Pathology Block Iii

Front 1

portal bridging fibrosis & necrosis

Back 1

chronic Hepatitis

necrosis of hepatocytes at interface b/w portal triads and liver lobule --> bridging necrosis --> cirrhosis with portal bridging fibrosis and nodular regeneration

incidence of chronic hepatitis is highest with HCV infection partially b/c anti-HCV IgG are not protective antibodies

Note: if see portal bridging fibrosis & nodular regeneration, this is suggestive of cirrhosis, which can result from hepatitis or another cause

Front 2

concentric bile duct fibrosis

Back 2

occurs in sclerosing cholangitis

usu. associated with IBD

Front 3

copper deposition in liver

Back 3

Wilson's Dz

may be associated with chronic hepatitis & cirrhosis (but not related to the more common HCV ix)

Front 4

Histological findings in primary biliary cirrhosis

Back 4

granulomatous bile duct destruction

Front 5

Budd-Chiari syndrome

Back 5

hepatic venous stenosis --> hepatic enlargement & necrosis, ascites

Front 6

microvesicular steatosis in liver

Back 6

acute fatty liver of pregnancy or Reye syndrome in children

Front 7

antimitochondiral antibody

Back 7

primary biliary cirrhosis

Front 8

anti-smooth muscle antibody

Back 8

autoimmune hepatitis

clinically similar to chronic viral hepatitis but viral serologic markers are absent and various autoantibodies may be present (anti-smooth muscle, anti-ANA)

Front 9

transaminases (ALT & AST) in the thousands

Back 9

autoimmune hepatitis
or
acute viral hepatitis

Front 10

PAS stain reveals pink globules in hepatocytes

Back 10

alpha-1-antitrypsin deficiency

allows destruction of lung parenchyma by elastase leading to emphysema

Front 11

piecemeal necrosis

Back 11

chronic active HBV or HBC

Front 12

loss of intrahepatic bile ducts

Back 12

primary biliary cirrhosis

will see granulomatous inflammation of ducts in portal triad & anti-mitochondrial antibodies

Front 13

bile duct proliferation in the triads

Back 13

extrahepatic biliary obstruction

gallstone, extrahepatic biliary atresia (congenital)

Front 14

giant cells in liver

Back 14

probably neonatal hepatitis, which is either idiopathic or associated with congenital ix (i.e. CMV)

Front 15

microvesicular steatosis

Back 15

acute liver dmg

such is due to aspirin consumption (Reye's syn. in kids), pregnancy, other drugs

Front 16

macrovesicular steatosis

Back 16

slow chronic cause

usually alcohol associated fatty liver dz

if no EtOH hx, obesity, DM, or both can be considered as causes of NASH

Front 17

What is papilledema?

Back 17

optic disc swelling due to elevated ICP

Front 18

How are elecotrolyte values affected by cirrhosis?

Back 18

Ca++: decreased (b/c albumin decreased)
Na+: decreased (I don't know why)
K+: decreased (secondary aldosteronism)

Front 19

Mallory bodies

Back 19

characteristic of but not specific to alcoholic hepatitis

see globular eosinophilic cytoplasmic inclusions (bigger but dimmer than the PAS+ globuels in aat) & acute inflammation

Front 20

histological picture of chronic HB vs chronic HCV

Back 20

HBV: inflammatory infiltrate around portal triad, may extend to lobules & surround hepatocytes if active

HCV: infiltrate forms lymphoid aggregates or follicles; steatosis

Front 21

causes of micronodular cirrhosis of liver

Back 21

alcholoic liver dz, NASH, hemachromatosis

macro & micronodular cirrhosis will appear similar in late stages of dz

Front 22

causes of macronodular cirrhosis of liver

Back 22

viral hepatitis, Wilson's Dz (copper build-up), & alpha-1 antitrypsin deficiency

macro & micronodular cirrhosis will appear similar in late stages of dz

Front 23

What is papilledema?

Back 23

optic disc swelling due to elevated ICP

Front 24

How are elecotrolyte values affected by cirrhosis?

Back 24

Ca++: decreased (b/c albumin decreased)
Na+: decreased (I don't know why)
K+: decreased (secondary aldosteronism)

Front 25

Mallory bodies

Back 25

characteristic of but not specific to alcoholic hepatitis

see globular eosinophilic cytoplasmic inclusions (bigger but dimmer than the PAS+ globuels in aat) & acute inflammation

Front 26

histological picture of chronic HB vs chronic HCV

Back 26

HBV: inflammatory infiltrate around portal triad, may extend to lobules & surround hepatocytes if active

HCV: infiltrate forms lymphoid aggregates or follicles; steatosis

Front 27

causes of micronodular cirrhosis of liver

Back 27

alcholoic liver dz, NASH, hemachromatosis

macro & micronodular cirrhosis will appear similar in late stages of dz

Front 28

causes of macronodular cirrhosis of liver

Back 28

viral hepatitis, Wilson's Dz (copper build-up), & alpha-1 antitrypsin deficiency

macro & micronodular cirrhosis will appear similar in late stages of dz

Front 29

florid duct lesions

Back 29

destruction of bile ducts in primary biliary cirrhosis (an autoimmune dz with anti-mitochondrial antibody)

Front 30

pANCA

Back 30

ulcerative colitis

Front 31

anti-Sacchormycers cervisiae Ab

Back 31

Crohn's Dz

Front 32

ankylosing spondylitis

Back 32

associated with Crohn's & Ulcerative Colitis

Front 33

sclerosing cholangitis is associated with what?

Back 33

ulcerative colitis >>Crohn's

Front 34

HLA-B27

Back 34

patients with IBD & ankylosing spondilitis

Front 35

colon cancer due to abnormal mismatch repair genes

Back 35

HNPCC

Front 36

elevated alk phos, but NOT elevated bilirubin

what do these labs suggest?

Back 36

hepatic metastasis

(focal destruction of liver cells)

Front 37

what is a pancreatic pseudocyst? what predisoposes to it?

Back 37

= area of necrosis with wall of granulation tissue

usually develops from chronic pancreatitis, especially that due to alcohol abuse

Front 38

Whipple Dz

Back 38

Tropheryma whippelii = causative organism

see foamy, PAS+ macrophages in submucosa of small intestine, adjacent lymph nodes, & extraintestinal sites

sx include diarrhea and sequelae of malabsorption. but this dz affects sites outside the GI as well, including the brain, and may cause visual hallucinations.

Front 39

Cullen sign

Back 39

umbilical bruise

sign of pnacreatitis

Front 40

Gray-Turner sign

Back 40

flank bruise

sign of pancreatits

Front 41

symptoms of pancreatitis

Back 41

nausea, vomiting, umbilical or flank bruises, duodenal obstruction

Front 42

ARDS

Back 42

cx of pancreatitis
lipase in blood damages lungs

Front 43

hypocalcemia & elevated lipase & hyperglycemia

Back 43

pancreatitis:
fat binds calcium
decreased insulin causes hypergycemia & hyperlipidemia

Front 44

DM
steatorrhea
calcifications on xray

Back 44

diagnostic triad for chronic pancreatitis

may see pseudocyst instead of calcifications

Front 45

black male with jaundice, painful swelling that alternates legs

Back 45

carcinoma of pancreas
associated with smoking
K-RAS mutation
Courvoisier's sign (bile obstruction --> palpable gall bladder)
Trousseau's sign = the swollen legs = hypercoaguability (paraneoplastic)

Front 46

steatorrhea, gallstones, DM, achlorhydria

Back 46

somatostatinoma

Front 47

migratory necrolyti erythema

Back 47

rash associated with glucagonoma
pt will have high glucose too

Front 48

HLA-DR3 or DR4

Back 48

associated with DM Type I

Front 49

pancreas stains green with Congo red

Back 49

amyloid deposits in pancreas = Type II DM

amylin released iwth insulin

Front 50

thyroid stains green with congo red

Back 50

medullary cancer of thyroid

Front 51

sentinel loop & left sided pleural effusion

Back 51

acute pancreatitis

Front 52

hyperglycemia can set off PKC, causing what?

Back 52

pro-inflammatory storm (VEGF, TGF-beta, PAI-a, inflammatory cytokines, etc.)

Front 53

polyol pathway

Back 53

triggered by hyperglycemia in DM

converts glucose to sorbital

causes neuropathy & ocular cx

Front 54

strawberry gall bladder seen on histo

Back 54

cholesterolosis

Front 55

which hepatitis is a DNA virus?

Back 55

HepB

also has longest incubation period (3-6 months)

Front 56

liver fluke

Back 56

Chlonarchis srensis

causes hepatitis

Front 57

Dane particle

Back 57

HepB virus

Front 58

on gross exam, liver's capsule appears wrinkled

Back 58

indicates hepatic necrosis, likely due to hepatitis

Front 59

drug that causes fulminant hepatitis

Back 59

acetominophen

Front 60

Mallory bodies

Back 60

alcoholic hepatitis

clups of disorganized cytoskeletal filaments

Front 61

Kupffer cells

Back 61

macrophages lining sinusoids of liver
responsible for early EtOH-related injury in chronic alcoholics

appear kind of blue amidst reddish hepatocytes

Front 62

what is associated with OCPs

Back 62

liver cell adenoma

cholestasis

Front 63

causes of hepatocellular carcinoma

Back 63

liver fluke
aflatoxins (in peanuts & lots of foods Asians like to eat. what?)
HepB

Front 64

klatskin tumor

Back 64

ca in bile ducts abutting liver

("klat" = tight)

causes bile obstruction but you won't see Courvoisier's sign (distended gall bladder)

Front 65

Hurthle cells

Back 65

Hashimoto's thyroiditis

cells pink due to increased mitochondria

in Hashimoto's, will also see nodular, mixed cell infiltrate & germinal center form'n by active B cells

Front 66

subactue thyroiditis that is painful

Back 66

Subacute Granulomatous Thyroiditis (aka DeQuervain's)

post-viral

Front 67

subacute, painless thyroiditis

Back 67

subacute lymphocytic thryoiditis

Front 68

HLA-Dr3 & DR5

Back 68

associated with Hashimoto's thyroiditis

Front 69

what is associated with a high risk of thyroid lymphoma?

Back 69

Hashimoto's

Front 70

thyroid cancer with capsular invasion

Back 70

follicular cancer (requires biopsy to see capsular invasion--aspirate not enough b/c no distinctive cellular signs)

RAS mutation

hematogenous spread

Front 71

orphan annie eyes

Back 71

papillary cancer of thyroid

psammoma bodies as well
lymphatic spread
good prognosis
RET mutation

Front 72

what do MEN IIa & IIb have in common?

Back 72

medullary cancer of thyroid (= a cancer of the chief cells causing high clacitonin +/- low ca; histological sign is amyloid deposition)

RET mutation

Front 73

osteitis fibrosis cystica

Back 73

= Brown's tumor

high PTH causes bone resorption, bleeding into bone

Front 74

Parathyroid carcinoma

Back 74

deadly but rare

asymptomatic or sx of hypercalcemia

Front 75

what causes secondary hyperparathyroidism?

Back 75

renal failure (response to high phosphate, low calcium)

Front 76

GNAase mutation

Back 76

causes pseudohypoparathyroidism b/c body is unresponsive to PTH

sx of hypocalcemia: hyperreflexia (Trousseau's sign, Chevostek's sign), cramps, hand & perioral numbness & tingling

Front 77

21 hydroxylase deficiency

Back 77

low aldosterone, low cortisol
high androgens

high ACTH (& pigmentation)

Front 78

Waterhouse Friedrichson syndrome

Back 78

N. meningitis infection
causes bleeding intn or infarction of adrenals

Front 79

worldwide, what is the leading cause of the following lab findings?:
low Na, high K
metabolic acidosis
hypoglycemia

Back 79

addison's dz = no response to ACTH --> adrenal insufficiency

worldwide mcc: TB
USA mcc: autoimmune, idiopathic or prolonged steroid use

ACTH builds up (as does POMC, causing hyperpigmentation)
but you don't get any aldosterone or cortisol

Front 80

high dexamethasone test: ACTH not suppressed

Back 80

means the source of ACTH is not in the pituitary (we're not dealing with Cushing's Dz/pituitary adenoma)

when the high dexamethasone test successfully suppresses ACTH, then the source of the ACTH is the pituitary

Front 81

Conn's Syndrome

Back 81

tumor in adrenal cortex's glomerulosa

high aldosterone

causes high Na, low K, possible alkalosis
hypertension

Front 82

2 mutations common in pituitary adenomas

Back 82

PTTP
GSP (no inhibition of GTPase activity)

Front 83

2 causes of high prolactin in pituitary adenoma

Back 83

functional adenoma: overproduction of prolactin without appropriate stimulation

stalk effect: DA can't reach pituitary from hypothalamus to inhibit prolactin secretion due to mass effect of adenoma

Front 84

ca19-9

Back 84

carcinoembryonic antigen

elevated in colon ca, pancreatic ca

Front 85

Thryoid histology shows:
tall columnar epithelium with papillary infoldings
scalloping of the colloid

Back 85

Grave's dz

Front 86

Pancreatic histology shows:
acinar neutrophilic infiltrate
necrosis
hemorrhage

Back 86

acute pancreatitis

Front 87

Pancreatic histology shows:
acinar fibrosis
fatty change

Back 87

Cystic fibrosis

Front 88

Pancreatic histology shows:
amyloid deposition in islets

Back 88

some cases of Type II DM

Front 89

Pancreatic histology shows:
normal islets in fibrous stroma

Back 89

chronic pancreatitis
shows minimal chronic inflammation

Front 90

Pancreatic histology shows:
islet hyperplasia

Back 90

infant born to diabetic mother

Front 91

Pancreatic histology shows insulitis (mediated by T cell infiltration) but no sx

Back 91

type I dm (sinulitis occurs before onset of symptoms)