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159 Cards in this Set
- Front
- Back
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what is the end product of heme degradation in splenic macrophages?
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UCB
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is UCB lipid soluble?
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Yes
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what makes bilirubin water soluble?
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conjugated bilirubin is water soluble
glucuronic acid makes bilirubin water soluble |
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what converts CB to UBG?
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intestinal bacteria
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how much UBG is recycled to the liver and kidneys?
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20%
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what is responsible for the color of the stool and urine?
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Urobilin
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what is the most common cause of jaundice?
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viral hepatitis
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what is the 2nd most common cause of jaundice?
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Gilbert's disease
- fasting unconjugated hyperbilirubinemia |
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what are the phases of acute hepatitis?
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Prodrome
Jaundice Recovery |
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during hepatitis what peaks in the serum before jaundice occurs?
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serum transaminases
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Describe the findings in hyperbilirubinemia with an increased production of UCB?
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Urine bilirubin: absent
Urine UBG: increased Disorders: extravascular hemolytic anemia: spherocytosis, Rh and ABO HDN, warm AIHA |
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describe the findings in hyperbilirubinemia in which there is decreased uptake or conjugation of UCB?
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Urine bilirubin: absent
Urine UBG: normal Disorders: Gilbert's syndrome, Crigler-Najjar syndromes, Physiologic jaundice of Newborn, Breast milk jaundice |
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Describe Gilbert's syndrome
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familial nonhemolytic jaundice
- common AR or AD defect (depending on the mutation) - occurs in > 5% of population - 2nd MCC of hereditary cause of jaundice - Males > females - impaired glucuronyl transferase activity - jaundice occurs with fasting or increase in alcohol/phenobarbital intake - serum UCB rarely > 5mg/dL - all other liver functions tests are normal - liver biopsy not necessary - no treatment required |
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describe Crigler-Najjar syndromes
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genetic disorders with decreased to absent glucuronyl transferase enzyme
type with no enzymes incompatible with life (liver transplant necessary) |
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Describe physiologic jaundice of a newborn
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begins on day 3 of life
caused by normal macrophage destruction of fetal RBCs and inability of newborn liver to handle excess load |
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describe why breast milk causes jaundice
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due to pregnancy 3-alpha, 2-alpha-diol
does not require treatment |
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how much of the population of the US is affected by Gilberts syndrome?
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7%
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describe the findings of viral hepatitis
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defect in uptake of bilirubin
conjugation of UCB and secretion of CB urine bilirubin: increased urine UBG: increased |
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what would the CB finding be in obstructive jaundice?
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CB > 50%
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would Urine UBG be absent/present in obstructive jaundice?
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absent
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what are some examples of causes of obstructive jaundice?
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decreased intrahepatic bile flow
- drug induced - primary biliary cirrhosis - Dubin- Johnsons syndrome - Rotor's syndrome Decreased extrahepatic bile flow - Gallstone in common bile duct - Carcinoma of head of pancreas |
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describe Dubin-Johnson syndrome
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AR disorder in secretion into intrahepatic intrahepatic bile ducts
black pigment in hepatocytes |
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describe Rotors syndrome
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AR disorder in secretions into intrahepatic bile ducts without black pigment in hepatocytes
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cytomegalovirus
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common cause of diarrhea in AIDS when CD4 T-cell count is < 50-100 cells/mm
Treatment: ganciclovir |
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Norwalk virus
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most common cause of adult gastroenteritis
nausea, vomiting, diarrhea that resolves in 12-24 hours occasionally can be fatal fecal-oral transmission common infection on cruise ships tx: supportive |
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Rotavirus
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most common cause of childhood diarrhea, particularly occurs in winter months
Fecal-oral transmission Damages ion transport pump in small intestine Secretory diarrhea Rotazyme test on stool establishes dx Rotavirus vaccine highly effective in prevention: oral vaccine |
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Bacillus cereus
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Gram positive rod
food poisoning with preformed toxin associated with reheated fried rice/tacos self-limited |
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Campylobacter jejuni
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Curved or S-shaped gram negative rod
animal reservoirs: cattle, chicken, puppies Fecal-oral transmission via contaminated water, poultry, unpasteurized milk |
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what is the most common food borne illness and invasive enterocolitis in the US?
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Campylobacter jejuni
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describe the mechanism of diarrhea caused by Campylobacter jejuni
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invasive and secretory entercolitis
dysentery (bloody diarrhea) with crypt abscesses and ulcers resembling ulcerative colitis high fever and cramping abdominal pain organisms in stool with blood and leukocytes |
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what are some complications of Campylobacter jejuni?
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Gullian-Barre syndrome (antibodies cross react with neurons)
hemolytic uremic syndrome HLA-B27 positive seronegative spondyloarthropathy |
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what is the treatment of Campylobacter jejuni?
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Erythromycin
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Describe Clostridium botulinum.
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Gram positive rod
adult food poisoning with preformed toxins: blocks the release of ACh in presynaptic terminal of NM junction in ANS causes descending paralysis, mydriasis, dry mouth treatment: trivalent antitoxin |
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what causes floppy baby constipation?
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infant food poisoning often contracted by eating spores of Clostridium botulinum in honey
- infants lack protective bacteria |
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what type of organism is Clostridium difficile?
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gram positive rod
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what is C. difficile associated with?
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associated with pseudomembranous colitis the most common cause of nonsocomial diarrhea
secretory type of diarrhea |
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what is one of the main causes of a C. difficile infection?
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antibiotics induced in 65-90% of cases
antibiotics cause overgrowth of toxin producing C. diff. in colon toxins A and B release pro-inflammatory mediators and cytokines that attract neutrophils and stimulate excess fluid secretion (watery diarrhea) |
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what does the pseudomembrane caused by C. diff. consist of?
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Pseudomembrane covers colon mucosa: composed of cellular debri, leukocytes, fibrin, and mucin
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what type of culture has a higher specificity in diagnosis of C. diff. infection?
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Cytotoxin assay of stool has greater specificity than culture of stool for securing dx
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describe Escherichia coli.
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Gram negative rod
ETEC: certain strains produce toxin that activates adenylate of guanylate cyclase; causing secretory diarrhea |
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what is STEC O157:H7 serotype E. coli?
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contracted by eating undercooked beef
produces hemolytic uremic syndrome antibiotics are not recommended because may enhance toxin release |
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describe Mycobacterium avium-intracellulare complex
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Acid fast rods
causes diarrhea with malabsorption in AIDS foamy macrophages in lamina propria simulate Whipples disease |
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Describe Mycobacterium tuberculosis.
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Acid fast organism swallowed from primary focus in lung
invades Peyer's patches circumferential spread in lymphatics to stricture formation |
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What type of bacteria is Salmonella?
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Gram negative rod
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describe Salmonella enteritidis entercolitis.
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second most common food borne illness in US
contacted by eating raw or undercooked eggs products, raw milk products, and poultry or drinking contaminated water tx: ciproflaxacin or levofloxacin |
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describe typhoid fever caused by S. typhi:
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week 1: invades Peyers patches and produces sepsis (blood cultures best for dx)
Week 2: diarrhea (positive stool culture) classic triad: bradycardia, neutropenia, splenomegaly treatment: treat if symptomatic with fluroquinolone; antibiotics do not shorten the duration of illness and may cause increase frequency of carrier states |
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what is Shigella dysenteria and Shigella sonnei
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Gram negative rod
no animal reservoirs highly infectious: children in day care centers & mental institutions Mucosal ulcerations, pseudomembranous inflammation in rectosigmoid, dysentery associated with HLA-B27 positive serotype spondyloarthropathy treatment: treat if symptomatic with fluroquinolone or azithromycin |
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describe the diarrhea caused by Staphylococcus aureus.
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Gram positive coccus
food poisoning with preformed toxin culture food, not stool Gastroenteritis occurs 1-6 hours after eating self-limited |
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Vibrio cholera
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gram negative comma shaped rod
enterotoxin stimulates adenylate cyclase in small bowel contracted from drinking contaminated water or eating contaminated seafood especially crustacea tx: fluid replacement; glucose & sodium required in oral supplements |
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Yersinia enterocolitica
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Gram negative coccobacillus with bipolar staining
enterocolitis in children: mesenteric lymphadenitis that stimulates acute appendicitis associated with HLA-B27 positive seronegative spondyloarthropathy treatment: TMP-SMX |
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what is Balantidium coli?
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Protozoa
largest protozoan transmitted by ingestion of cysts in food and water produces colonic ulcers with bloody diarrhea tx: tetracycline |
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what is Cryptosporidium parvum?
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protozoa (sporozoa)
transmitted by ingestion of oocytes in food and water responsible for outbreaks of diarrhea in water supply most common cause of diarrhea in AIDS |
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how do you diagnose a patient with diarrhea caused by Cryptosporidium parvum?
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stool antigen test
oocytes partially acid fast |
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what are the 3 common pathogens in AIDS diarrhea?
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Cyclospora
Microsporidia Isospora belli |
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how does a patient get a cyclospora belli infection?
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contaminated rasberries
fecal oral transmission of the protozoa |
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how does a patient with AIDS get a Microsporidia belli infection?
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fecal oral transmission of the protozoa
spores are partially acid fast |
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what protozoa causes diarrhea in AIDS patients and are partially acid fast?
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Cyclospora
Microsporidia Isospora |
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describe Entamoeba histolytica infection?
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Protozoa
Transmitted by ingestion of cysts in food and water cysts are nonmotile and are present in formed stool trophozoites are motile and are present in diarrhea produces dysentery (bloody diarrhea) cysts excyst in the cecum and become trophozoites in the cecum; trophozoites release powerful histolytic agents that produce flask shaped ulcers trophozoites can penetrate portal vein tributaries and drain to the the liver to produce liver abscess trophozoites can penetrate hepatic vein tributaries and produce systemic disease |
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T/F
Trophozoites characteristically phagocytose red blood cells |
True
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how do you diagnose a E. histolytica infection?
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stool antigen test
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what is Giardia lamblia
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Protozoa
most common protozoal cause of diarrhea in US Transmitted by ingestion of cysts in food and water common in day care centers, mental hospitals, hikers, water supplies, men who have sex with men, IgA deficiency common variable immunodeficiency |
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describe the diarrhea caused by Giardia lamblia
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produces acute and chronic diarrhea with malabsorption
- cysts in formed stool - trophozoites in loose stools |
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how do you diagnose a Giardia lamblia infection?
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stool antigen test
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What type of bacteria is Salmonella?
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Gram negative rod
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describe Salmonella enteritidis entercolitis.
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second most common food borne illness in US
contacted by eating raw or undercooked eggs products, raw milk products, and poultry or drinking contaminated water tx: ciproflaxacin or levofloxacin |
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describe typhoid fever caused by S. typhi:
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week 1: invades Peyers patches and produces sepsis (blood cultures best for dx)
Week 2: diarrhea (positive stool culture) classic triad: bradycardia, neutropenia, splenomegaly treatment: treat if symptomatic with fluroquinolone; antibiotics do not shorten the duration of illness and may cause increase frequency of carrier states |
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what is Shigella dysenteria and Shigella sonnei
|
Gram negative rod
no animal reservoirs highly infectious: children in day care centers & mental institutions Mucosal ulcerations, pseudomembranous inflammation in rectosigmoid, dysentery associated with HLA-B27 positive serotype spondyloarthropathy treatment: treat if symptomatic with fluroquinolone or azithromycin |
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describe the diarrhea caused by Staphylococcus aureus.
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Gram positive coccus
food poisoning with preformed toxin culture food, not stool Gastroenteritis occurs 1-6 hours after eating self-limited |
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Vibrio cholera
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gram negative comma shaped rod
enterotoxin stimulates adenylate cyclase in small bowel contracted from drinking contaminated water or eating contaminated seafood especially crustacea tx: fluid replacement; glucose & sodium required in oral supplements |
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Yersinia enterocolitica
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Gram negative coccobacillus with bipolar staining
enterocolitis in children: mesenteric lymphadenitis that stimulates acute appendicitis associated with HLA-B27 positive seronegative spondyloarthropathy treatment: TMP-SMX |
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what is Balantidium coli?
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Protozoa
largest protozoan transmitted by ingestion of cysts in food and water produces colonic ulcers with bloody diarrhea tx: tetracycline |
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what is Cryptosporidium parvum?
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protozoa (sporozoa)
transmitted by ingestion of oocytes in food and water responsible for outbreaks of diarrhea in water supply most common cause of diarrhea in AIDS |
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how do you diagnose a patient with diarrhea caused by Cryptosporidium parvum?
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stool antigen test
oocytes partially acid fast |
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what are the 3 common protozoa in AIDS patients that cause diarrhea?
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cyclospora, microsporidia, isosproa belli
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If an AIDS patient eats rasberries that are contaminated with Cyclospora how can the patient be diagnosed with that protozoa?
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cyclospora oocysts are acid fast
- Microsporidia and Isospora belli oocytes are also acid fast |
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what is entamoeba histolytica?
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protozoa (amoeba)
transmitted by ingestion of cysts in food and water |
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describe the cysts in an Entamoeba histolytica infection.
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cysts are nonmotile and are present in formed stool
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describe the trophozoite of Entamoeba hisytolytica infection.
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trophozoites are motile and are present in diarrhea
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describe the Entamoeba histolytic infection.
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Produces dysentery
cysts excysts in the cecum and become trophozoites in the cecum trophozoites release powerful histolytic agents that produce flask shaped ulcers trophozoites can penetrate portal vein tributaries and drain to the liver to produce a liver abscess trophozoites can penetrate the hepatic vein tributaries and produce systemic disease |
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T/F
trophozoites from a Entamoeba histolytica infection typically phagocytose red blood cells |
True
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how do you diagnose a patient with Entamoeba histolytica?
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stool antigen test
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what is the most common protozoal infection in the US?
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Giardia lamblia
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describe Giardia lamblia.
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Protozoa
MC protozoal infection in US transmitted by ingestion of cysts in food and water common in day care centers, mental hospitals, hikers, water supplies, men who have sex with men, IgA deficiency, common variable immunodeficiency |
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describe the infection of Giardia lamblia
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produces an acute and chronic diarrhea with malabsorption
- cysts in formed stool - trophozoites in loose stools |
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how do you diagnose a Giardia lamblia infection?
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stool antigen test
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what is Anisakis simplex?
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Intestinal nematode
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describe the infection of Anisakis simplex.
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Transmission: eating raw fish dishes, eating pickled herring
Larvae penetrate gastic and intestinal mucosa Produce cramping abdominal pain; epigastric distress with nausea, vomiting, and diarrhea within a few hours after eating dx: endoscopy, IgE antibody test |
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what is the most common Helminth infection in the US?
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Enterobius vermicularis
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what is enterobius vermicularis?
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intestinal nematode
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does Enterobius vermicularis cause eosinophilia?
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NO because the adult worms are not invasive
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describe the enterobius vermicularis infection.
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intestinal nematode
- transmission by ingestion of eggs - eggs deposited in anus by adult worms cause pruritus ani - other infections: urethritis in girls, acute appendicitis |
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what is Trichuris trichiura?
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intestinal nematode (whipworm)
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does Trichuris trichiura produce eosinophilia?
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YES
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describe the Trichuria trichirua infection.
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intestinal nematode
- transmitted by ingestion of eggs - produces diarrhea, can produce rectal prolapse in children - dx: stool for ova and parasites, eosinophilia |
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what is Ascaris lumbricoides?
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intestinal nematode
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what is the Largest intestinal nematode?
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Ascaris lumbricoides
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describe the infection of Ascaris lumbricoides.
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transmitted by ingestion of eggs
- Larval phase through lungs: cough, pneumonitis, eosinophilia (invasive tissue) - bowel obstruction in adult phase: no eosinophilia (no invasion of tissue) |
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does Ascaris lumbricoides cause eosinophilia?
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YES
- larval phase in lungs causes eosinophilia - adult phase in bowel does not cause eosinophilia |
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what is Necatar americanus?
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Intestinal nematode (hookworm)
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how does Necatar americanus cause diarrhea?
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intestinal nematode adult attach to villi, resulting in blood loss and iron deficiency
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what is Strongyloides stercoralis?
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intestinal nematode
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describe the infection caused by Strongyloides stercoralis.
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Transmission: filariform larvae in soil penetrate the feet > larvae phase through the lungs > swallowed and molt into adults that enter the intestinal mucosa and lay eggs > eggs hatch into rhabditiform larvae which enter the intestinal lumen and are passed in the stool > develop into filariform larvae (infective form) in the soil
- Autoinfection may occur if filariform larvae in the intestine penetrate the mucosa and migrate to the lungs to repeat the cycle - produces abdominal pain and diarrhea |
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what is the intestinal cestode that causes diarrhea?
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Diphyllobothrium latum
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what is Diphyllobothrium latum?
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intestinal cestode (tapeworm)
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describe the infection caused by Diphyllobothrium latum.
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transmission: ingest larvae in lake trout (Great lakes)
produce diarrhea with or without vitamin B12 deficiency preferential uptake of vitamin B12 by the worm dx: eggs in the stool |
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Types of hepatitis with no protective antibodies
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Hepatitis C and D
presence of IgG antibodies indicates that they have active infection |
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Types of hepatitis with no chronic state
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Hepatitis A and E
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Most common type of hepatitis found in daycare centers
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Hepatitis A
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Most common type of hepatitis leading Hepatocellular carcinoma
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Hepatitis B and C
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Most common hepatitis in travelers to places outside the US
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Hepatitis A
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Most common hepatitis in jails and corrective institutes
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Hepatitis A
anal intercourse and by food transmission |
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Most common sexually transmitted type of hepatitis
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Hepatitis A, B, and C
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Most common cause of post transfusion hepatitis and chronic hepatitis
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Hepatitis C also MC hepatitis without jaundice
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Most common type of hepatitis prevented by immunization with hepatitis B vaccine
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Hepatitis B and D
also prevents hepatocellular carcinoma from HBV post necrotic cirrhosis |
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Most common types of hepatitis transmitted parenterally
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Hepatitis B, C, And D
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Most common type of hepatitis with protective antibodies
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hepatitis A,B, and E
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Most common hepatitis producing a fulminant hepatitis in a patient with a pre-existing hepatitis
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Hepatitis D
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Most common types of hepatitis transmitted by fecal-oral route
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Hepatitis A and E
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Most common type of hepatitis in homosexuals
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Hepatitis A: unprotected anal intercourse
virus in feces |
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Most common types of hepatitis that may lead to a chronic hepatitis
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Hepatitis B, C (most common), and D
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Most common type of hepatitis associated with cryoglobulins and type I membranoproliferative glomerulnephritis
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Hepatitis C (also HBV to a lesser extent)
HBV: membranous glomerulopathy and polyaritis nodosa association |
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Most common type of hepatitis transmitted by accidental needle stick.
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Hepatitis B
also underscores why HBV hepatitis is the MC systemic disease in IVDA |
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a 6 year old with nephrotic syndrome and ascites develops fever and rebound tenderness. a peritoneal tap shows numerous neutrophils phagocytosing gram positive diplococci
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Spontaneous peritonitis due to Streptococcus pneumonia
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a 22 year old woman overdoses on acetaminophen and lapses into a coma. Initially the transaminases were elevated but then the transaminases fell and the PT became markedly prolonged
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Fulminant hepatic failure
MC drug causing FHF Liver shrunken and not enough parenchyma left to increase transaminases PT prolonged because of synthesis of coagulation factors is impaired |
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A 65 year old with polycythemia vera develops sudden onset of fever, jaundice, painful hepatomegaly, and ascites
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Hepatic vein thrombosis
example of posthepatic obstruction of blood flow. Polycythemia is MCC followed by OCP. HCC can also cause it due to vessel invasion |
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a 62 year old man with left and right sided heart failure develops hepatomegaly with jaundice and elevated transaminases
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Centrilobular hemorrhagic necrosis
Left sided heart failure decreases perfusion to the liver due to decreased cardiac output and right sided heart failure produces back up of blood into the central vein producing hemorrhage example of intrahepatic obstruction to blood flow |
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a 23 year old woman in her 3rd trimester develops hypertension, proteinuria, dependent pitting edema, and hemolytic anemia with fragment RBCs and thrombocytopenia
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HELLP syndrome. patient has preeclampsia
H: hemolytic anemia with fragmented RBCs EL: elevated transaminases from zone 1 periportal hepatic necrosis LP: low platelets from consumption due to DIC |
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a 45 year old man from a developing country has caput medusae, heptosplenomegaly, ascites, and esophageal varices.
A CBC shows marked eosinophilia A liver biopsy shows concentric fibrosis around portal vein radicles |
Schistosomiasis due to S. mansoni
adults live in portal vein radicals and lay eggs that incite fibrosis of portal vein with development of portal vein HTN causing the previous findings |
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a 32 year old black man with restrictive lung disease and uveitis has hepatomegaly. Biopsies show non-caseating granulomas
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Granulomatous hepatitis due to sarcoidosis the MC non-infectious hepatitis
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what is the MC infectious cause of granulomatous hepatitis
|
TB is the MC infectious cause
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a 29 year old man has conjugated hyperbilirubinemia and absence od dye in the gallbladder after receiving contrast medium to visualize the gallbladder
A liver biopsy shows black pigmentation in the hepatocytes. |
Dubin-Johnson syndrome
AR disorder with defect in secretion of bile out of hepatocytes into the bile canaliculi. LIver has non-melanin black pigmentation. Dye used in oral cholecystogram does not enter the gallbladder since it uses the same mechanism as conjugated bilirubin for entering the bile ducts |
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a 32 year old woman has fever and tender hepatomegaly with elevated transaminases. A serum ANA is positive and anti-smooth muscle antibodies are present
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autoimmune hepatitis
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a 31 year old man with ulcerative colitis develops jaundice
A dye study is performed on the common bile duct and shows a "beading" effect of the common bile duct. |
Primary sclerosing cholangitis
Fibrosis is around the common bile duct, so the lumen is narrowed Uninvolved parts of the CBD fill normally. Similar in concept to beading effect of renal artery in fibromuscular hyperplasia PSC predisposes to cirrhosis and cholangiocarcinoma |
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A 28 year old woman is in a car accident and suffers injury to her abdomen. At surgery multiple contusions and lacerations are present in the liver. Blood is present in her bile
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Hematobilia
blood enters bile in liver trauma |
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A 26 year old man with acute appendicitis develops ascites and splenomegaly. A CT scan of the abdomen shows air in the portal vein. the liver is not enlarged
|
Portal vein thrombosis
Acute appendicitis is MCC of pylephlebitis Gas producing bacteria produces air in the portal vein. Phlebitis causes portal vein thrombosis Example of prehepatic obstruction to bile flow. Note the liver is not enlarged |
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a 38 year old black man with sickle cell anemia has cirrhosis of the liver. A Prussian blue stain of the liver shows blue granular material in Kupffer cells and hepatocytes
|
Hemosiderosis (secondary hemochromatosis)
iron overload due to excess transfusions, most of the iron accumulation is in macrophages rather than in parenchymal cells |
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A 32 year old who has been on OCP for the past 10 years becomes pregnant shortly after she discontinues the pills. Midway through her pregnancy she suddenly develops hypovolemic shock due to intraperitoneal hemorrhage from a mass in the liver.
|
Liver cell adenoma
OCP predispose to this development of this benign tumor, which has a tendency to rupture and produce intraperitoneal hemorrhage |
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A 28 year old pregnant woman develops marked transaminasemia and painful hepatomegaly. A liver biopsy is performed and shows diffuse fatty change. The baby is delivered and both mother and baby recover without any sequelae
|
Acute fatty liver of pregnancy
defect in B-oxidation of fatty acids Must deliver mother immediately to save child and mother |
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A 26 year old on OCPs develops conjugated hyperbilirubinemia and pruritus.
Serum Alkaline Phosphatase and GGT are both elevated. Her stools are light colored and urine is dark yellow-green She discontinues use of OCPs and the jaundice disappears |
Benign intrahepatic cholestasis
- estrogen in OCP inhibits secretion of conjugated bilirubin into the bile canaliculi Patient will also develop jaundice in pregnancy |
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A 29 year old man develops jaundice, fever, painful hepatomegaly. The conjugated bilirubin percentage is 40%, serum AST > ALT and serum GGT is elevated
CBC shows neutrophilic leukocytosis A liver biopsy reveals fatty change, liver cell necrosis, a neutrophilic infiltrate, and pink staining material in the hepatocytes Fibrosis is noted around some of the central veins |
Alcoholic hepatitis
pink staining material is Mallory bodies (damaged keratin filaments) Fatty change, neutrophilic infiltrate, perivenular fibrosis |
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A 39 year old man with alcoholic cirrhosis develops mental status abnormalities
When his hand and arm are raised up, his hand begins to show flapping tremors |
Asterixis
sign of hepatic encephalopathy |
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A 44 year old man with alcoholic cirrhosis has oliguria and serum BUN of 60 mg/dL and serum creatinine of 6 mg/dL
His early morning urine shows normal concentration |
Hepatorenal syndrome
note the BUN:Cr ratio < 15:1 indicating renal failure yet tubular function is intact (ability to concentrate urine) At autopsy, the kidneys are grossly and microscopically normal |
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At autopsy a 42 year old man has three 1 cm red colored lesions in the liver.
Histological sections of the lesions show a proliferation of thickened vascular channels |
Cavernous hemangiomas
MC benign tumor of the liver Can rupture but are not related to estrogen |
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A 62 year old smoker with weight loss and cough develops a mass in the right main stem bronchus and pain in the RUQ
CT scan shows multiple nodular densities in the liver |
Metastatic disease
primary lung cancer has metastasized to the liver Metastasis is the most common cause of cancer of the liver and lung cancer is the most common primary site followed by colorectal cancer |
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A 52 year old man with post necrotic cirrhosis due to HCV develops fever and rapidly increasing ascites. A peritoneal tap shows bloody ascitic fluid. A serum AFP level is markedly increased
|
Hepatocellular carcinoma
|
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A 48 year old man from Vietnam with post necrotic cirrhosis due to HBV develps secondary polycythemia
The AFP level is increased |
Hepatocellular carcinoma
Post necrotic cirrhosis due to HBV in association with aflatoxin in food is the MC cancer in Southeast Asia. Immunization could potentially prevent cancer. HCC can ectopically secrete EPO producing secondary polycythemia. It can also produce an insulin like factor causing hypoglycemia |
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A 49 year old man, who works in a factory that makes plastic tubing for sprinkler systems develops a mass in the liver
|
angiosarcoma
Polyvinyl chloride is the MCC of angiosarcoma Arsenic and thorium dioxide are also causes |
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A 42 year old woman develops fever, jaundice, and RUQ pain. An US shows a stone in the common bile duct. A CT scan of liver shows multiple liver abscesses
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Ascending cholangitis
a stone in the CBD starts the infection that ascends up the bile ducts into the liver parenchyma to produce the liver abscesses |
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Clonorchis sinensis, primary sclerosing cholangitis, Caroli's disease and choledochal cysts may cause this cancer
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Cholangiocarcinoma
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child with abdominal pain, intermittent jaundice, cirrhosis, and cysts in the biliary tract
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Choledochal cysts
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child with segmental dilation of the intrahepatic bile ducts and polycystic kidney disease
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Caroli's disease
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HIDA radionuclide scan is useful in confirming diagnosis of this disorder
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Acute cholecystitis
HIDA scan identifies the stone in the cystic duct Stone produces increased intraluminal pressure and ischemia to gallbladder wall predisposing to mucosal ulceration and infection by E. coli |
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Adult with recurrent epigastric pain 1-2 hours postprandially. US reveals stones in gallbladder
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Chronic cholecystitis most common symptomatic disorder of the gallbladder
Due to cholelithiasis with repeated attacks of minor inflammation primarily due to chemical inflammation |
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Gallbladder shows speckled mucosal surface
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Cholesterolosis: due to excess cholesterol in bile; cholesterol deposits in macrophages
no clinical significance |
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Elderly woman with weight loss and RUQ pain
Radiograph reveals calcification of the gallbladder |
Gallbladder cancer
dominant in elderly females; most common primary cancer of biliary tract due to cholelithiasis or porcelain gallbladder |
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T/F
Porcelain gallbladder is due to dystrophic calcification |
True
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A child has signs of small bowel obstruction
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Annular pancreas
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An alcoholic has fever, epigastric pain with radiation of pain to the back, hemorrhage in the left flank, and around the umbilicus
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Acute pancreatitis
with Grey Turner sign and Cullen's sign |
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a patient with acute pancreatitis has persistence of amylase for over 1 week
A CT scan shows a cystic mass around the pancreas |
Pancreatic pseudocysts
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