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103 Cards in this Set

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Mitochondrial damage
cytochrome C release and caspase activation
sinusaoidal endothelial cell apoptosis
initial event in the ischemic reperfusion of liver - relevant in transplantation - cold storage and reperfusion - and graft survival
stellate cells
produce growth factors such as HGF and other cytokines
NAFL seen in
kwashiorkor, total parenteral nutrition, jejunal bypass
ALT
cytosol, liver, def of pyridoxine 5 phosphate results in reduces ALT in alcoholic liver disease
AST
cytosolic, mitochondrial, many organs
alkaline phosphatase
present in apical poles of hepatocytes and choliangoles and secreted in bile in large amounts, ATPase, marker of cholestasis
liver synth clotting factors
I II V VII XI X
F P
causes of chirrosis
wilson's, alpha-1 antitrypsin def, liver fluke (schistosoma), PBC, PSC, autoimmune
features of chirrosis
peptic ulcers, anemia, palmarerythema
HCC development
increasing ascites, change in color-bloody, alphafetoprotein levels increase, alkaline phosphatase increase, hypoglycemia
acute viral hepatitis
lobulat dissaray, smudging of cell outline
balooning and acidiphillic hyaline bodies (councilman bodies)
areas of focal hepatic necrosis
lymphocytic parenchymal and portal inflammation
cholestasis
kupfercell and macrophage hypertrophy, hyperplasia
then, regeneration, binucleation of hepatocytes
acute viral hepatitis with submassive or massive necrosis
entire central and/or midzones necrotic (all involved in massive and marked collapse occurs)
bridging necrosis-to hepatic failure or chirrosis
when all lobules involved death is inevitable
inflamation with mononuclear cells, few neutrophils
HBV extrahepatic
polyarteritis nodosum, membrano-proliferative glomerulonephritis
HCV
itty bitty fat, germinal centers
(not with HBV)
PBC
AMA (against 2-oxo acid dehydrogenase complex, 2-oxo glutaric acid dehydrogenase complex, and pyruvate dehydrogenase complex)
gradual destruction of small bile ducts (ductopenia)
the retension of components of bile st sites proximal to the bile cannaliculous and associated lack of bile in the intestine are responsible for most of the symptoms
pruritis, fatiguability,jaundice,xanthomas, osteoperosis, osteomalacia, night blindness
increased alkaline phosphatase
PBC
AMA (against 2-oxo acid dehydrogenase complex, 2-oxo glutaric acid dehydrogenase complex, and pyruvate dehydrogenase complex)
gradual destruction of small bile ducts (ductopenia)
the retension of components of bile st sites proximal to the bile cannaliculous and associated lack of bile in the intestine are responsible for most of the symptoms
pruritis, fatiguability,jaundice,xanthomas, osteoperosis, osteomalacia, night blindness
increased alkaline phosphatase
PBC pathology
chronic non-supporative destructive cholangitis involving septal and iterlobular bile ducts
epithelioid granulomas containing cytotoxic T cells and inflammation in portal tracts realted to bile ducts
loss of ducts(ductopenia)
progression to billiary chirrosis 5-20yrs
increased risk of liver cancer
PBC pathology
chronic non-supporative destructive cholangitis involving septal and iterlobular bile ducts
epithelioid granulomas containing cytotoxic T cells and inflammation in portal tracts realted to bile ducts
loss of ducts(ductopenia)
progression to billiary chirrosis 5-20yrs
increased risk of liver cancer
PSC
elevated serum alkaline phosphatase
inflammation,cholangitis, fibrosis, obliteration of intralobular and septal bile ducts,ductopenia, billiary chirrosis,cholestasis
risk of HCC and cholangiocarcinoma (free radical or inflammation)
PSC
elevated serum alkaline phosphatase
inflammation,cholangitis, fibrosis, obliteration of intralobular and septal bile ducts,ductopenia, billiary chirrosis,cholestasis
risk of HCC and cholangiocarcinoma (free radical or inflammation)
Angiosarcoma
(hemangiosarcoma) following vinyl chloride, thorotrast. Arsenic
cytosolic ALDH
ALDH1 - same in a races
lipogranuloma
livercell breaks, realeses fat, histyocytes accumulate around fat
common in alcoholic liver
alcoholic hepatitis
necrosis of liver cells in the pericentral lobule, mallory bodies, neutrophils, perivenular fibrosis
complications of acute pancreatitis
hypotension, renal failure, respiratory failure

pancreatic necrosis, pancreatic abscess, pseudocyst, chronic pancreatitis, bacterial infections
chronic calicified pancreatitis
alcohol realted
characterized by intraductal stones and ductal injury, parenchymal fibrosis, protein plugs
chronic pancreatitis
shrunken, hard, fibrotic, whitish, ducts have irregular calibers and may contain calliculi
chronic pancreatitis complications
pseudocyst, common bile duct obstruction, DM, steatorrhea, pancreatic cancer (slight)
acute pancreatitis
swollen, edmatous, whitish yellow plaques on surface and in septa (fat necrosis), congestion , hemorrhage, inflammatory infiltrate

symptoms: abdominal pain, nausea, low grade fever, hypotension
acute pancreatitis diagnosis
serum amylas x 3, trypsinogen-2, trypsynogen-2-alpha-1 antitrypsin complex
benign pancreatic ductal tumors
serous cytadenoma
mucinous cystadenoma
intraductal papillary mucinous tumor
borderline pancreatic ductal tumors
solid pseudopapillary tumor
mucinous tumor with dysplasia
intraductal papillary mucinous tumor with dysplasia
malignant ductal tumors of the pancreas
ductal adenocarcinoma and its variants
molecular alterations in oancreatic cancer
oncogenes: ***K-ras, c-erbB-2
tumor supressor genes: p53, p16
growth factors:epidermal growth factor-r, TGF-alpha
pancreatic adenocarcinoma diagnostics
carcinoembryonic antigen, CA19-9, imaging, ERCP
intercalatedduct
centroacinar cells
intralobular duct
low cuboidal cells
interlobular duct
cuboidal of low columnar
main duct
columnar with goblet
reflux esophagitis findings
erythema, edema , friability, erosions, leukoplakia, hyperemia, ulcers, basal cell hyperplasia, vascular congestion andextension of CT papilae almost to surface, esinophils, neutrophils
autoimmune chronic gastritis
body and fundus
lymphocytes and plasma cells in the deep mucosaand pseudopyloric and intestinal metaplasia
Complications: 1)hyper plasia of gastrin producing cells and enterochromaffin like cells
2)development of carcinoid tumors
3)development of epithelial dysplasia followed by adenocarcinoma
diffuse antral chronic gastritis
antrum, H pyplori, lymphoid follicles
complications: 1)prepyloric and duodenal ulcers
2)gastric lymphoma
3)risk of gastric carcinoma is low
multifocal chronic atrophic gastritis
dietary and environmental risk factors, finland and japan, begins at incisura
complications:1)gastric ulcer
2)intestinal type of adenocarcinoma
3)lymphoma
noninflammatory pathogens
vibrio cholerae, clostridium perfringens, s aureus, giardia, cryptosporidium
inflammatory pathogens
shigella, salmonella, campylobacter jejuni, yersinia entericolitica, clostridium difficile, entameba hystolitica
most common bacterial cause of food born ilness in US
campyplobacter
most common viral cause of food born illness in US
norwalk
vibrios - general
live in salt water, gram neg comma shaped rod, facultative anarobe, cholera, O1, O139
vibrio determinants of pathogenicity
toxin co-regulated pilli TCP- binding to intestinal epi
cholera toxin CTX - A-B txin, encoded by a phage, A1 is an ATP ribosylating enzyme to increase cyclic AMP which increases chloride secretion and decreses sodium absorbtion
vibrio symptoms
rice water stools
vibrio labs
thiosulfate-citrate- bile salt-sucrose TCBS selective agar
oxidase pos (to diff from enterobacteriacaea)
ETEC
heat labile (simmial to cholera A-B toxin) and stable toxin
clostridium perfringens
anaerobic, gram pos, bacillus
from meat, poultry, legumes
bacillus cereus
gram pos rod
2 toxins:1)like LT 2)like staph causing vomiting from rice (heating issues)
staph
enterotoxins ABCDE
lasts 10 hrs
vomiting diarrhea
rotavirus
fever
immunoassay for anitgen in stool
norwalk
fecal oral
vomiting, diarrhea
incubation 18-72
low grade fever 50%
enzyme linked immunosorbent assays
lasts 24-48hrs
giardia
adheres to epi of SI and causes maladsorbtion
diahrrhea, flatulence, bloating, cramping
1-4 wks
repeat stool examination, enzyme immunoassay of parasite Ag
cryptospridium
fecal-oral
domestic animals
chronic malabsorbtion in immunocomp
acid-fast,direct imunoflourescence antibody staining
EHEC
bloody, crampy, no/low fever
HUS-no antibiotics
undercooked meat, unpasturized milk.juice
Shigella
enterobacteriacaea
fingers food flies feces fomites
only 200 needed
invade colonic mucosa
transcytose through M cells
type III secretion / Ipa
cell to cell
some sectrete shiga toxin - HUS
fever
stool culture
community acquired
water chlorination
campylobacter jejuni
curved gram neg rod (sea gull)
self limited
guillian barre
yersinia enterocolitica
gram neg rod, enterobacteriaceae
enlargement of mesenteric lymph nodes, possible bacteremia
survives well at 4 deg C
CIN agar cefsulodin irgasan novobiacin
clostridium difficile
toxin A - enterotoxin - diarrhea
toxin B - cytotoxin - kills cells
can lead to seriousPMC pseudomembranous colitis
tissue culture assay detects toxin B, now immunoassays detect both
entamoeba histolytica
trophozoites and cysts
releases pore-forming toxin that lyses cells and leads to flask-shaped ulcers
visualize in stool, Ag in stool, Ab in serum
histamine on heart
H1 slows conduction in AV node
H2 increases rate and force of cardiac contraction
urticaria pigmentosa
disease - huge number of mast cells in skin
chlorpheniramine
otc anti-allergy,cold tablets
(anticholinergic effect of drying up secretions-block muscarinic receptors)
diphenhydramine
for sleep
for insect bites, poison ivy, and othermild allergic rxns
anticholinergic/muscarinic
dimenhydrinate
dramamine
central anti-ACh
hydroxyzine
opioid plus antihistamine
with morphine as pre-op
reduces anxiety and emesis from opiates
atropine-like actions
astemizole
2nd generation,minimal sedative effects but arrythmias
terfenadine
2nd generation,minimal sedative effects but arrythmias
loratadine
2nd gen
rapid onset
no arrythmias
recemic mixture
nives, itching, and allergic rhinitis
desloratadine
single isomer of loratadine
(2nd gen
rapid onset
no arrythmias
recemic mixture
nives, itching, and allergic rhinitis)
fexofenadine
2nd generation
terfenadine derivative
w/o cardiac effects
cetirizine
2nd generation
cimetidine
cns effects w/ renal or hepatic disturbance
anti-androgenic
hyperprolactinemic
ranitidine
5-10 time more potent than cimetidine
lower affinity for p450
infrequent CNS effects
reverses anti-androgenic effects
famotidine
4-5 times more potent than
no side effects
less expensive
one a day
H1 works through
phospholipase C
H2 works through
adenylyl cyclase
doxepin
tricyclic anti depressant
acts as combined H1 H2 blocker
esophageal spasm
usually retains primary parastaltic waves
non-parastaltic high amplitude prolonged contractions with chest pain
corkscrew eophagus
dysphagia for solids and liquids
olgive's syndrome
acute colinic pseudoobstruction
marked colonic dilation in absence of obstruction
post operative
parasympathetic underactivity, sympathetic over activity, metabolic disturbances and opiate effects
granulaoma
collection of epitheliod cells
crypt abscess
collection of neutrophils in lumen of gland
what is absorbed in the proximal SI
iron, calcium, vitamins, and fat
what is absorbed in the midinterstin
carbs and AA
what is absorbed in the terminal illeum
bile acid and B12
normal height of SI villous
3 x that of crypt
hahartomas
tumor-like malformations
abnormal mixture and overgrowth of tissues
eg. peutz-jegher
peutz-jegher
dominant
intestinal polyposis and mucocutaneous melanin pigmentation
lobulated,pedunculated polyps in GI,esp small bowel
branching smooth muscle covered by epi w/ a lamina propria
paneth cells and endocrine cells at base of crypts
diorganized, hyperplastic mucosal glands, containging absorbtive, mucous and paneth cells
possible hmmorhage, intussusception or malignancy
whipples
migratory polyarthragia, steattorhea, wasting, diarrhea
immune def. host allows bacteria to enter body through SI
mitral and aortic valve, CNS, mesenteric lymph nodes, lungs, kidney
intestine:dialated, thick ,rigid
mesentary: thickened
villous atrophy
macrophages in lamina propria containing acid-schiff staining bacilli
celiacs 100% soecificity
antiendomysial antibodies
complications of celiacs
lymphomas and adenocarcinomas
ulcerative jejunoileitis
carcinoids
tumors arising from gut endocrine cells
mostly appendix and distal illeum
frequntly multi centric
ilieal and colonic are frequently malignant (not appendiceal and rectal)
cacinoid syndroms
carcinoid syndrome ,gastrinoma syndrome (zollinger ellison), somatostatinoma syndrome, cushings sydrome
carcinoid syndrome
carcinoid cells take up large amounts of dietary tryptophan and convert it to seritonin
flushing, athsma attackish, diarrhea, R sided hear failure due to stenosis of tricuspid and pulmonary valves
occasionally peptic ulcers and malabsorbtion
classically midgut
chron's
sarcoid type granulaomas
transmural inflammation
apthous ulcers
thickened bowel wall
amyloidosis
ankylosing spondylitis
polyarthritis
adenocarcinoma
carcinoids
appendix and rectum-usually singular
small bowel-multiple
insulartrabecular and microacinar patterna
tumor cells are small and uniform w/ round nuclei and granular esinophillic cytoplasm
prognosis: size, depth, location
appendicitis
leukocytosis
left shoft of neutrophils in blood
complications: thrombophlebitis, fistula to intestine or bladder