Pathology Exam 3

Front 1

Jaundice

Back 1

Jaundice (or icterus) is yellow-green pigmentation of the skin or sclerae caused by and increase in bilirubin.
1. Overproduction of bilirubin caused by increased breakdown of red cells, (e.g.,intravascular hemolysis-hemolytic anemia)
2. Impaired uptake of bilirubin from blood secondary to liver disease, (e.g., sepsis, drug, toxicity)
3. Decreased conjugation of bilirubin in the hepatocyte, (e.g., hepatitis, neonatal jaundice,
Gilbert's syndrome)
4. Impaired secretion/excretion of bilirubin either intrahepatic (e.g. Dubin-Johnson's
Syndrome, recurrent jaundice of pregnancy) or extrahepatic (e.g., obstructive gallstones, carcinoma of head of pancreas)

Front 2

Disease states of hepatitis (5)

Back 2

a. Chronic hepatitis
b. Fulminant hepatic necrosis
c. Carrier states (varies for each type of hepatitis)
d. Cirrhosis
e. Hepatocellular cancer

Front 3

Acute hepatitis

Back 3

Diffuse liver injury w/ lobular disarray

Front 4

Chronic hepatitis

Back 4

Portal tract inflammation w/ interface hepatitis

Front 5

Necrosis of random, isolated liver cells

Back 5

Councilman bodies

Front 6

Benign hepatic neoplasms (4)

Back 6

- Focal nodular hyperplasia (?vascular, reactive non-neoplastic),
- Bile duct adenomas
- Liver cell adenomas, (birth control pills, steroids).
- Hemangioma

Front 7

Types of malignant hepatic neoplasms (3)

Back 7

1) Hepatocellular CA
2) Cholangiocarcinoma (Bile Duct Tumor)
3) Hepatocholangiocarcinoma

Front 8

Etiology of Hepatocellular carcinoma

Back 8

- Protracted (chronic) HBV or HCV
- Aflatoxin B1
- Cirrhosis (any cause)
** Note: Any cause for chronic cell turnover

Front 9

USA - 2-3 cases/100,000 population; 7th decade; Males>females (2:1 up to 8:1); Cirrhosis in 80-90% cases (in Western World)

Back 9

Epidemiology of hepatocelluar CA

Front 10

Clinical Hx of hepatocelluar CA

Back 10

Upper abdominal pain, fatigue, weight loss, elevated serum alpha-fetoprotein (from neoplastic cells)

Front 11

Carcinoma of the Pancreas (exocrine)

Back 11

a. Possible Etiology - Smoking, high fat intake, benzidine, history of gastrectomy
b. Gross pathology - Majority in head of pancreas
c. Symptoms - obstruction, painless jaundice
d. Histology - adenocarcinoma (glands)
e. Origin from ducts
f. Very poor prognosis

Front 12

Islet cell tumor (endocrine)

Back 12

- Insulinomas most common, most often benign glucagonomas, somatostatinomas and VIPomas also seen.
- Some malignant (metastases seen)
- Clinical triad

Front 13

Clinical triad (insuloma)

Back 13

1) Attacks of hypoglycemia
2) Acute confusion/stupor
3) Relief w/ glucose administration/infusion

Front 14

Transmission: Fecal-oral
Inc. Period: 15-45 days
Carrier state: None
Chronicity: None

Back 14

Hep A (HAV) RNA

Front 15

Transmission: Parenteral
Inc. Period: 30-180 days
Carrier state: 0.1-1% Blood donors
Chronicity: Acute

Back 15

Hep B (HBV) DNA

Front 16

Transmission: Parenteral
Inc. Period: 30-50 days
Carrier state: Drug addicts, homos
Chronicity: ?

Back 16

Hep D or delta (HDV) RNA

Front 17

Transmission: Transfusion (parenteral)
Inc. Period: 14-180 days
Carrier state: 2-3% blood donors
Chronicity: ?

Back 17

Hep C (HCV) RNA

Front 18

Transmission: Water-borne
Inc. Period: 6 weeks
Carrier state: None
Chronicity: Rare

Back 18

HEV (calivirus) RNA

Front 19

Councilman bodies

Back 19

Necrosis of random, isolated liver cells

Front 20

Histopath of cirrhosis

Back 20

a. Disorganized liver architecture
b. Fibrosis
c. Parenchymal nodules secondary to
d. Reorganized vascular architecture

Front 21

Etiologies of cirrhosis (7)

Back 21

a. Fatty liver (alcohol, obesity, DM, medications): 60 - 70 %
b. Postnecrotic cirrhosis e.g.(post-viral): 10%
c. Biliary cirrhosis (Primary and secondary): 5-10%
d. Cirrhosis associated with hemochromatosis (iron): 5%
e. Cirrhosis associated with Wilson's disease (copper): rare
f. Cirrhosis associated with alpha-1 anti- trypsin deficiency: rare
g. Cryptogenic: 10 - 15%

Front 22

20 x 106 Americans affected w/ these

Back 22

Gallstones (cholelithiasis)

Front 23

Pathogenesis of gallstones

Back 23

- Supersaturation of bile (Bile has 3 constituents - Cholesterol, Bilirubin, Lecithin)
- Initiation of stone formation.
- Growth

Front 24

Demography - Northern Europe, American Indians, Mexican Americans, probable familial disposition

Back 24

Gallstones

Front 25

Etiology of gallstones (7)

Back 25

1) Obesity
2) High calorie diet
3) Clofibrate therapy
4) Gastrointestinal disorders; ileal (e.g., Crohn's disease, resection, or bypass; cystic fibrosis with pancreatic insufficiency)
5) Female sex hormones; female preponderance after puberty; estrogenic medications; ? oral contraceptives
6) Advancing age
7) Probable but not well established; pregnancy, multiparity, diabetes

Front 26

Etiology of pigment stones

Back 26

1) Chronic hemolysis
2) Alcoholic cirrhosis
3) Biliary infection
4) Advancing age

Front 27

Demography; Oriental more than Occidental; rural more than urban

Back 27

Pigment stones

Front 28

Clinical consequences include obstruction of common duct, biliary cholic, predisposition to cholecystitis

Back 28

Pigment stones

Front 29

Morphology of pigment stones

Back 29

- Pure cholesterol stones
- Pigment stones
- Mixed stones

Front 30

90% of cases secondary to impacted gallstone. Secondary gram negative infection

Back 30

Cholecystitis (inflammation of the bladder)

Front 31

Pathology of cholecystitis

Back 31

Enlarged gallbladder, red to purple color with acute inflammation in gallbladder wall

Front 32

Sudden onset of abdominal pain associated with elevated serum pancreatic enzymes (amylase, lipase). Secondary inflammation and necrosis (parenchymal and fat necrosis) of pancreas

Back 32

Acute pancreatitis

Front 33

Symptoms of chronic pancreatitis (4)

Back 33

1) Abdominal pain (with each relapse)
2) No symptoms
3) Pancreatic insufficiency
4) Diabetes Mellitus (late)

Front 34

Causes of chronic pancreatitis (4)

Back 34

- Alcoholism
- Biliary tract disease
- Familial hereditary
- Cystic Fibrosis

Front 35

Conditions and etiologic agents associated w/ pancreatitis (12)

Back 35

1) Cholelithiasis
2) Alcoholism
3) Trauma
4) Extension from adjacent tissues
5) Blood-borne bacterial infection
6) Viral infections
7) Ischemia
8) Vasculitis
9) Drugs
10) Hyperlipidemia
11) Hypercalcemia
12) Hereditary/familial

Front 36

T/F Diabetes affects endocrine pancreas while pancreatitis affects the exocrine pancreas

Back 36

True

Front 37

Carcinoma of head of pancreas can lead to what?

Back 37

Impaired secretion/excretion of bilirubin extrahepatically