Term
| risk factors for acute pancreatitis? |
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Definition
Alcoholism & gallstones (obstruction)
Trauma
hypercalcemia
hyperlipidemia
scorpion stings
drugs (DDI, DDS, D4T, asparaginase, valproic acid)
mumps
perforated posterior duodenal ulcer |
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Term
| where do you see the cutaneous manifestation of hemorrhage in acute pancreatitis? |
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Definition
| periumbilical & flank hemorrhage (necrosis spreads into periumbilical soft tissue & retroperitoneum) |
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Term
| what enzyme will be persistently elevated if a pancreatic pseudocyst develops? |
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Definition
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Term
| what organism most commonly causes a pancreatic abscess? |
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Definition
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Term
| are amylase/lipase elevated in chronic pancreatitis? |
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Definition
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Term
| Serum marker for pancreatic adenocarcinoma |
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Definition
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Term
| top 2 risk factors for pancreatic ductal adenocarcinoma? |
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Definition
| smoking & chronic pancreatitis |
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Term
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Definition
| used for pancreatic cancer: removes head & neck of pancreas (most cancers from this region), proximal duodenum, & gallbladder |
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Term
| Jaundice w/ progression to cirrhosis in first 3 months of life |
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Definition
Biliary atresia
(failure to form or early destruction of extrahepatic biliary tree) |
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Term
3 things that can lead to gallstones:
1) Supersaturation w/ ____ (2 things)
2) Decreased ____ (2 things)
3) _____ |
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Definition
1) Cholesterol or billirubin
2) Phospholipids or bile acids
3) Stasis (e.g. rapid weight reduction, macrolides, etc) |
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Term
| OCPs, clofibrate, Native american ethnicity, Crohn disease, & cirrhosis are risk factors for what type of gallbladder pathology? |
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Definition
Cholesterol gallstones
Also, remember: Fat, Fertile, Female, Fourties
NOTE: clofibrate both increases HMG-CoA reductase & decreases 7-alpha hydroxylase); Crohn's b.c. decrease bile acid enterohepatic circulation (like cholestyramine) due to ileal dysfunction |
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Term
3 bugs that can cause pigment stones:
1 is a bacterial
1 is a nematode
1 is a trematode (fluke) |
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Definition
E.coli
Ascaris lumbricoides
Clonarchis sinensis (increased risk for cholangitis & cholangiocarcinoma)
NOTE: also chronic hemolytic anemia (e.g. malaria, G6PD). These stones are usually radiopaque (in contrast to cholestrol, which are usually lucent) |
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Term
| T/F: gallbladder cancer rate is increased in someone with gallstones? |
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Definition
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Term
| if you see "glands" in the gallbladder on histology, what does this indicate? |
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Definition
herniation of gallbladder mucosa into muscular wall (Rokitansy-Aschoff sinus), indicative of CHRONIC CHOLECYSTITIS
ASIDE: signs of chronic cholecystitis: vague upper right quadrant pain w/ eating; Calcification of wall ("Porcelain gallbladder") is a late complication;
PG is due from chronic inflammation, fibrosis, & dystrophic calcification --> indicates an increased risk for gallbladder carcinoma |
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Term
| What type of bacteria usually cause ascending cholangitis (complication of obstruction of bile ducts by stone, etc) |
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Definition
| enteric gram-negative bacteria |
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Term
| Cholecystitis in an elderly female who has chronic gallstones & annular rim of calcification in upper right quadrant on radiography |
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Definition
gallbladder adenocarcinoma
this type of cancer has a poor prognosis |
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Term
Give color of urine & stool w/ cause for each in each disorder:
1) Extravascular hemolysis/ineffective erythropoiesis
2) Physiologic jaundice of newborn
3) Gilbert syndrome (during stress)
4) Crigler-Najjar syndrome
5) Dubin-Johnsom syndrome
6) Rotor syndrome
7) Biliary tract obstruction (obstructive jaundice)
8) Viral hepatitis |
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Definition
1) dark urine & stools from increased urobilinogen)
2) normal; kernicterus is a concern
3) Normal, stools may be pale
4) pale stools from no urobilinogen
5) Dark urine from conjugated bilirubin (remember black-colored liver)
6) same as DJ, but liver isn't black
7) Dark urine from conjugated bilirubin, stools are pale (also: pruritis, hypercholesterolemia, xanthomas, steatorrhea)
8) Dark urine from conjugated bilirubin (urobilinogen is normal or decreased); there is an increase in serum UCB & CB |
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Term
| what causes jaundice? what is the concentration? |
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Definition
| bilirubin >2.5mg/dL (either conjugated or unconjugated) |
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Term
| marker for infectivity in chronic HepB? |
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Definition
Envelope antigen (i.e. HBeAg), or HBV DNA
NOTE: Serum has IgM HBcAb, but core antigen doesn't get into blood, only HBeAg
NOTE: HBsAg is a bad predictor for viral load b.c. it's produced in massive excess |
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Term
| Where is the inflammation in chronic hepatitis? |
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Definition
portal tracts.
In contrast, acute heptatitis inflammation is in lobules & portal tract & is accompanied by hepatocyte apoptosis (CD8+ mediated) |
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Term
| what cell secretes what cytokine mediating the fibrosis reaction in cirrhosis? |
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Definition
| TGF-beta secreated by stellate cells |
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Term
3 manifestations of hyperestrinism:
2 have to do with skin
1 has to do w/ hormones |
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Definition
palmar erythema & spider angioma
gynecomastia
ASIDE: hyperestronism occurs because of 1) decreased metabolism of estrogens; 2) decreased metabolism of androgens which get aromatized in the periphery (mostly DHEA); 3) increased production of steroid hormone binding globulin, which binds androgens more tightly than estrogens |
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Term
| what coagulation parameter is followed to monitor extent of cirrhosis? |
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Definition
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Term
what do you see Mallory bodies in?
what are they made out of? |
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Definition
Alcoholic cirrhosis
cytokeratin filaments |
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Term
| Why is AST>ALT in alcoholic cirrhosis? |
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Definition
| AST is in the mitochondria & EtOH is a mitochondrial poison |
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Term
| what EtOH metabolite mediates damage? |
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Definition
Acetaldehyde
highly reactive --> forms adducts w/ proteins & causes phospholipid oxidation & cause kuppfer cells to activate stellate cells to secrete TGF-beta and fibrose |
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Term
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Definition
part of the receptor complex that detects serum transferrin bound to Fe
High serum Fe --> HFE activated --> signals downstream to increase Hepcidin release & mediates intestinal crypt cell function (to decrease Fe absorption) |
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Term
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Definition
- Cirrhosis
- Diabetes mellitus (from Fe-mediated destruction of pancreas)
- Bronze skin
(i.e. "bronze diabetes") |
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Term
| Defective gene in Wilson's disease? |
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Definition
ATP7B (ATP-dependent Cu transporter)
needed for Cu transport into bile, Cu incorporation into cerruloplasmin, & for Cu excretion into blood |
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Term
| child w/ behavioral changes, demetia, chorea, & parkinsonian symptoms? |
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Definition
Wilson's disease (deposition of Cu in Basal ganglia cause the parkinsonian Sx)
look for Kayser fleisure rigns, increased urinary Cu, decreased serum cerruloplasmin |
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Term
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Definition
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Term
Antibody for:
1) Primary Biliary Cirrhosis
2) Primary Sclerosing Cholangiitis
3) Autoimmune hepatitis |
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Definition
1) Anti-mitochondrial
2) pANCA
3) Anti-Smooth Muscle (type1); Anti-Liver/Kidney microsome (type2) |
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Term
1) Intrahepatic cholestasis resulting in obstructive jaundice; antimitochondrial antibody
2) Intrahepatic & Extrahepatic bile duct "onion-skin" fibrosis; pANCA; UC association |
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Definition
1) Primary biliary sclerosis (increased risk for cirrhosis)
2) Primary sclerosing cholangitis (increased risk for cholangiocarcinoma) |
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Term
| what disease, that presents with virus-like symptoms in a kid, would you treat with aspirin? |
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Definition
Kawasaki disease
Normally, aspirin is completely contraindicated in kids because if it's given during a viral infections, it causes Reye's disease --> unknown mechanism causes mitochondrial damage in hepatocytes leading to hypoglycemia, elevated liver enzymes to possible coma & death |
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Term
| How do aflatoxins cause hepatocellular carcinoma? |
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Definition
induces mutations in p53
remember they are produced by Aspergillus, which grow on fermenting, stored grains |
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Term
| hepatomegaly with a nodular free edge |
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Definition
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Term
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Definition
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