Exocrine Pancreas, Gall Bladder And Liver Pathology

Front 1

developmental malformation in which pancreas forms a ring around the duodenum .

there is a risk for duodenal obstruction

Back 1

annular pancreas

Front 2

inflammation and hameorrhage of pancreas

Back 2

acute pancreatitis

Front 3

acute pancreatitis is due to ?

there is premature activation of ___ leading to activation of other pancreatic enzymes

Back 3

due to autodigestion of pancreatic parenchyma by pancreatic enzymes

trypsin

Front 4

acute pancreatitis results in which type of necrosis?

Back 4

liquefactive

fat necrosis

Front 5

cause of acute pancreatitis?

Back 5

alcohol

gall stones

trauma

hypercalcemia

hyperlipidemia

drugs

scorpion stings

mumps

rupture of posterior duodenal ulcer

Front 6

clinical features of acute pancreatitis?

Back 6

epigastric abd pain radiating to back

nausea

vomiting

periumbilical and flank hemorrhage

elevated serum lipase and amylase

hypolcalcemia

Front 7

out of lipase and amylase, which is more specific for pancreatic damage?

Back 7

lipase

Front 8

complication of acute pancreatitis?

Back 8

shock

pancreatic pseudocyst

pancreatic abscess

DIC

ARDS

Front 9

why does shock occur in acute pan?

Back 9

due to peripancreatic hemorrhage and fluid sequestration

Front 10

pancreatic pseudocyst is formed by ?

presents as?

rupture of it is associated with ?

Back 10

fibrous tisue surrounding liquefactive necrosis and pancreatic enzymes

abd mass with elecated serum amylase

release of enzymes into abd cavity and hemorrhage

Front 11

pancreatic abscess in acute pan is due to ?

and presents with ?

Back 11

E coli

abd pain, high fever, elevated amylase

Front 12

fibrosis of pancreatic parenchyma often secondary to recurrent acute pancreatitis is called?

Back 12

chronic pancreatitis

Front 13

cause of chronic panc?

Back 13

alochol

cystic fibrosis (kids)

Front 14

clinical features of chronic pan?

Back 14

epigastric abd pain radiating to the back

pancreatic insuffienecy

dystrophic calcification of pancretic parenchyma on imaging

secondary diabetes mellitus

increased risk for pancreatic carcinoma

Front 15

pancreatic insuf in chronic pan results in ?

Back 15

malabsorption with steatorrhea and fat soluble vitamin deficiency

Front 16

are amyalse and lipase useful serologic markers in chronic pan

Back 16

no

Front 17

what do contrast studies reveal in chronic pan?

why?

Back 17

chain of lakes pattern

due to dilatation of pancreatic ducts

Front 18

adenocarcinoma that arises from pancreatic ducts is called?

seen in which age?

Back 18

pancreatic carcinoma

elderly (70years)

Front 19

major risk factors of pancreatic carcinoma?

Back 19

smoking

chronic pancreatitis

Front 20

clinical features of pancreatic carcinoma?

Back 20

epigastric abd pain

weight loss

obstructive jaundice

pale stools

palpable gallbladder

secondary diabetes mellitus

pancreatitis

migratory thrombophlebitis

Front 21

serum tumor marker in pancreatic carcinoma is ?

Back 21

CA 19-9

Front 22

migrartory thrombophlebitis aka?

presents as?

Back 22

trousseau sign

swelling, erythema, tenderness in extremities

Front 23

failure to form or early destruction of extrahepatic biliary tree

Back 23

biliary atresia

Front 24

biliary atresia leads to ____ within first 2 months of life

Back 24

biliary obstruction

Front 25

biliary atresia presents with ?

progresses to ?

Back 25

jaundice

cirrhosis

Front 26

solid round stones in gall bladder?

Back 26

gall stones

Front 27

gall stones aka ?

Back 27

cholelithiasis

Front 28

gall stone are due to precipitation of __ and ___

Back 28

cholestrol

or bilirubin

Front 29

why do gallstones arise?

Back 29

due to supersatutarion of cholestrol or bilirubin

decreased phospholipids or bile acids or stasis

Front 30

most common type of stones? in which part of the world?

Back 30

cholestrol

west

Front 31

are cholestrol stone radiolucent or radioopaque?

Back 31

radiolucent

Front 32

risk factors of cholestrol stones?

Back 32

age 40s

estrogen(female,obesity,multiple pregnancies, oral contraceptives)

clofibrate

native american ethnicity

crohn dsz

cirrhosis

Front 33

are bilirubin stones radiolucent or radioopaque?

Back 33

radioopqaue

Front 34

rask factors of bilirubin stones?

Back 34

extravascular hemolysis

biliary tract infection

Front 35

biliary tract infection can be caused by ?

Back 35

e coli

ascaris lumbricoides

clonorchis sinensis

Front 36

clonorchis sinensis increases the risk of ?

Back 36

cholangitis

gallstones

cholangicarcinoma

Front 37

gallstone are ___ and complications include?

Back 37

asymptmatic

biliary colic

acute and chronic cholecystitis

ascending cholangitis

gallstone ileus

gallbladder cancer

Front 38

waxing and waning right upper quadrant pain is called?

Back 38

biliary colic

Front 39

billiary colic occurs due to ?

Back 39

gallbladder contracting against a stone lodged in cystic duct

Front 40

symtoms are relieved by what in bilary colic?

and common bile duct obstruction results in ___ or ____

Back 40

if the stone passes

acute pan or obstructive jaundice

Front 41

acute inf of gall bladder wall

Back 41

acute cholecystitis

Front 42

in acute chole, imapcted stone in the cystic duct results in ?

Back 42

dilatation with pressure ischemia

bacterial overgrowth

inflammation

Front 43

clinical signs of acute chole?

Back 43

right upper quadrant pain radiating to right scapula

fever with inc WBC count

nausea

vomit

inc serum alkaline phosphatase

Front 44

if acute cholecysitis isnt treated, then what happens?

Back 44

there is risk of rupture

Front 45

chronic inf of gall bladder ?

Back 45

chronic chole

Front 46

chronic chole is due to ?

Back 46

chemical irritation from longstanding cholelithiasis

Front 47

chronic chol is characterized by ____

and presents with ?

Back 47

herniation of gall bladder mucosa into muscular wall( rokitansky-aschooff sinus)

vague right upper quad pain after eating

Front 48

what is a complication of chronic chole?

Back 48

porcelain gallbladder

Front 49

what is porcelain gallbladder?

due to ?

Back 49

shrunken, hard gallbladder

due to chronic inf, fibrosis and dystrophic calcification

Front 50

treatment for chronic choleystitis?

Back 50

cholecystecomty especially if poreclain gallbladder is present

Front 51

bacterial inf of bile ducts is called

Back 51

ascending cholangitis

Front 52

ascending cholangitis is due to ?

Back 52

ASCENDING INFECTION with enteric gram -ve bacteria

Front 53

ascending cholangitis presents with ?

Back 53

sepsis(high fever and chills)

jaundice

abd pain

Front 54

there is increased incidence of ascending cholangitis with ??

Back 54

choledocholithiasis (stones in biliary duct)

Front 55

gallstone enters and obstructs the small bowel is called/?

Back 55

gallstone ileus

Front 56

gallstone ileus is due to?

Back 56

cholecystitis with fistula formation between gallbladder and small bowel

Front 57

adenocarcinoma arising from glandular epethelium that lines gall bladder wall is called?

Back 57

gallbladder carcinoma

Front 58

risk factors of gallbladder carcinoma?

Back 58

gallstones

Front 59

gallbladder carcinoma presents as ?

Back 59

cholecysitis in elderly women

Front 60

yellow discoloration of skin?

Back 60

jaundice

Front 61

earliest sign of jaundice?

Back 61

scleral icterus

Front 62

jaundice is due to ?

Back 62

increase serum bilirubin >2.5mg/dL

Front 63

normally, RBC are consumed by macrophages of the ______

protophorphyrin is converted to _____

____ carries UCB to the liver

____ conjugates bilirubin

____ is trasnferred to bile canaliculi to form bile which is stored in gallbladder

bile is released into small bladder to aid in ___

intestinal flora converts ____ to ____,which is oxidized to stercobilin and urobilin

Back 63

reticuldoendothelial system

UCB

albumin

UGT

CB

digestion

CB to urobilinogen

Front 64

in extravascular hemolysis or ineffective erythropiesis, there is high level of ____ which overwhelms the ______ of the liver.

lab finding is ?

Back 64

UCB

conjugating ability

inc UCB

Front 65

clinical features of extravascular hemolysis or inffective erytho?

Back 65

dark urine due to inc urine urobilinogen

inc risk for pigmented bilirubin gallstones

Front 66

etiology of physiologic jaundice of the new born?

lab findings?

Back 66

low UGT activity

inc UCB

Front 67

clinical features of physiological jaundice of new born is that ____ is a fat soluble and can deposit in _____ (aka______) leading to neurological deficit and death

treatment is ?which does what?

Back 67

UCB

basal ganglia (kernicterus)

phototherapy, makes UCB water soluble

Front 68

etiology of gilbert syndrome?

lan findings?

clinical features are?

Back 68

low UGT activity

inc UCB

jaundice during stress

Front 69

cause of crigler najjar syndrome?

lab findings?

clinical findings?

Back 69

absecne of UGT

inc CB

kernicterus

Front 70

cause of dublin johnson syndrome?

lab findings ?

Back 70

deficiency of bilirubin canalicular transport protein

inc CB

Front 71

clinical faetures of dublin johnson syndrome?

Back 71

liver is dark

Front 72

which syndrome is similar to dublin johnson syndrome but liver isnt dark in it?

Back 72

rotor syndrome

Front 73

cause of biliary tract obstruction (obs jaundice)

Back 73

gallstones

pancreatic carcinoma

cholangiocarcinoma

parasites

liver fluke

Front 74

lab findings of obs jaundice?

Back 74

inc CB

inc alkalin phosphatase

dec urine urobilinogen

Front 75

clinical features of obs jaundice?

Back 75

dark urine

pale stool

pruritus

hypercholestremia with xanthomas

steatorrhea with malabsorption of fat soluble vitamins

Front 76

why is there dark urine ?

why is there pruritus?>?

Back 76

due to bilirubinurea

due to inc plasma bile acids

Front 77

cause of viral hepatitis?

Back 77

inf disrupts hepatocytes and small bowell ductules

Front 78

lab findings of viral hep?

Back 78

inc in both CB and UCB

Front 79

clincial features of viral hep?

Back 79

dark urine due to inc urine bilirubin

normal urine urobiliogen or decreased

Front 80

which hep viruses have fecal oral transmission?

Back 80

Hep A

hep E

Front 81

HAV is commonly avquired by ?

Back 81

travellers

Front 82

HEV is more commonly acquired by ?

Back 82

contaminated water or undercooked sea food

Front 83

what marks active infection in HAV and HEV?

and what marks protective and what does its presence indicate?

Back 83

anti virus igM

IgG

prior infection or immunization

Front 84

HEV in pregnant women indicates what?

Back 84

fulminant hepatitis (liver failure with massive liver necrosis)

Front 85

transmission of hep B virius?

Back 85

parenteral transmission ex:

chldbirth

unprotected sex

IV drug

Front 86

which hep virus has acute state and chronic states?

Back 86

hep A- acute only

hep B-acute and chronic

hep E-acute only

hep C-acute and chronic

Front 87

hep c tranmission is ?

Back 87

parenteral transmission

Front 88

_____ test confirms infection in HCV virus

decreased ___ levels indicate recovery

Back 88

HCV-RNA

RNA

Front 89

hep D virus is dependent on ___ for infection

superinfection upon existing HBV is more ____ than coinfection

Back 89

HBV

severe

Front 90

inflammation of liver parenchyma is called?

Back 90

viral hep

Front 91

viral hep occurs due to ?

Back 91

hep virus (MCC)

others are :EBV and CMV

Front 92

hep virus causes ___ which may progress to ___

Back 92

acute hep

chronic hep

Front 93

acute hep presents as ?

Back 93

jaundic (mixed CB and UCB)

dark urine

fever

malaise

nausea

elevated liver enzymes (ALT>AST)

Front 94

in acute hep,inflammation involves lobules of___ and ___ and is characterized by ______

Back 94

liver

portal tracts

apoptosis of hepatocytes

Front 95

what is the duration of symptoms in acute hep?

Back 95

less than 6 months

Front 96

duration of chronic hep symptoms?

Back 96

>6 months

Front 97

inflammation in chronic hep involves?

and can progress to ?

Back 97

portal tract

cirrhosis

Front 98

end stage liver damage characterized by disruption of normal hepatic parenchyma by bands of fibrosis and regnerative nodules of hepatocytes

fibrosis is mediated by ____ from stellate cells which lie beneath the endothelial cells that line the sinusoids

Back 98

cirrhosis

TGF beta

Front 99

clinical features of cirrhosis?

Back 99

portal hypertension

decreased detoxification

decreased protein synthesis

Front 100

portal hypertension leads to ?

Back 100

ascites

congestive splenomegaly/hypersplenismportosystemic shunts(esophageal varices, hemorrhoids)

hepatorenal syndrome

Front 101

decreased detoxification results in ?

Back 101

mental status change

asterixis and eventual coma

gyenomastia, spider angiomata, palmar erythema

jaundice

Front 102

decreased protein synthesis leads to ?

Back 102

hypoalbuminemia with edema

coagulopathy due to decrease synthesis of clotting factors

Front 103

damage to hepatic parenchyma due to consumption of alochol is called?

Back 103

alcohol related liver dsz

Front 104

MCC of liver dsz in the west is ?

Back 104

alochol related liver dsz

Front 105

____ is accumulation of fat in hepatocytes?

results in heavy , greasy liver, resolves with ___

Back 105

fatty liver

abstinence

Front 106

alocholic hepatitis results from chemical i njury to ____ , seen with ____

_____ mediates damage

characterized by swelling of hep with formation of ____,___ and ____

presents with painful ____ and elevated____

Back 106

hepatocytes

binge drinking

acetaldehyde

mallory bodies, necrosis, acute inf

hepatomegaly ,liver enzymes (AST>ALT

Front 107

what is a compplication of alochol related liver dsz

Back 107

cirrhosis

Front 108

fatty change , hepatitis and or cirrhosis that develop without exposure to alochol ?

due to ?

diagnosis?

Back 108

non alocholic fatty liver dsz

obesity

ALT>AST

Front 109

excess body iron leading to deposition in tissue and organ damage

Back 109

hemochromatosis

Front 110

tissue damage is mediated by ?

Back 110

generation of free radicals

Front 111

hemochromatosis is due to ?

Back 111

defect in iron absorption or chronic transfusions

Front 112

primary hemochromatosis is due to mutation in ___ gene usually____

Back 112

HFE gene

C282Y

Front 113

classic triad in hemochromatosis is?

other findings are?

Back 113

cirrhosis , secondary diabetes mellitus

bronze skin

dilated cardiomyopathy

cardiac arrythmias

gonadal dysfucntion

Front 114

lab findings of hemochromatosis?

Back 114

inc ferritin

dec TIBC

inc serum iron

inc % sat

Front 115

what does liver biopsy show in hemochromatosis?

what distingushies iron from lipofuscin?

Back 115

accumulation of brown pigment in hepatocytes

prussian blue stain

Front 116

___ is a brown pigment that is a by-product from turnover of peroxidized lipids ,present in hepatocytes

Back 116

lipofuscin

Front 117

increased risk of which cancer in hemochromatosis?

Back 117

hepatocellular carcinoma

Front 118

treatment of hemochromatosis?

Back 118

phlebotomy

Front 119

defect in ATP mediated hepatocyte copper transport?

which gene is involved?

result in lack of ___ transport into bile and lack of copper incorporation into _____

Back 119

wilson dsz

ATP7B gene

copper,ceruloplasmin

Front 120

in wilson dsz, ___ builds up in hepatocytes, leaks into serum and deposits in tissue.

Back 120

copper

Front 121

wilson dsz presents with ?

Back 121

cirrhosis

neruoligcal manifestations such as ( behavorial changes, dementia, chorea and parkinsonian systems

kayser feisher rings in cornea

Front 122

lab findings of wilson dsz?

Back 122

inc urinary copper

dec serum ceruloplasmin

inc copper on liver biopsy

Front 123

there is inc risk of which cancer in wilson dsz?

treatment of wilson?

Back 123

hepatocellulcar carcinoma

d-penicillamine

Front 124

autoimmune granulomatous destruction of intrahepatic bile ducts?

arises in?

associated with which dsz?

Back 124

primary biliary cirrhosis

women

other autoimmune dsz

Front 125

etiology of primary biliary cirrhosis?

which AB is present?

Back 125

unkown

antimitochondrial Ab

Front 126

feaatures of primary biliary cirrhosis?

Back 126

features of obstructive jaundice

Front 127

inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

Back 127

primary sclerosing cholangitis

Front 128

what appears on histology in primary sclerosing cholangitis?

and uninvolved regions are dilated resulting in a ____ apperance on contrast imaging.

Back 128

onion skin fibrosis

beaded

Front 129

etiology of primary sclerosing cholangitis?

associated with ?

____ is positive

Back 129

unknown

UC

p-ANCA

Front 130

primary sclerosing cholangitis presents with ?

___ is a late complication.

and increased risk of _____

Back 130

obstructive jaundice

cirrhosis

cholangiocarcinoma

Front 131

fulminant liver failure and encephalopathy in children with viral illness who take aspirin

related to mitochondrial damage of ____

Back 131

reye syndrome

hepatocytes

Front 132

reye syndrome presents with ?

Back 132

hypoglycemia

elevated liver enzyme

nausea with vomit

coma and death

Front 133

benign tumor of hepatocytes?

Back 133

hepatic adenoma

Front 134

hepatic adenoma is associated with ?

regresses due to ?

Back 134

oral contraceptive use

cessation of drug

Front 135

in hepatic adenoma there is risk of ?

tumors are subscapular and grow with exposure to ?

Back 135

rupture and intraperitoneal bleeding especially during pregnancy

estrogen

Front 136

malignant tumor of hepatocytes?

Back 136

hepatocellular carcinoma

Front 137

risk factos of hepatocellular carcinoma?

Back 137

chronic hepatitis

cirrhosis

aflatoxins derived from aspergillus

Front 138

there is increased risk of what in hepatocellular carcinoma?

liver infarction secondary to ____ vein obstruction

presents with ?

Back 138

budd chiari syndrome

hepatic

hepatomegaly and ascites

Front 139

serum tumor marker of hepatocellular carcinoma?

Back 139

alpha fetoprotein

Front 140

common sources of metastasis to liver?

results in____ in liver.

detected as ?

Back 140

colon, pancres lung and breast carcinomas

multiple nodules

hepatomegaly with a nodular free edge of liver