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186 Cards in this Set
- Front
- Back
What physical finding is associated with the inability of a damaged liver to catabolize hormones and serum proteins?
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Gynecomastia (Results from the inability of the liver to catabolize estrogen in men; typcially observed in chronic alcoholics with liver disease).
|
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What are the metabolic functions associated with hepatocytes?
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- Glycogen storage (fed state)
- Glycogenolysis and gluconeogenesis (when fasting) |
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What are the catabolic functions associated with hepatocytes?
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- Catabolism of hormones and serum proteins
- Detoxification of foreign compounds |
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What term describes the yellow discoloration of skin, sclerae, and tissues cause by hyperbilirubinemia?
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Jaundice
|
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What are three causes of excess production of bilirubin resulting in unconjugated hyperbilirubinemia?
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- Hemolytic anemia
- Ineffective erythropoiesis - Resorption of blood from internal hemorrhage |
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What type of hereditary hyperbilirubinemia is associated with reduced activity of UGT?
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Gilbert syndrome
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What hereditary hyperbilirubinemia syndromes result in unconjugated hyperbilirubinemia?
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- Crigler-Najjar syndrome
- Gilbert syndrome |
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What type of hereditary hyperbilirubinemia is associated with a deficiency of UGT?
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Crigler-Najjar syndrome (Type I UGT absent, Type II UGT greatly reduced)
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What type of hereditary hyperbilirubinemia is caused by a defect in hepatocellular excretion of bilirubin glucuronides across the canalicular membranes, and also a pigment liver?
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Dubin-Johnson syndrome
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What is the cause of neonatal jaundice?
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- Increased bilirubin production
- Immaturity of hepatic UDP-glucuronosyl transferase (UGT) |
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What diagnosis should be considered if a baby has persistent, marked unconjugated hyperbilirubinema (>20 mg/dL), secondary to hemolytic disease of the newborn?
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Erythroblastosis fetalis
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What condition in newborns can result from unconjugated bilirubin levels above 20 mg/dL?
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Kernicterus
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What is Kernicterus?
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Bilirubin encephalopathy (unconjugated bilirubin crosses the poorly developed BBB of the neonate resulting in deposition in the basal ganglia and damage to the CNS.
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What tests are markers of hepatocellular necrosis?
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Elevated:
- AST - ALT - LDH |
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What LFTs are markers of cholestasis?
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Elevated:
- Alkaline phosphatase - GGT - 5'-Nucleotidase |
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What type of jaundice is clinically manifested as conjugated hyperbilirubinemia?
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Obstructive Jaundice
|
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Why do patients with obstructive jaundice sometimes develop pruritus?
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Pruritus is caused by regurgitaed bile acids into blood due to common bile duct obstruction.
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What are the five morphological features associated with hepatic injury?
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- Degeneration of hepatocyte with intracellular accumulations
- Necrosis and apoptosis of hepatocytes - Inflammation - Regeneration - Fibrosis |
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What is the most common cause of acute hepatic failure?
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Acetaminophen ingestion
|
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What etiologies are associated with hepatic dysfunction without necrosis?
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Tetracycline & acute fatty liver of pregnancy (viable hepatocytes, however, they do not perform normal metabolic functions).
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What characterizes Cirrhosis of Liver?
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- Diffuse fibrosis (irreversible)
- Nodularity (due to regenerating nodules of hepatocytes) |
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What is the most common etiology associated with Cirrhosis of Liver?
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Alcoholic liver disease
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What complications of Cirrhosis of Liver are consequences of intrahepatic scarring with portal hypertension?
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- Esophageal Varices
- Rectal hemorrhoids - Caput medusae - Retroperitoneal shunt - Splenomegaly |
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Formation of Ascites in Cirrhosis of Liver is the result of?
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- Portal hypertension
- Hypoalbuminemia - Increased production of hepatic lymph (due to increase venous portal pressure) - Hyperaldosteronism |
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What are some neurologic manifestations associated with Hepatic encephalopathy?
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- Confusion
- Personality Change - Asterixis (flapping tremor of hands) - Knee Clonus - Ankle Clonus - Babinski Sign (+) - Coma |
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What type of hepatic injury is indicated by feathery degeneration?
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Cholestatic liver injury
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What mushroom is associated massive hepatic necrosis?
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Amanita phylloides
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What is steatosis?
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Fatty Liver (Most frequent morphologic abnormality caused by alcohol and is reversible).
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What is the most common cause of jaundice?
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Viral hepatitis
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What are the sings/symptoms associated with the Pre-icterus phase of acute viral hepatitis?
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- Fever
- Tender (painful) hepatomegaly - Increased ALT and AST (ALT > AST) |
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What are the four phases of acute viral hepatitis?
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- Incubation
- Pre-icteric Stage - Icteric Stage - Convalescence |
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What is the most common viral hepatitis and cause of jaundice?
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Hepatitis A Virus (HAV)
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What histopathological findings are associated with acute viral hepatitis?
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- Ballooning degeneration of hepatocytes
- Apoptosis of hepatocytes (Councilman bodies) |
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What marker is specifically indicative of an active Hep A infection?
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Anti-HAV-IgM
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What marker is indicative of recovery from Hep A or vaccination?
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Anti-HAV-IgG (Protective Antibody)
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What is the first specific marker of Hep B infection?
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HBsAg (Persists up to 4 months in acute hepatitis)
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What is indicated by HBsAg persisting > 6 months?
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Chronic HBV infection (Chronic Hep B infection is defined by HBsAg > 6 months).
|
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What are the infective particles that appear shortly after HBsAg in HBV infection?
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- HBeAg
- HBV-DNA **HBeAg & HBV-DNA also disappear before HBsAg |
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What does the Anti-HBs indicate?
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- Recovery from HepB infection
- Immunization |
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What markers will be present in a Chronic infective carrier of HBV?
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- HBsAg
- HBeAg - Anti-HBc-IgG - HBV-DNA |
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What markers will be present in a "Healthy" chronic carrier of HBV?
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- HBsAg
- Anti-HBc-IgG |
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What marker will be present in a patient who recovered from HBV or was immunized?
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Anti-HBs (anti-HBV surface antibody)
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What is indicated by the presence of anti-HCV-IgG?
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Infection or recovery (anti-HCV-IgG is not a protective antibody)
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What is indicated by the presence of anti-HDV-IgM or anti-HDV-IgG?
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Active HDV infection
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What is indicated by anti-HEV-IgM?
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Active HEV infection
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What is indicated by anti-HEV-IgG?
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Indicates recovery from HEV infection
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What types of viral hepatitis infections do not lead to chronic hepatitis?
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- Hep A virus
- Hep E virus |
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Which Hepatitis virus is dependent upon HBV infection?
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HDV does not produce envelop antigens, requires HBsAg to form an envelope.
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What laboratory studies other than viral antibodies and antigens are observed in viral hepatitis?
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- Increased urine UBG and urine bilirubin
- Increased ALT and AST (ALT > AST) |
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What LFTs are increased in autoimmune hepatitis?
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- Anti-smooth muscle antibody (ASMA)
- Antinuclear antibody (ANA) |
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What types of Hepatitis virus infections are associated with the Fecal-Oral mode of transmission?
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HAV & HEV
|
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What types of hepatitis virus infections are associated with parenteral, sexual, and blood born transmissions?
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-HBV
-HCV -HDV |
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What histopathological finding is associated with cholestatic liver injury?
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Feathery degeneration of hepatocytes
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What is fulminant hepatitis?
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A severe variant of acute hepatitis with rapid clinical course progressing to hepatic encephalopathy
|
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Which hepatitis viruses can result in Fulminant hepatitis?
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- HBV & HCV (HCV > HBV > HBV-HDV > HAV)
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What gross morphology describes the appearance of the liver in Fulminant hepatitis?
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Shrunken with wrinkled capsule (Limp red liver)
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What form chronic hepatitis is associated with a strong female predominance?
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Autoimmune hepatitis
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What is the predominant portal tract infiltrate seen in autoimmune hepatitis?
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Plasma cells
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What autosomal recessive disorder results in unrestricted reabsorption of iron in the small intestine?
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Hereditary Hemachromatosis
|
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What autosomal recessive mutation is a known etiology of hereditary hemochromatosis?
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Mutations in the hereditary hemachromatosis gene (HFE).
|
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What disease is considered to be an acquired iron overload disease?
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Hemosiderosis (caused by multiple blood transfusion, alcohol abuse, and well water.
|
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What pathogen/disease is associated with right lobe liver abscess?
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Amebiasis (Entamoeba histolytica)
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What parasite/disease is associated with increased incidence of cholangiocarcinoma?
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Clonorchiasis (Clonorchis sinesis - Chinese liver fluke)
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What laboratory findings are associated with Fulminant liver failure (Fulminant hepatitis)?
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- Decreased ALT and AST (from previous values)
- Increased PT and ammonia |
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What type of liver tumors is associated with exposure to vinyl chloride, thorium dioxide, and arsenic?
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Angiosarcoma
|
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What type of liver tumor is associated with exposure to thorium dioxide?
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Cholangiocarcinoma
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What type of liver cancer is associated with exposure to alfatoxin (produced by Aspergillus flavus)?
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Hepatocellular carcinoma
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What drugs mentioned in Goljan are etiological causes of drug-induced hepatitis?
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- Isoniazid
- Halothane - Acetaminophen - Methyldopa (alpha-methyldopa) |
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What etiological agents are associated with drug-induced cholestasis?
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- Oral contraceptives
- Anabolic steroids |
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What complication associated with cirrhosis of liver increases the risk of developing spontaneous peritonitis?
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Ascites
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What physical findings are associated with hyperestrinism that results from cirrhosis of liver?
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- Gynecomastia (males)
- Spider telangiectasia |
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What type of cirrhosis is the result of autoimmune destruction of the bile ducts in the portal triad (portal tract)?
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Primary biliary cirrhosis
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What is the most common congenital anomaly of the pancreas?
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Pancreas divisum (Failure of fusion of the dorsal and ventral portions of the pancreas)
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A majority of hereditary pancreatitis cases are due to what specific mutation?
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Mutation in cationic trypsinogen gene (PRSS1) - Autosomal dominant inheritance
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A mutation in SPINK1 gene is associated with what pathology?
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Hereditary pancreatitis (autosomal recessive)
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What type of cirrhosis is the result of autoimmune destruction of the bile ducts in the portal triad (portal tract)?
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Primary biliary cirrhosis
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What is the most common congenital anomaly of the pancreas?
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Pancreas divisum (Failure of fusion of the dorsal and ventral portions of the pancreas)
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A majority of hereditary pancreatitis cases are due to what specific mutation?
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Mutation in cationic trypsinogen gene (PRSS1) - Autosomal dominant inheritance
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A mutation in SPINK1 gene is associated with what pathology?
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Hereditary pancreatitis (autosomal recessive)
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What congenial pancreatic anomaly is defined by the formation of a ring around the duodenum by the dorsal and ventral buds of the pancreas?
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Annular Pancreas (associated with duodenal obstruction)
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What is the most common site of ectopic pancreatic tissue?
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Stomach
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What type of pancreatitis is defined as being a reversible process that is the result of biliary tract obstruction or alcoholism?
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Acute pancreatitis
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What type of pancreatitis is defined as being an irreversible loss of pancreatic tissue as a result of long-term alcohol abuse?
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Chronic pancreatitis
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What historical finding is the most important finding associated with hereditary pancreatitis?
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Recurrent bouts of acute pancreatitis beginning in childhood?
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What two genetic mutations are the most strongly associated with hereditary pancreatitis?
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- PRSS1
- SPINK1 |
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Which gene encodes for a pancreatic secretory inhibitor?
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- SPINK1 (Mutation is SPINK1 is autosomal recessive associated with hereditary pancreatitis)
|
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What is the cationic trypsinogen gene?
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- PRSS1 (Autosomal dominant mutation results in trypsin that is resistant to autocleavage; associated with hereditary pancreatitis).
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What are the macroscopic findings associated with acute pancreatitis?
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Hemorrhage and fat necrosis
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What are the microscopic findings associated with acute pancreatitis?
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- Edema
- Fat necrosis - Proteolysis of the pancreas - Acute inflammation - Vasucular destruction with hemorrhage. |
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What type of necrosis is specifically associated with acute pancreatitis?
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Fat Necrosis (results in a soapy appearance upon histological examination).
|
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What is the most common cause of acute pancreatitis?
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Alcohol abuse
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What signs/symptoms are associated with acute pancreatitis?
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- Nausea
- Fever - Vomiting - Severe (boring) midepigastric pain that radiates into the back |
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What laboratory findings are associated with acute pancreatitis?
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- Increased serum amylase (24 hrs)
- Increased serum lipase (72 hrs to 96 hrs) |
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What is the treatment for acute pancreatitis?
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Resting the pancreas, total restriction of oral intake, IV supportive fluids and analgesia.
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What complications are associated with acute pancreatitis?
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- Systemic organ failure
- DIC - Pancreatic abscess - Pancreatic pseudocyst - Duodenal obstruction |
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What defines chronic pancreatitis?
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Inflammation of the pancreas with irreversible destruction of the pancreatic parenchyma.
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Dilations of the pancreatic ducts is associated with which type of pancreatitis?
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Chronic pancreatitis
|
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What complication of acute or chronic pancreatitis should you consider if there is persistent elevation of serum amylase?
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Pancreatic pseudocyst
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What are the complications associated with chronic pancreatitis
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- Pancreatic pseudocyst
- Pancreatic duct obstruction - Malabsorption, hypoalbuminemia, steatorrhea - Secondary diabetes mellitus - Pancreatic cancer |
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What characterizes benign serous cystadenoma?
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Numerous 1-3 mm cysts, lined by glycogen-rich cuboidal cells, filled with clear/watery fluid.
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What morphological features characterizes mucinous cystic neoplasms of the pancreas?
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Multilocular (larger than serous cysts) cysts lined by columnar mucin-producing epithelium, filled with thick dense mucin, surrounded by dense ovarian-like stroma.
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What characterizes intraductal papillary mucinous neoplasms?
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Intraductal mucin producing tumors, usually arise in the head of the pancreas and do not have an ovarian stroma.
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What neoplasm is considered to be the 4th leading cause of death in the US?
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Pancreatic carcinoma
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What risks factors are associated with increased risk of developing pancreatic carcinoma?
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- Smoking (2x)
- Alcohol (2x) - Diets rich in fat - Chronic pancreatitis - Hereditary pancreatitis |
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What characterizes the precursor lesion associated with pancreatic carcinoma?
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Pancreatic intraepithelial neoplasms (PanIN)
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What genetic mutations are associated with PanIN-1A and PanIN-1B?
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KRAS mutations - Most common oncogene mutation associated with pancreatic carcinoma.
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What genetic mutations are associated with PanIN-2?
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CDNK2A (p16) - Most common tumor suppressor gene inactivated in associated with pancreatic carcinoma.
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What are the most common genetic mutations associated with invasive pancreatic adenocarcinoma?
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- KRAS mutations and mutations in p16 (CDNK2A) are present in almost all invasive pancreatic adenocarcinoma.
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What is Trousseau's sign?
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Migratory thrombophlebitis - spontaneously appearing and disappearing thrombophlebitis of the superficial veins. Physical finding associated with pancreatic carcinoma.
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What term refers to spontaneously appearing and disappearing migratory thrombophlebitis of the superficial veins that is associated with pancreatic carcinoma?
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Trousseau's Sign
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What is stated by Courvoisier's Law?
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If the common bile duct is obstructed by a stone dilation is rare, however, if the duct is obstructed by something else (i.e. tumor of the head of the pancreas) then dilation is common.
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What are the signs of common bile duct obstruction by carcinoma of the head of the pancreas?
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- Jaundice (Conjugated Hyperbilirubinemia)
- Light-colored stools (absence of urobilinogen) - Palpable gallbladder (Courvoisier's Sign) |
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What portion of the pancreas is most likely to be affected by a pancreatic adenocarcinoma?
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Head of the pancreas (65% of cases of pancreatic carcinoma occur in the head of the pancreas).
|
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What pathological features are associated with pancreatic adenocarcinoma?
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- Most likely to occur in the head of the pancreas.
- Intensive desmoplastic response - Propensity to invade nerves (perineural invasion) and retroperitoneum |
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Where does pancreatic adenocarcinoma typically metastasize?
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- Liver
- Diaphragm (Peritoneal Carcinomatosis) |
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What etiology is associated with secondary biliary cirrhosis?
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Extrahepatic obstruction (no sex predilection)
|
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What etiology is associated with primary biliary cirrhosis?
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Autoimmune destruction of portal tract bile ducts (Female predominance)
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What etiology is associated with primary sclerosing cholangitis?
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Periductal fibrotic reaction (Strong association with Ulcerative colitis - male predominance).
|
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What are the signs/symptoms associated with intrahepatic biliary tract diseases?
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- Pruritus, jaundice, malaise, dark urine, and light stools
|
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What laboratory findings are associated with intrahepatic biliary tract diseases?
|
- Conjugated hyperbilirubinemia
- Increase alkaline phosphatase |
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What radiological finding is indicative of primary sclerosing cholangitis?
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A beaded appearance of the common bile duct is a typical finding of primary sclerosing cholangitis.
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What histological finding is specific for primary sclerosing cholangitis?
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Onion skinning fibrosis (Bile duct in a dense "onion skin" concentric scar - concentric periductal fibrosis).
|
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Which intrahepatic biliary tract disease has a strong association with Ulcerative colitis (IBD)?
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Primary sclerosing cholangitis
|
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What autoantibodies will be present in primary scleroisng cholangitis?
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- ASMA
- ANA - atypical p-ANCA |
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What histological finding is indicative of primary biliary cirrhosis?
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Non-suppurative granulomatous destruction of interlobular bile ducts (florid duct lesion).
|
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What laboratory findings are associated with primary biliary cirrhosis?
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- Increased alkaline phosphatase
- Increase cholesterol - Hyperbilirubinemia - Anitmitochondrial antibodies (AMA) |
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Individuals with primary sclerosing cholangitis are at increased risk of developing what type of cancer?
|
Cholangiocarcinoma
|
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Individuals with primary biliary cirrhosis are at increased risk of developing what type of cancer?
|
Hepatocellular carcinoma
|
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What major feature characterizes bile duct adenoma?
|
Consists of well-differentiated, cytologically benign bile ducts in a thin fibroconnective stroma (No fibrous capsule).
|
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What tumor is characterized as being essentially an adenocarcinoma with prominent desmoplastic reaction?
|
Cholangiocarcinoma
|
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Which organs does cholangiocarcinoma metastasize to via hematogenous spread?
|
- Lungs
- Vertebrae - Adrenals - Brain |
|
What is the clinical progression associated with cholangiocarcinoma?
|
Rapid, definitive treatment liver transplant, without transplant death usually results within six months.
|
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What major features are associated with liver cell adenoma?
|
Cytologically benign hepatocytes from cords not thicker than 2 cells.
|
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Use of oral contraceptives has a strong association with which type of hepatic neoplasm?
|
Liver cell adenoma (Usually solitary vascular neoplasms, that are present predominately in the right lobe of the liver).
|
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Does discontinuation of oral contraceptives cause the regression of liver cell adenoma?
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Yes, discontinuation of oral contraceptive results in the regression of a liver cell adenoma?
|
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What hepatic tumor-like condition is more common than liver cell adenoma and is characterized by ductules and fibrous septa radiating from a central stellate scar?
|
Focal Nodular Hyperplasia (Radiological findings will strongly suggest diagnosis)
|
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What characterizes Focal Nodular Hyperplasia?
|
Central stellate scar in a center of spontaneous lobulated mass/lesion.
|
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What morphological characteristics are associated with nodular regenerating hyperplasia?
|
Multiple small, well delineated white nodules that resemble a liver cell adenoma.
|
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What liver disease occurs in conditions affecting intrahepatic blood flow?
|
Nodular Regenerating Hyperplasia
|
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What conditions may cause false positive alpha-fetoprotein results?
|
- Yolk sac tumors of gonads
- Liver diseases - Normal pregnancy - Fetal distress or death - Fetal neural tube defects (anencephaly and spina bifida) |
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What is the most common visceral malignant tumor in the world?
|
Hepatocellular carcinoma
|
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Approximately 40% of patients with hereditary tyrosinemia develop what type of cancer?
|
Hepatocellular carcinoma
|
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What type of hepatic cancer arises in healthy young adults and is characterized by nest and cords of carcinoma cells that are separated by dense fibrous tissue?
|
Fibrolamellar Variant of Hepatocellular carcinoma (60% 5-yr survival, better prognosis than diffuse variant hepatocellular carcinoma)
|
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What is the most common liver tumor of young children?
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Hepatoblastoma (frequent activation of WNT/beta-catenin signaling pathway)
|
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What is the most common malignancy seen in the liver?
|
Metastatic adenocarcinoma?
|
|
What is HELLP Syndrome?
|
- Hemolytic anemia
- Elevated serum transaminases - Low platelets ** May be observed as a complication of preeclampsia ** |
|
What is choledocholithiasis?
|
Presence of gallstone in the common bile duct.
|
|
What are the hepatic complications of bone marrow transplantation?
|
- Drug toxicity
- Graft-versus-host-disease (GVHD) |
|
What are the hepatic complications of liver organ transplantation?
|
- Graft failure or graft rejection
- Non-immunological damage to liver allografts. |
|
Drug toxicity after bone marrow transplantation may result in what hepatic tumor-like condition?
|
Nodular regenerating hyperplasia
|
|
What is the relative composition of a cholesterol stone?
|
- > 50% cholesterol
- Calcium salts - Mucin |
|
Use of what pharmacological agent is associated with a higher incidence of cholesterol stones?
|
- Oral contraceptives
|
|
Why are women more prone to develop cholesterol stones than men?
|
- Estrogens stimulate the formation of lithogenic bile
- Progesterone inhibits the discharge of bile acids from the gallbladder. |
|
What is the relative composition of pigmented stones?
|
Mixture of calcium bilirubinate and inorganic calcium salts.
|
|
What cause the formation of cholesterol gallstones?
|
- Supersaturation of bile with cholesterol (Increased cholesterol in bile)
- Decreased bile salts and lecithin |
|
What are risk factors associated with developing cholesterol gallstones?
|
- Female
- > Forty years old - Obesity - Use of oral contraceptives (estrogen increase cholesterol in bile) - Rapid weight loss, use of lipid-lowering drugs - Native Americans |
|
What is the most common type of gallstone?
|
Cholesterol gallstone
|
|
Black pigment gallstones is a sign of what underlying pathology?
|
- Hemolysis (Hemolytic anemia, sickle cell anemia, and thalassemia)
- Calcium bilirubinate resulting from the hydrolysis of bilirubin glucuronides by microbial beta-glucuronidases. |
|
What is the underlying etiology associated with 90% of the cases of acute calculous cholecystitis?
|
Gallstone obstruction of the neck of the gallbladder or cystic duct.
|
|
What is responsible for the chemical irritation that occurs in acute calculous cholecystitis?
|
- Lecithin is hydrolyzed to lysolecithin which disrupts mucosal barriers exposing mucosa to direct detergent action of bile acids.
|
|
Where does the pain associated with cholecystitis typically radiate?
|
Right scapula
|
|
What is the etiology associated with acute acalculous cholecystitis?
|
Direct ischemic compromise (the cystic artery is an end artery, poor collateral circulation).
|
|
What is the most common symptomatic disorder of the gallbladder?
|
Chronic cholecystitis
|
|
What characterizes the pathogenesis of chronic cholecystitis?
|
Repeated bouts of acute cholecystitis; almost always due to gallstones.
|
|
What clinical findings are associated with chronic cholecystitis?
|
- Severe pain 1 to 2 hours post-prandially
- Recurrent epigastric distress, belching, and bloating |
|
What histopathological finding is indicative of chronic cholecystitis?
|
Aschoff-Rokitansky sinus
|
|
What is the etiology associated with acute acalculous cholecystitis?
|
Direct ischemic compromise (the cystic artery is an end artery, poor collateral circulation).
|
|
What is the most common symptomatic disorder of the gallbladder?
|
Chronic cholecystitis
|
|
What characterizes the pathogenesis of chronic cholecystitis?
|
Repeated bouts of acute cholecystitis; almost always due to gallstones.
|
|
What clinical findings are associated with chronic cholecystitis?
|
- Severe pain 1 to 2 hours post-prandially
- Recurrent epigastric distress, belching, and bloating |
|
What histopathological findings are indicative of chronic cholecystitis?
|
- Aschoff-Rokitansky sinuses
- Mononuclear cell infiltration |
|
What variant of chronic cholecystitis occurs secondary to extensive dystrophic calcification within the gallbladder wall?
|
Porcelain gallbladder
|
|
What variant of chronic cholecystitis occurs as a result of retention of clear secretions in an atrophic chronically obstructed gallbladder?
|
Hydrops of gallbladder
|
|
What is another name for cholesterolosis?
|
Strawberry gallbladder
|
|
What is cholesterolosis?
|
Excess cholesterol deposition in mucosal macrophages (cluster of foamy macrophages in lamina propria).
|
|
What clinical findings are associated with acute cholecystitis?
|
- Fever, nausea, vomiting (post-prandially)
- Initial midepigastric colicky (constant and dull) pain - Pain radiating to the scapula - Jaundice (stone in the CBD) - Elevated WBC with left shift |
|
What are the complications of persistent obstruction of the common bile duct?
|
- Jaundice (conjugated hyperbilirubinemia)
- Cholestasis - Bile lakes and bile infarcts - Complicated by ascending cholangitis - Secondary biliary cirrhosis |
|
What cancer is associated with the gallbladder?
|
Gallbladder adenocarcinoma (60-90% the is cholelithiasis; dominant in elderly women, very poor prognosis)
|
|
Which ethnic group is marked by a high incidence of gallbladder adenocarcinoma?
|
Native Americans (Pima Indians and other Native Americans in the Southwest region).
|
|
Gallbladder adenocarcinoma has the propensity to invade what organs?
|
- Liver (via vascular dissemination and direct spread).
|
|
What are the four F's associated with cholelithiasis?
|
Fat Fertile Female over Forty
|
|
What are the types of gallstones (cholelithiasis)?
|
- Cholesterol stones
- Pigmented stones - Mixed stones |
|
What are some causes of non-immunological damage to liver allografts?
|
- Preservation injury (i.e. improper handling and care, hypoxia in donor's life)
- Vascular thrombosis (hepatic artery, occurs during the first several weeks after transplantation, or even 1-3 years later). - Bile duct obstruction or biliary leaks |
|
What histopathological findings are indicative of chronic liver allograft rejection?
|
- Foamy cell obilterative arteriopathy
- Interlobular bile duct damage and destruction (vanishing bile duct syndrome). |
|
What histopathological findings are indicative of acute liver allograft rejection?
|
- Portal tract inflammation with mixed inflammatory infiltrate
- Endothelitis - Interlobular bile duct inflammation |
|
In what time frame does acute cellular liver allograft rejection typically occur?
|
Occurs most commonly between 5 and 30 days.
|