Pathology(Gallbladder,liver,exocrine Pancreas)*

Front 1

Jaundice during 1st week of life;not clinically important;charact. by uncongugated hyperbilirubinemia;due to inc. bilirubin prod. & def. glucuronyl transferase in immature liver

Back 1

Physiologic jaundice of the newborn
-distinguished from neonatal cholestasis(due to extrahepatic biliary atresia, alpha1-antitrypsin def.,CMV infxn, & many other conditions)

Front 2

Commonly occuring congenital hyperbilirubinemia charact. by inc. serum unconjugated bilirubin w/ no clinical consequence due to dec. uptake of bilirubin by liver cells & dec. glucuronyl transferase activity

Back 2

Gilbert Synd.

Front 3

Severe congenital hyperbilirubinemia charact. by inc. unconjugated bilirubin due to deficiency of glucuronyl transferase;leads to early death due to Kernicterus(damage to basal ganglia & CNS)

Back 3

Crigler-Najjar Synd.
-responds to Phenobarbital w/c dec. serum conc. of unconjugated bilirubin

Front 4

An autosomal recessive form of unconjugated hyperbilirubinimia due to defective bilirubin transport & charact. by brown-black discoloration of the liver due to deposition of dark pigment granules

Back 4

Dubin-Johnson Synd.

Front 5

Similar to Dubin-Johnson Synd but w/o the abnormal pigment present

Back 5

Rotor Synd.

Front 6

Type of juandice charact. by inc. serum conjugated or unconjugated bilirubin, inc. urine bilirubun,normal-dec. urine urobilinogen,inc. ALT,AST,ALP(indicates intrahepatic obstruction)

Back 6

Hepatocellular
-hepatocellular damage results in impaired conjugation;intrahepatic cholestasis results in retention of conjugated bilirubin

Front 7

Type of jaundice charact. by inc. serum conjugated bilirubin,inc. urine bilirubin,dec. urine urobilinogen,inc. ALP,variable ALT & AST

Back 7

Obstructive
-w/ complete obstruction,stools are pale & clay colored,urine urobilinogen is undetectable

Front 8

Type of jaundice charact. by inc. serum unconjugated bilirubin,absent urine bilirubin(acholuria),inc. urine urobilinogen

Back 8

Hemolytic
-degree of urobilinogen inc. directly related to inc. hemoglobin catabolism

Front 9

Liver dse. charact. by jaundice,inc. serum aspartate(AST)& alanine aminotransferase(ALT)due to RNA viral agents(EBV,CMV)except for HBV(DNA virus)

Back 9

Acute Viral Hepatitis
-presents w/ fever,anorexia,nausea, vomitting,jaundice,dark urine,pale feces,elevated transaminase levels

Front 10

Type of hepatitis spread via fecal-oral route,has no carrier state,does not lead to chronic liver dse.,incubation period(15-45dys),no relation to hepatocellular carcinoma,affects mostly children

Back 10

HAV
-presence of IgM antibody(ongoing infxn,most important for dx.,not found in acute stage),IgG(past infxn)

Front 11

Type of hepatitis virus containing a DNA genome;spread via parenteral, sexual,vertical route;incub.(60-90dy); assoc. w/ hepatocellular carcinoma; results in a carrier state or chronic liver dse.;charact. by "ground-glass" appearance of hepatocytes

Back 11

HBV(hepadna family)
-consist of HBcAg,HBeAg(indicator of infectivity),HBsAg(if present >6mos.~carrier state,elicits anti-HBsAg,persist for 3-4mos)

Front 12

Serum marker in HBV infection w/c is present during the window phase

Back 12

HBcAg
-also anti-HBcAg(appears 4wks after appearance of HBsAg,present during acute illness,remain inc. for years)

Front 13

Hepatitis virus transmitted parentally(common cause of transfusion mediated hepatitis);leads to a carrier state & chronic hepatitis;assoc. w/hepatocellular carcinoma

Back 13

HCV
-formally known as non-A,non-B hepatitis

Front 14

Hepatitis virus surrounded by a proteinaceous coat of HBsAg; replicatively defective(requires simultaneous infxn. w/ HBV;transmitted sexually or parentally;found in high incidence w/ intravenous drug users

Back 14

HDV(delta agent)

Front 15

Hepatitis virus transmitted fecal-oral route(similar to HAV);occurs in water borne epidemic form in underdevelop countries

Back 15

HEV

Front 16

Hepatitis in w/c symptoms persist for >6mos.;results from any viral hepatitides(except HAV,VEV)infxn,liver damagedue from non-viral agents or from non immunologic abnormalities(marked by hypergammaglobulinemia & anti-smooth muscle antibodies)

Back 16

Chronic Hepatitis

Front 17

Inflammatory liver disorder of unknown etiology charact. by multinucleated giant cells;demonstrates bile pigment & hemosiderin w/ in the parenchyma; results in juandice during 1st wk of life

Back 17

Neonatal Hepatitis

Front 18

Virus w/c causes "infectious mononucleosis" often causing hepatitis & involving other organ systems

Back 18

Epstein-Barr virus(EBV)

Front 19

Virus affecting the liver in infants & immunocompromised people demonstrating the charact. "owl's eye appearance"

Back 19

Cytomegalovirus(CMV)

Front 20

Liver infxn. charact. by a midzonal hepatic necrosis & peresence of "councilman bodies"(dying hepatocytes condense into contracted eosinophilic forms)

Back 20

Yellow Fever

Front 21

Inflammatory liver disorder caused by leptospira species charact. by jaundice,renal failure, & hemorrhagic phenomena

Back 21

Leptospirosis
-also known as Weil dse or icterohemorrhagic fever

Front 22

Inflammatory liver disorder caused by ingestion of tapeworm eggs from the feces of dogs & sheep resulting in hydatid dse. of the liver in w/c parasitic cyst invade the liver

Back 22

Echinococcus Granulosus

Front 23

Inflammatory liver dse. caused by Schistosoma mansoni or S.japonicum in w/c the adult worms lodge in the portal vein & branches~eggs are anitgenic, stimulating granuloma formation resulting in tissue destruction, scarring, & portal HPN

Back 23

Schistosomiasis

Front 24

A liver disorder assoc. w/ presence of small fat vacoules in parenchymal liver cells

Back 24

Microvesicular fatty liver
-differs from large fat containing vacoules charact. of fatty change

Front 25

An acute microvesicular fatty liver disorder found in young children also charact. by encephalopathy & coma; assoc. w/ aspirin administration in children w/ acute viral infections

Back 25

Reye Synd.

Front 26

Most common form of liver dse. in the U.S w/c vary from fatty liver(steatosis,most frequent,reversible) to alcoholic hepatitis & cirrhosis;may be asymptomatic,assoc. w/ mild-severe hepatic infl.,cirrhosis, or encephalopathy

Back 26

Alcoholic Liver Dse
-assoc. w/ excessive alcohol consumption

Front 27

Variant of alcoholic liver dse. charact. by fatty change,focal liver cell necrosis,infiltrates of neutrophils & Mallory bodies(intracytoplasmic eosinophilic hyaline inclusions) derived from cytokeratin intermediate filaments

Back 27

Alcoholic Hepatitis
-assoc. w/ irreversible fibrosis w/c surround the central veins(perivenular fibrosis,sclerosing hyaline necrosis, central hyaline necrosis)leading to central vein obstruction & fibrosis surrounding the liver cells causing cirrhosis

Front 28

Chronic liver dse. charact. by generalized disorganization of hepatic architecture w/ scarring & nodular form. due to cell damage,regenerative activity,& fibrosis;assoc. w/ inc. incidence of hepatocellular carcinoma

Back 28

Cirrhosis
-classified on basis of nodular size(micronodular,macronodular,mixed)

Hint 28

nodular

Front 29

Most common form of cirrhosis assoc. w/ alcoholism w/ micronodular pattern evolving in late stages to typical hobnail liver w/ large, irregular nodules

Back 29

Alcoholic(Laennec,nutritional)

Front 30

Type of cirrhosis due to a familial defect in control of iron absorption~accumulation of hemosiderin in hepatic & pancreatic parenchymal cells,myocardium etc.;micronodular

Back 30

Hemochromatosis(Hereditary primary)
-triad of cirrhosis,diabetes mellitus, & inc. skin pigmentation

Front 31

Cirrhosis due to accumulation of copper in the liver,kidney,brain & cornea;can be micronodular or macronodular;dec. serum ceruplasmin

Back 31

Wilson Dse.

Front 32

Cirrhosis assoc. w/ galactosemia, glycogen storage dse., or alpha1-antitrypsin def.

Back 32

Inborn errors of metabolism

Front 33

Findings in alcoholic cirrhosis assoc. w/ hepatocellular damage & liver failure

Back 33

Jaundice(mixed),hypoalbuminemia(dec. albumin synthesis),coagulation factor def.(dec. synthesis of coagulation factors except von Willebrand factor, hyperestrinism(palmar erythema;spider nevi of face,upper arms,chest;loss of body hair;testicular atrophy & gynecomastia

Front 34

Causes of peripheral edema,ascites, or hydrothorax w/c are changes due to liver cell damage & portal HPN in alcoholic cirrhosis

Back 34

Inc. portal venous pressure(leads to inc. production of hepatic lymph),dec. plasma oncotic pressure(due to hypoalbuminemia),retention of Na & H20(due to dec. hepatic degradation of aldosterone,activation of renin-angiotensin system, or both)

Front 35

Consequence of intrahepatic scarring w/ inc. portal venous pressure in alcoholic cirrhosis

Back 35

Esophageal varices(leads to upper GI bleeding),rectal hemmorhoids,caput medusae(periumbilical collaterals), splenomegaly

Front 36

Pathology of encephalopathy(portal-systemic encephalopathy)due to cell damage & portal HPN in alcoholic cirrhosis

Back 36

Shunting of portal bld. to systemic circulation~delivery of unfiltered neurotoxins(ammonia,enteric degradation products)directly into systemic circulation~confusion,deep coma, asterixis(flapping tremor of hands)

Front 37

Morphologic abnormalities found in alcoholic liver dse.

Back 37

Enlarge-small-shrunken liver; miconodular;fibrous bands surrounding nodules of distorted liver cell plates; presence of proliferating bile ducts & inflammatory cells(lymphocytes,plasma cells)in fibrous bands;hobnail liver(form. of large,irregular nodules resulting in scarred,shrunken liver in the late stages)

Front 38

Cirrhosis charact. by large,irregular nodules due to broad fibrous bands dividing the liver w/c often contain intact hepatic lobules;sequela of chronic active hepatitis(HBV&HCV are most common)

Back 38

Postnecrotic(macronodular,posthepatic)cirrhosis
-may result from alcoholic cirrhosis; leads to hepatocellular carcinoma;may be caused by noninfxn. hepatotoxic agents

Front 39

Cirrhosis autoimmune in origin assoc. w/ inc. incidence of other autoimmune disorders & charact. anti-mitochondial antibodies;common in middle-age women; inc. parenchymal copper concentration; charact. by severe obstructive jaundice,itching,hypercholesterolemia(leads to cutaneous xanthoma form.)

Back 39

Primary Billiary Cirrhosis

Front 40

Cirrhosis due to extrahepatic biliary obstruction~dilation,inc. pressure w/in intrahepatic bile ducts & cholangioles~ ductal injury,ductal & periductal infl.~fibrous tissue form.;complicated by ascending cholangitis & bact. infl. of intrahepatic bile ducts

Back 40

Secondary Biliary Cirrhosis
-marked histologically by bile stasis, bile lakes, & accumulation of bile w/in the hepatic parenchyma

Front 41

Cirrhosis charact. by inflammation, fibrosis,stenosis of intrahepatic & extrahepatic bile ducts resulting in biliary cirrhosis;rare except in assoc. w/ inflammatory bowel dse(ulcerative colitis);assoc w/ inc. incidence of cholangiocarcinoma

Back 41

Primary Sclerosing Cholangitis

Front 42

Cirrhosis charact. by triad of cirrhosis(micronodular,pigmented cirrhosis), diabetes mellitus, & inc. skin pigment.(hemosiderin & melanin deposition)also known as bronze diabetes;inc. serum iron w/ dec. TIBC~inc. transferrin iron saturation,inc. serum ferritin

Back 42

Hereditary Hemochromatosis
-familial defect of iron absorption by the intestinal mucosa;one of the most common autosomal recessive disorder

Front 43

Test done to detect hereditary hemochromatosis in its early stages so it may be treated successfully before end organ damage

Back 43

Screening for inc. transferrin iron saturation or for mutation in the Hfe gene on chromosome 6

Front 44

Asterixis

Back 44

Hepatic(portosystemic)encephalopathy
-flapping tremor & neurologic sign, caused by nitrogenous metabolites w/c cannot be detoxified by the damaged liver

Front 45

Biliary tract dse., commonly seen in assoc. w/ ulcerative colitis

Back 45

Primary Sclerosing Cholangitis
-histologically characterized by onion-skin fibrosis of bile ducts

Front 46

Councilman bodies

Back 46

Viral Hepatitis
-Apoptotic hepatocytes

Front 47

Fatal thrombotic occlusion of the hepatic veins assoc. w/ polycythemia vera & other hypercoagulable states

Back 47

Budd-Chiari Synd

Front 48

Grossly ditended abdomen, esophageal varices, caput medusae, & hemorrhoides

Back 48

Cirrhosis
-caused by portal hypertention & active portocaval anastomoses

Front 49

Hepatolenticular degeneration causing extrapyramidal motor signs

Back 49

Wilson Dse.
-Copper deposits in the liver, cornea of the eye(Kayerser-Fleischer Rings), & putamen & lenticular nuclei of the basal ganglia

Front 50

Increase in AFP(alpha-fetoprotein)

Back 50

Hepatocellular Carcinoma
-also present in yolk sac tumors

Front 51

Macronodular pattern on the liver surface

Back 51

Posthepatitic(postnecrotic, macronodular)cirrhosis

Front 52

Mallory bodies, neutrophilic infiltrate,& hepatocyte swelling & necrosis

Back 52

Alcoholic hepatitis
-Mallory bodies=accumulation of cytokeratin intermediate filaments in hepatocytes

Front 53

Micronodules on the liver surface in early stages

Back 53

Alcoholic cirrhosis

Front 54

Most common liver dse. in the U.S.

Back 54

Alcoholic liver dse.

Front 55

Middle-aged female w/ pruritus, jaundice, xanthomas, & antimitochondrial antibodies

Back 55

Primary biliary cirrhosis
-histologically characterized by granulomatous destruction of intrahepatic bile ducts

Front 56

Most common primary malignancy of the liver

Back 56

Most common primary malignancy of the liver

Front 57

Obese multiparous woman w/ fat intolerance

Back 57

Cholelithiasis(gallstones)

Front 58

Obstructive jaundice w/ palpably enlarged gallbladder

Back 58

Carcinoma of the head of the Pancrease or carcinoma of the extrahepatic biliary ducts & ampulla of vater
-Courvoisier Law=obstructive jaundice w/ palpable gallbladder indicates probable tumor; jaundice w/ nonpalpable gallbladder indicates probable gallstones

Front 59

Palmar erythema, spider angiomatas, & gynecomastia

Back 59

Cirrhosis
-all caused by hyperestrinism

Front 60

Soft, yellow, greasy liver

Back 60

Fatty liver
-hepatic steatosis

Front 61

Sudden right upper quadrant or epigastric pain w/ nausea, vomitting, & leukocytosis

Back 61

Acute Calculous Cholecystitis
-one of the most common indications for abdominal surgery

Front 62

Triad of cirrhosis, skin pigmentation, and diabetes mellitus("bronze diabetes")

Back 62

Idiopathic Hemochromatosis
-primary defect in iron absorption leading to a net accumulation

Front 63

Malignant tumor assoc. w/ Clonorchis sinensis(liver fluke)infest.
;originates from intrahepatic biliary epith;propensity for invasion of vascular channels;not assoc. w/ HBV infect.;late complication of thorium dioxide administration

Back 63

Cholangiocarcinoma(bile duct carcinoma)

Front 64

Malignant tumor assoc. w/ toxic exposure to polyvinyl(vinyl)chloride, Thorotrast,& arsenic

Back 64

Hemangiosarcoma(angiosarcoma)

Front 65

Complications of cholelithiasis

Back 65

Biliary colic,common bile duct obstruction,ascending cholangitis, cholecystitis,acute pancreatitis, gallstone ileus,mucocele,malignancy

Front 66

Disease of the gallbladder characterized by yellow cholesterol-containing flecks in the mucosal surface;non-inflammatory;no special assoc. w/ cholelithiasis

Back 66

Cholesterolosis(strawberry gallbladder)

Front 67

Most common primary tumor of the gallbladder often assoc. w/ gallstones

Back 67

Adenocarcinoma
-benign,rare

Front 68

Tumor presenting w/ progressive obstructive jaundice & a palpable enlarged gallbladder;often adenocarcinoma

Back 68

Carcinoma of extrahepatic biliary ducts & ampulla of vater
-tumors obstructing the common bile duct~enlarge distended gallbladder; obstructing stones do not(Courvoisier law)

Front 69

Vascular disorder of the liver charact. by venous collaterals w/ varies in the submucosal veins of the esophagus,the hemorrhoidal plexus,& other sites

Back 69

Portal HPN
-classified by site of portal venous obstruction:prehepatic(portal & splenic obstruct. often by thrombosis), intrahepatic(intrahepatic vascular obstruct. due to cirrhosis or metastatic tumor),posthepatic(congestion of distal hepatic venous circl. due to constrictive pericarditis,tricuspid insuff.,CHF, hepatic vein occlusion(Budd-Chiari synd)

Front 70

Hepatic vascular disorder due to occlusion of the major hepatic veins~abdominal pain,jaundice, hepatomegally,ascites~liver failure

Back 70

Budd-Chiari Synd.
-assoc. w/ polycythemia vera, hepatocellular carcinoma,abdominal neoplasms;complication of pregnancy

Front 71

Benign tumors of the liver

Back 71

Hemangioma(most common),Adenoma(assoc. w/ oral contraceptives,may rupture ~intraperitoneal hemmorrhage when subscapular in location)

Front 72

Malignant tumors of the liver

Back 72

Metastatic tumor(common), Hepatocellular carcinoma(most common), Cholangiocarcinoma(bile duct carcinoma),Hemangiosarcoma(angiosarcoma)

Front 73

Malignant tumor assoc. w/ pre-existing cirrhosis of any kind,HBV infxn., aflatoxin B1 contamination of nuts & grains causing mutations in p53 gene; propensity for invasion of vascular channels w/ hematogenous dissemination

Back 73

Hepatocellular Carcinoma