Term
| what serology is used to detect hepA |
|
Definition
|
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Term
| polyarteritis nodosa, glomerular disease; dx? |
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Definition
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|
Term
| 15% resolves; 85% chronic (risks: older age, male, alcohol, HIV, fatty liver); dx? |
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Definition
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Term
| 15-40yo, pregnant women in 2nd to 3rd trimester; what is she at risk for and what serological tests do you run to confirm? |
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Definition
| hepE; look for RNA, HCV IgM and IgG |
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Term
| HBsAg, HBcIgM, HBeAg; what stage of hepB? |
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Definition
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Term
| porphyria cutanea tarda, cryoglobulinemia, glomerulonephritis, lichen planus, diabetes; dx? |
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Definition
|
|
Term
| which antibody is present during the window period (4-6mo) of hepB infection? |
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Definition
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|
Term
| HBsAb, HBcIgG, HBeAb; what stage of hepB? |
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Definition
|
|
Term
| HBsAg, HBcIgG, HBeAg/HBeAb; what stage of hepB? |
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Definition
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|
Term
| HBsAg, HBcIgG, HBeAb; what stage of hepB? |
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Definition
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Term
| serology for reactivation of hepB? |
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Definition
| HBsAg, HBcIgM/HBcIgG, HBeAb/HBeAg |
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Term
| what serology do you expect for a pt who is vaccinated for hepB? |
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Definition
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Term
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Definition
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Term
| HCV RNA can be detected within __. anti-HCV Ab can be detected within ___. |
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Definition
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|
Term
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Definition
| no antibodies (only cycling RNA) |
|
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Term
In what diseases do the following patterns of damage occur?
1. pan-acinar
2. periportal
3. pericentral |
|
Definition
1. pan-acinar: fulminant injury from chemicals, drugs, or virus
2. periportal: chronic injury from chronic viral hepatitis, autoimmune hepatitis, or primary billiary cirrhosis
3. pericentral: chemical toxicity, ischemia |
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Term
| liver biopsy shows ground glass eosinophilic cytoplasm, and stains positive for orcein and fuchsin; dx? |
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Definition
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Term
| pathogenesis of fulminant hepatitis |
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Definition
| liquefaction of hepatocytes, collapse of reticulin framework, little inflammation |
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Term
| pt presents with hepatitis, showing mild steatosis, inflammatory infiltrates in bile duct, and sinusoidal lymphocytosis; dx? |
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Definition
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Term
grading for hepatitis measures ___
staging for hepatitis measures ___ |
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Definition
grading: inflammation
staging: fibrosis |
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Term
| liver disease with systemic viral infection showing... 1. sinusoidal lymphocytosis; dx? 2. pan-acinar damage; dx? 3. bland necrosis; dx? |
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Definition
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Term
| deposition of ova within hepatocytes, granuloma formation, eosinophilic infiltration, fibrosis and destruction of portal vein branches leading to non-cirrhotic portal hypertension; dx? |
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Definition
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Term
| chronic hepatitis due to chinese liver flukes migrate up biliary tree and inhabit intrahepatic biliary ducts; dx? |
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Definition
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|
Term
| what characterizes regenerating nodules histologically? |
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Definition
|
|
Term
| diseases that show... 1. macronodular cirrhosis 2. micronodular cirrhosis |
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Definition
| 1. acute: viral hepatitis, drug reaction, chemical toxicity; 2. chronic: alcohol; (Wilson's and hemachromatosis can be macro or micro) |
|
|
Term
1. Councilman bodies are found in...
2. Mallory bodies are found in... |
|
Definition
1. any early hepatitis (viral, alcoholic, etc.)
2. alcoholic hepatitis |
|
|
Term
| what is the histological hallmark of chronic hepatitis? |
|
Definition
| piecemeal necrosis (i.e. interface hepatitis) |
|
|
Term
| What is the pathogenesis of 1. alcoholic hepatitis (2) 2. drug-induced hepatitis (3) |
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Definition
| 1. elevated NADH leads to more fat synthesis; acetaldehyde causes microtubular defects, depletes free radical scavengers, and increases lipid peroxidation 2. electrophilic radicals that inhibit cell function; free radicals cause lipid peroxidation; P450 forms TFA metabolite that reacts with hepatocellular proteins to make auto-neoantigens |
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Term
| young woman presents with hepatitis; she has HLA-DR3 and HLA-DR4; serology: ANA+, SMA+, anti-actin+; dx? |
|
Definition
| type I autoimmune hepatitis |
|
|
Term
| Mediterranean child presents with hepatitis; he has HLA-DRB1 and -DRQ1; serology: anti-LKM+; dx? |
|
Definition
| type II autoimmune hepatitis |
|
|
Term
| pt presents with left heart failure; what do you expect to see in a liver biopsy? |
|
Definition
| no congestion, zone 3 necrosis |
|
|
Term
| pt presents with right heart failure; what do you expect to see on a liver biopsy? gross? |
|
Definition
| zone 3 congestion, "nutmeg" liver |
|
|
Term
| chronic occlusion of a large hepatic vein leads to perivenular fibrosis and lysed RBCs; dx? |
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Definition
|
|
Term
| causes of vaso-occlusive disease (VOD) (5) |
|
Definition
| hepatoxic alkaloids, Jamaican bush tea, chemotherapy drugs, immunosuppressants, radiation patients |
|
|
Term
1. perivenular/sinusoidal fibrosis with neutrophilic infiltrates; dx?
2. piecemeal necrosis, lobular collapse with plasma cell infiltrates; dx?
3. piecemeal necrosis, lobular collapse with T cell infiltrates; dx? |
|
Definition
1. alcoholic hepatitis
2. autoimmune hepatitis
3. viral hepatitis |
|
|
Term
| what is the pathogenesis behind alcoholic steatosis? |
|
Definition
| acetaldehyde disrupts microtubule formation --> cannot secrete lipoprotein/fat |
|
|
Term
| what 3 systemic features characterize cirrhosis? |
|
Definition
| systemic vasodilation, hyperdynamic circulation, sodium avidity |
|
|
Term
| what are pre-hepatic causes of portal hypertension? |
|
Definition
| venous thrombosis, increased arterial blood flow |
|
|
Term
| what is a sinusoidal intra-hepatic cause of portal hypertension? |
|
Definition
|
|
Term
| what is a post-sinusoidal intra-hepatic cause of cirrhosis? |
|
Definition
|
|
Term
| NO is [increased/decreased] systemically and [increased/decreased] in the liver |
|
Definition
|
|
Term
| what complications of cirrhosis makes you a candidate for liver transplant? |
|
Definition
| HRS, bacterial peritonitis |
|
|
Term
| what are the criteria for hepatorenal syndrome (HRS)? |
|
Definition
| serum creatinine > 1.5mg/dl or creatinine clearance 40ml/min; oliguria; absence of: infection, shock, response to treatment, proteinuria |
|
|
Term
| how would an annular pancreas present? |
|
Definition
| adult, small bowel obstruction |
|
|
Term
| 40-70yo, M>F; elevated serum amylase, normal serum lipase, normal to low urine amylase; no clinical symptoms; incidental finding |
|
Definition
|
|
Term
| recurrent pulmonary infections, green lungs, pancreatitis, steatorrhea, malnutrition, infertility; elevated sweat Cl- (sensitive); histology: multicystic, dilated ducts, inflammation, atrophy, and fibrosis of acini, Islets are spared |
|
Definition
|
|
Term
|
Definition
| CFTR is mutated --> Cl- secretion is impaired --> dry mucus secretion that plugs up ducts --> cannot secrete pancreatic enzymes, sperm, lung lubricants, etc. |
|
|
Term
| elevated TIBC, elevated ferritin, elevated Fe content in liver biopsy; large, brown pancreas (early) to atrophic, fibrotic pancreas (late); bronze diabetes, hypogonadism, cardiomegaly, arthralgias |
|
Definition
| hemochromatosis (primary) |
|
|
Term
| caused by thalassemia, hemolytic anemia, multiple transfusions |
|
Definition
| hemochromatosis (secondary) |
|
|
Term
kwashiokor; how does it present histologically?
|
|
Definition
| malnutrition in tropical regions; atrophy and fibrosis of pancreas without inflammation |
|
|
Term
| 30-70yo; acute abdomen; can present as edematous (most common, generally benign) or hemorrhagic (high risk of necrosis); complications: hypocalcemia, sepsis-like syndrome, jaundice; elevated serum lipase, leukocytosis, hyperglycemia |
|
Definition
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|
Term
pathogenesis of acute pancreatitis
|
|
Definition
| most common causes are gallstones and alcohol; premature activation of trypsin and pancreatic enzymes leads to fat necrosis, FA+calcification= saponification, and pseudocyst formation |
|
|
Term
| genetics of idiopathic acute pancreatitis |
|
Definition
| PRSS1 mutation (autosomal dominant) causes trypsin to be resistant to inactivation; SPINK1 mutation creates a defective trypsin inhibitor |
|
|
Term
| 40yo, male; recurrent abdominal pain, maldigestion, diabetes; histology: fibrosis, necrosis, atrophy, loss of parenchyma (in tropical areas, calcification predominates); gross: enlarged pancreas then shrunken pancreas; low fecal elastase |
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Definition
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|
Term
| 50-70yo, female; large, painless, multiloculated cystic tumors in body or tail; dx? what types are there and which one is more malignant? |
|
Definition
| cystadenoma; mucinous and serous types; mucinous is more malignant, and serous is usually benign |
|
|
Term
| cystadenoma: mucinous vs. serous |
|
Definition
| mucinous is composed of columnar epithelium and malignant; serous is composed of cuboidal epithelium and benign |
|
|
Term
| 60-80yo, black male; hx: smokes, eats meat, diabetic; gnawing epigastric pain that radiates to the back, painless jaundice, Courvoisier's gallbladder, Trousseau's thrombophlebitis, anorexia, weight loss |
|
Definition
pancreatic carcinoma; most common are ductal adenocarcinomas; metastasizes to lungs and liver
|
|
|
Term
| most common, elevated insulin, usually an adenoma |
|
Definition
|
|
Term
| 50yo male; elevated HCl; hypercalcemic, esophagitis, diarrhea; which neoplasm do you suspect? |
|
Definition
|
|
Term
| 40-70yo female; elevated serum glucose, erythema, anemia, thrombosis, necrotizing migratory erythematous rash |
|
Definition
|
|
Term
| how would a somatostatinoma present? |
|
Definition
| delta cell tumor; rare; gallstones, steatorrhea, low HCl, mild diabetes |
|
|
Term
| explosive diarrhea; Verner-Morrison syndrome; high serum glucose, high Ca+; low K+, low HCl |
|
Definition
|
|
Term
| elevated 5HT and motilin; diarrhea; facial flush, hypotension, periorbital edema, lacrimation |
|
Definition
|
|
Term
| MEN1 mutation causes adenomas in what 3 organs? |
|
Definition
3P syndrome: pituitary, parathyroid, pancreas adenomas
|
|
|
Term
| how does acute cholestasis characterized vs. chronic cholestasis? |
|
Definition
acute: perivenular damage; bile accumulates in hepatocytes and Kupffer cells; bile thrombi; feathery degeneration
chronic: periportal damage; bile accumulates, extravasates; Cu accumulates; piecemeal necrosis, ductule proliferation, cholestasis rosettes; Mallory bodies
|
|
|
Term
| 40yo male; asymptomatic or abdominal pain, jaundice, fatigue, weight loss; post-chemotx; assc'd with UC; onion-ring fibrosis around bile ducts |
|
Definition
| primary sclerosing cholangitis (PSC) |
|
|
Term
| yellow to black composite gallstones, rarely pure |
|
Definition
|
|
Term
1. stone in CBD; constant pain with fever, chills
2. constant pain without fever or leukocytosis |
|
Definition
1. cholangitis
2. biliary colic |
|
|
Term
| gallbladder inflammation; asymptomatic but higher risk for complications: torsion, DM, vasculitis, trauma, burns |
|
Definition
| acute cholecystitis acalculus |
|
|
Term
| elderly men and DM pts; acute cholecystitis followed by ischemia of gallbladder wall and infection by gas-producing bacteria |
|
Definition
| emphysematous acute cholecystitis |
|
|
Term
| how can a gallstone present? |
|
Definition
| unremitting biliary pain that is worse within 1-2h of going to bed; little tenderness over the gallbladder; cholecystits/cholangitis/pancreatitis (depending on where the stone is lodged); empyema, hydrops, xanthogranulomas, porcelain gallbladder, limy bile |
|
|
Term
| occurs post-surgery due to biliary strictures |
|
Definition
| secondary biliary cirrhosis |
|
|
Term
| aggressive, late detection; 90% associated with gallstones; complication of chronic cholecystitis |
|
Definition
| gallbladder adenocarcinoma |
|
|
Term
| extrahepatic bile duct carcinoma located at the branchpoint between left and right hepatic ducts; indolent, sclerosis, can cause immediate obstruction; painless jaundice; risk factors: UC, PSC |
|
Definition
|
|
Term
| >5cm, hemorrhage/necrosis is common; no central scar |
|
Definition
|
|
Term
| <5cm, no hemorrhage; central stellate scar is common |
|
Definition
| focal nodular hyperplasia of liver |
|
|
Term
| eosinophilic inclusions, trabecular and acinar patterns; risk factors: hepB, hepC, cirrhosis, hemachromatosis, chemical carcinogens; can present as fibrolamellar variant (well circumscribed with central scar, young people, eosinophilic hepatocytes) |
|
Definition
|
|
Term
| young; Cu accumulation; liver and psychoneurological defects; Keyser-Fleischer ring; histology looks like viral hepatitis |
|
Definition
|
|
Term
| causes neonatal hepatitis, chronic hepatitis, cirrhosis, cholestasis, and eosinophilic inclusions |
|
Definition
| alpha 1-antitrypsin deficiency |
|
|
Term
| lots of mucin, shaped like biliary tree, feculent smelling, soft |
|
Definition
|
|
Term
|
Definition
|
|
Term
| 50-55yo woman presents with pruritus; histology shows "half moon" bile ducts; serology is positive for anti-mitochondrial antibody; dx? pathogenesis? |
|
Definition
primary biliary cirrhosis; autoimmune disorder with progressive destruction of interlobular and septal bile ducts with non-suppurative inflammatory reaction
|
|
|
Term
| progressive non-specific chronic inflammation of intra- and extra-hepatic ducts |
|
Definition
| primary sclerosing cholangitis (PSC) |
|
|
Term
| how does bile duct paucity present clinically? |
|
Definition
| "elfin" face, Alagille's syndrome; jaundice, xanthomas in skin, bile in teeth |
|
|
Term
| pathogenesis of cholesterol gallstone formation |
|
Definition
cholesterol supersaturates bile, becomes crystallized, combines with mucin to form a cholesterol gallstone; requires gallbladder hypomotility and reduced secretion of cholesterol
|
|
|
Term
|
Definition
| primary biliary cirrhosis |
|
|
Term
|
Definition
| primary sclerosing cholangitis (PSC) |
|
|
Term
| inflammation to due mechanical distension of walls, lysolecithin, and bacteria |
|
Definition
| acute cholecystitis calculus |
|
|
Term
| benign endpoint of ischemic obliteration; not a neoplasm |
|
Definition
| focal nodular hyperplasia of liver |
|
|
Term
| mutation in transport protein needed for Cu secretion (as ceruloplasmin) and Cu excretion (in bile); leads to Cu accumulation in liver, brain (basal ganglia), and eye |
|
Definition
|
|
Term
| codominant inheritance; impaired hepatic secretion of this protein leads to low serum levels |
|
Definition
| alpha 1-antitrypsin deficiency |
|
|
Term
| caused by chronic infection of biliary tree |
|
Definition
|
|
Term
| triad for Budd-Chiari syndrome |
|
Definition
| hepatomegaly, ascites, abdominal pain |
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