gallbaldder
47
what causes cholecystits
gallstones blockgin the cystic duct
48
pathogenesis of cholecystitis
stone into cystic duct -- biliary colic - impacts in cystic uct with bacterial proliferation - bacteria invade wall - perforation
49
diffuse mid epigastric colicky pain - RUQ constant pain dull achey - positive murphys sign
cholecystits
50
who is most likely to get cholecystitis
females in 5th to 6th decade in North America
51
``` fever stage dependent pain localization PMn above 12 000 bilirubin above 4 palpable GB jaundice vomiting increased/not increased amylase ```
obstruction at cbd cholecystis with out without acute pancreatitis
52
what tis a porcelain gallbladder
dystrophic calcification fo the gall bladder | must be removed -- gallbladder carcinoma -- very poor prognosis <2 % 5 year survival
53
what causes porcelain gallbladder
chronic cholecystitis
54
who presents with porcelain gallbladder
elderly women
55
what is acute pancreatitsi
autodigestion of the panrease by pancreatic enzymes
56
GET SMASHED
``` gallstones ethanol trauma scorpion bite mumps autoimmune disease steroids hypercalcemia, hyperTAGemia ercp drugs: sulfa drugs, NRTIs, protease inhibitors ```
57
``` epigastric abdominal pain radiating to back anorexia nausea increased amylase increased lipase hypocalcemia ```
acute pancreatitsi
58
what causes acute pancreatitis
hypertriglyceridemia, hypercalcemia, scorpions, sulfa drugs, NRTIs, protease inhibitos, gallsontes, alcohol, truma, steroids, mumps, autoimmune diseases, ercp
59
drugs that can cause acute pancreatitis
NRTIs, protease inhibitors sulfas
60
what are complications of acute pancreatitis
``` pseudocyst DIC ARDS difuse fat necrosis - hypocalcemia (collects in pancreatic soap deposits) hemorrhage infection multi organ system failure ```
61
what causes ARDS in acute pancreatitis
phospholipases degrade surfactant
62
what casues hypovolemia in acute pancreatitis
pancreatic fluid build up - increased third space fluid
63
what causes hypoxemia in acute pancreatitis
phospholipase degrade surfactant - ARDS
64
what is ARDS?
acute onset of respiratory failure with bilateral lung opacities with no heart failure. can be cacused by trauma, sepsis shock, gastric aspiration uremia, acute pancreatitis, AF embolism diffuse alveolar damage - increased alveolar capillary permeability and protein rish leakage into alveoli and noncardiogenic pulmonary edema with normal PCWP. intraalveolar hyaline membranes - initial damge due to relase from PMNs that are toxic to alveolar wall - activates coagulation cascades and ROS
65
what can cause ARDS
``` trauma sepsis shock gastric aspiration uremia acute pancreatitis AF embolism ```
66
what is a pseudocyst
abdominal mass of pancreatic enzymes that is surrounded by granulation tissue not epithelium.
67
what is most common cause of acute pancreatits in children
seatbelt trauma
68
what viruses can cause acute pancreatitsi due to damge to alveolar celsl
CMV mumps coxsackie viruses
69
what causes hemorrhage in acute pancreatitsi
elastases going to town on bvs
70
what is chronic pancreatits
chornic inflammation, atrophy and calcification fo the pancreas
71
what are the major causes of chronic pancreatitis?
OH idiopathy CF
72
what is major cause of chronic pancreatitis in developing countries
malnutrition
73
steathorrhoea vitamin ADEK, folate B12 deficiencies diabetes mellitus
chornic pancreatitis
74
dxtic tools for chronic pancreatitis please
amylase and lipase may or may not be elevated asses with secretin stimulation test and bentromidefert test - ability of pancreatic chymotrypsin fto cleave orally administered wahterver to PAH and then assesses levels in urine.
75
what is the prognosis of pancreatic adenocarcinoma
average survival is one year after diagnosis
76
histoathos of pancreatic adenocarcinoma
of the exocrine pancrease | very aggressive tumoru arising from pancreatic ducts - disorganized glandular structure with cellular infiltration
77
what is common when pancreatic adenocarcinoma presents
mets already :(
78
tumour marker of pancreatic adenocarcinoma please
CA 19-9 and sometimes CEA, can also look at genes KRAS, p16 and p53
79
what genes are associated with pancreatic adenocarcinoma
KRAS p16 p53
80
risk factors for pancreatic adenocarcinoma please
``` MOST COMMON - SMOKING chronic pancreatits for more than 30 years diabetes > 50 years old jweish and African america ```
81
nationality most likely to get pancreatic adenocarcinoma
jewish | African americans
82
``` abdominal pain radiating to back weight loss light stools jaundice palpable gallbladder redness and tenderness on palpation of extremities ```
pancreatic adenocarcinoma weight loss - malabsoprtion and anorexia obstructive jaundice - at head = light stools, jaundice and palpable gallbladder redness and tenderness on palpation of extremities - migratory thrombophlebitis
83
what is trousseaus syndrome
migratory thrombophlebitis - redness and tenderness on
84
migratory thrombophlebitis - redness and tenderness on palpation of extremities
pancreatic adenocarcinoma
85
acanthosis nigricans
gastric adeocarcinoma
86
dermatitis herpetiformis
celiac
87
seborrhoeic keratosis
gastric adenocarcinoma
88
list the associated pathology: a) acanthosis nigricans b) dermatitis herpetiformis c) seborrhoeic keratosis d) migratory thrombophlebitis
a) acnathosis nigricans - gastric adenocarcinoma b) dermatitis nigricans - celiac disease c) seborrhoeic keratosis - gastric adenocarcinoma d) migratory thrombophlebitis - pancreatic adenocarcinoma
89
how to treat pancreatic carcinoma
whipple - take out head and neck leave tail chemo radiation
90
``` epigastric pain weight loss jaundice light coloured stools palpable gallbladder red and tenderness on palpation fo extremities vichows node sister mary joseph ```
pancreatic adenocarcinoma remember virchows: gastric adenocarcinoma, squamous (weird.... maybe my brain si wrong and is adeon that does this) esophageal, cervical, pancreatic do this but GASTRIC is MOST COMMON

Gastrointestinal - step (10 decks)

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