Pathology Exam 1- Liver/pancreas

Front 1

lobules anatomy

Back 1

receives blood flow from arterioles and portal vein (hepatic triad) which enter the liver sinusoids, which drain to the central vein (aka THV) which goes to the hepatic vein

Front 2

ALT/AST

Back 2

alanine aminotransferase
aspartate aminotransferase
"liver function tests"- maybe it is damaged

Front 3

enzymes to screen for biliary tree damage

Back 3

alkaline phosphatase
GGT

Front 4

bilirubin (2)

Back 4

gives yellow color to conjunctiva and skin during jaundice
byproduct of the breakdown of rbc

Front 5

bilirubin is elevated in...(4)

Back 5

severe liver dmg (severe hepatitis, decompensated cirrhosis, biliary obstruction due to tumor or gallstones, severe hemolysis)

Front 6

acute liver failure

Back 6

"fulminant" (super fast) necrosis takes healthy liver to dead liver in a few days to weeks

Front 7

causes of fulminant necrosis in liver (4)

Back 7

viral (hep B/C)
adverse drug rxn (tylenol)*******
autoimmune hepatitis**
miscellaneous- wilson's disease, mushroom poisoning...

Front 8

cirrhosis (3)

Back 8

chronic (> 6 months)
not a disease, but an "end state" of other disease
necrosis-->fibrosis-->loss of function

Front 9

chronic diseases that lead to cirrhosis (4)

Back 9

alcohol
chronic hepatitis (C,B,autoimmune)
biliary disease- mechanical obstruction, PBC, PSC
miscellaneous- hemochromatosis (iron overload), alpha-1-antitrypsin deficiency, wilson's disease

Front 10

hepatitis and types (4)

Back 10

inflammation of the liver
alcoholic
adverse drug
autoimmune
viral- systemic or liver-directed (A,B,C******,D,E)

Front 11

hepatitis virus (A,B,C) clinical courses (3)

Back 11

can be acute- lasts many weeks
asymptomatic
chronic (except for hep A cannot be chronic. mostly is hep C > 50%)

Front 12

hep B and hep C are usually transmitted...

Back 12

parenterally

Front 13

hep B transmission (5)

Back 13

IV drug abuse
sexual contact (takes much less virus to infect as opposed to hep C, which is not really transmitted sexually)
tattoos
transfusions
occupational (?)

Front 14

chronic is defined as

Back 14

> 6 months

Front 15

histology of acute hepatitis

Back 15

lymphocytes everywhere
liver cells die by either ballooning up or shriveling up (acidophil bodies)

Front 16

how does acute hepatitis resolve itself

Back 16

liver is good at replacing it's cells, as long as loss of cells does not exceed the rate of replacement, and there is no fibrosis

Front 17

histology of chronic hepatitis

Back 17

virus lingers and you get fibrosis

Front 18

hep B vs. hep C resolution

Back 18

hep B usually resolves itself (very few cases go on to chronic)
hep C- mostly becomes chronic stable disease, fulminant necrosis is rare, a small proportion goes onto cirrhosis and possible death

Front 19

hep B vs hep c vaccine

Back 19

no vaccine for C
good vaccine for B

Front 20

adverse drug reactions and liver damage

Back 20

mimic liver disease symptoms
recognition depends on temporal relationship (when drug was started, when abnormal tests began)

Front 21

acetaminophen + alcohol =

Back 21

liver necrosis
alcohol alters metabolic pathways of liver so even low doses of acetaminophen can be damaging

Front 22

if liver is over 70% necrotic...

Back 22

patient wont' live unless he gets a transplant

Front 23

of the 50% acute liver failure cases...

Back 23

36% are due to acetaminophen

Front 24

idiosyncratic acute liver failure due to drugs

Back 24

drugs that cause the damage will vary with individuals (hypersensitivity)
not dose dependent

Front 25

alcohol abusers and cirrhosis (% occurence)

Back 25

only the minorities of alcohol abusers that develop cirrhosis (15-20%)

Front 26

other co-occurence of disease in alcoholics who have cirrhosis

Back 26

hemochromatosis
hep C
pancreatitis
adverse drug reaction

Front 27

non-alcoholic steatohepatitis

Back 27

occurs in obese individuals
type II diabetic
becoming one of the leading causes of cirrhosis

Front 28

cirrhosis definition

Back 28

diffuse process characterized by fibrosis and abnormal regenerative nodules (surrounded by collagen)

Front 29

biliary diseases (2)

Back 29

primary biliary cirrhosis (more in females)- intrahepatic only, antimitochondrial Ab
primary sclerosing cholangitis (more in males)- intra/extra hepatic, patients usually also have ulcerative colitis

Front 30

hemachromatosis

Back 30

5 per 1000 have abnormal gene that leads them to take too much iron up from normal diet
deposited in liver, pancreas, heart (get associated organ disease)
treated by phlebotomy

Front 31

cirrhosis causes of death (4)

Back 31

common- hepatic bleeding (varices)
hepatic coma (not detoxifying ammonia)

uncommon- infection
malignant tumor (hepatocellular carcinoma)

Front 32

connection between cirrhosis and esophageal varices

Back 32

cirrhosis decreases bloodflow through the liver from the hepatic portal veins. because the blood cannot flow fast enough through portal veins, through liver, this causes portal vein hypertension, which causes blood to find other places to reroute. One of these routes is through the esophagus, and the increased amount of blood dilates the vessels there causing varices.

Front 33

gallstones risk factors

Back 33

women
increase with age
ethnic
environmental
hemolysis

Front 34

cholelithiasis and cholecystitis

Back 34

choleithisasis- stone formation in gall bladder
cholecystitis- inflammation if gall bladder

Front 35

gallbladder carcinoma

Back 35

rare cancer, but dangerous

Front 36

cause of pancreatitis

Back 36

choleithisasis
alcohol abuse
others (less common)- familial, hyperlipidemia

Front 37

acute pancreatitis

Back 37

when inflamed, pancreas releases enzymes into itself rather than GI tract. you get fat necrosis.

Front 38

indicators of pancreatitis (labs)

Back 38

amylase
lipase

Front 39

complications of acute pancreatitis

Back 39

shock
pseudocyst

Front 40

complications of chronic pancreatitis

Back 40

intractable pain
pseudocyst
maldigestion

Front 41

pancreatic neoplasms types

Back 41

carcinoma- arises from duct, sublinical til lethal

islet cell tumors