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56 Cards in this Set

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Gross pathology reveals black lumps in the gallbladder.
Pigmented cholethiasis (gallstones)
What is acalculous cholecysitis?
Ischemia due to cysic artery obstruction secondary to inflammation or edema which comrpomies blood flow
Acute calculous cholecystitis
Chemical irritation and inflammation of the obstructed gallbladder (due to gallstones)

Bile salts are often irritating exposed mucosal walls
87yo M critically ill, on long-term TPN w RUQ pain. Abdomen is tender. Murphy’s sign elicited. No similar episodes in past. Ultrasound: No GB wall thickening, pericholecystic fluid present, no gallstones. Diagnosis: ?
Acute acalculous cholcystisis
Stones within the bile ducts of the biliary tree
Narrowing of bile duct; could be secondary to bacterial infection, inflammation, tumor or gallstone
46yo F p/w RUQ pain, jaundice, acholic stools, dark tea-colored urine, no fever. Past history of cholelithiasis. No treatment ever undertaken. Exam: unremarkable. HepB/C neg. Ultrasound: solitary CBD stone, dilated CBD > 1cm. Diagnosis: ?
46yo F p/w fever, RUQ pain, acholic stools, dark tea-colored urine.
If also altered mental status and signs of shock = Raynaud’s pentad
Ascending cholangitis
72 yo F p/w mild RUQ pain since last several months. She also complains of intermittent episodes of acute colicky pain. She gives past history of gall stones. Her last U/S taken 2 years ago reveal thickend gall bladder, with multiple stones. No pericystic fluid was observed. CBD was not affected. Her present U/S reveals an infiltrative mass occupying most of the gall bladder. Also noticed are gall stones. Cholecystectomy was performed. Gross and histo-pathology are shown. Diagnosis?
Carcinoma of the gallbladder
Von Hippel Lindau disease
vascular neoplasms found in the retina, cerebellum or brain stem in association with congenital cysts in the pancreas, liver and kidney
How can you histologically determine a cyst?
Cyst lacks a true epithelial lining and is lined by fibrin and granulation tissue
A 20-year old woman was first admitted with nausea, weakness, vomiting, dizziness, and visual disturbance. The findings of a fundoscopy were normal, but a CT scan showed a cerebellar tumor in the posterior fossa, which was removed. Histopathologic examination confirmed a cerebellar hemangioblastoma. The patient remained completely asymptomatic until 4 years later, when she presented again with vomiting and dizziness. On admission, an abdominal CT scan showed a 14X10-cm, well circumscribed, thin-walled cyst in the head of the pancreas, and multiple smaller cysts in the tail and body region of the pancreas. She also had bilateral ovarian cysts.
Von Hippel Lindau Disease
Acute pancreatitis
Reversible pancreatic parenchymal injury associated with inflammation
What two laboratory findings wil you find in acute pancreatitis?
Marked elevation of serum amylase levels during the first 24 hrs followed by rising serum lipase levels in 72-96 hours.
Chronic Pancreatitis
Inflammation of the pancreas with irreversible destruction of exocrine parenchyma, fibrosis, and in the late stages, the destruction of endocrine parenchyma.
What is the most common cause of chronic pancreatitis?
Long term alcohol abuse
What happens to the pancreas of an alcoholic in chronic pancreatitis?
Elevated protein concentrations form ductal plugs which calcify; contribute to chronic pancreatitis
Mucinous Cystic Neoplasm
95% arise in women associated with invasive carcinoma; often at body or tail
Histology of Mucinous cystic Neoplasms (Mucinous Cystadenoma)
Lined by columnar mucinous epithelium
Serous Cystadenoma
Benign cystic neoplasms composed of glycogen rich cuboidal cells surroudning small cysts containing clear, thin, straw colored fluid
Intraductal Papillary Mucinous Neoplasms
arise more frequently in men then women, involve the head of the pancreas instead of the tail
Histology of Intraductal Papillary Mucinous Neoplasms
Lack the dense ovarian stroma and involve a larger pancreatic duct
Solid Pseudopapillary Neoplasm
Large, well circumscribed pancreatic masses with solid and cystic components
Histology of solid pseudopapillary neoplasm
Grows in solid sheets or papillary projectoins
Often manifests as a sac between the stomach and pancreas; usually arise after acute pancreastitis (often chronic alcoholic pancreatitis)

Hapens when body walls of peripancreatic hemorrhagic fat necrosis with fibrous tissue
CA 19-9 Use
Pancreatic cancer marker
What causes cholelithiasis?
Supersaturation of bile with cholesterol (cholesterol stones) or bilirubin salts (pigmented stones) promotes stone formation
A jaundice patient with a history of gallstones suggests what?
common bile duct obstruction (choledocholiathiasis)
biliary atresia
complete obstruction of bile flow due to destruction or absence of some part of the extrahepatic bile ducts (most common cause of liver failure death in early childhood)
annular pancreas
pancreatic tissue completely encircles the second portion of the duodenum; can cause duodenal obstruction
pancreas divisum
failure of fusion of the ventral and dorsal pancreatic primordia; causes secretions to drain only through
which enzyme is inappropriately activated in pancreatitis?
trypsin, which goes on to activate other enzymes
What is the function of the cationic trypsinogen gene PRSS1?
PRSS1; codes for a failsafe site on trypin critical for its own activation; if its trypsin will be hyperactive and cause pancreatitis
What is the function of serine protease inhibitor, kazal type 1 (SPINK1)?
mutation leads to a defective protein that can no longer inactive trypsin, resulting in pancreatitis
A pt has a positive urease breath test. Is the organism h. pylori or c. jejuni?
H. pylori
A pt has a positive H2S production test. Is the organism h. pylori or c. jejuni?
C. Jejuni
A pt has a positive nitrate reduction test with an organism that grows at 42C (NOT 37C). Is the organism h. pylori or c. jejuni?
C. Jejuni
Compare the morphology of h. pylori with c. jejuni?
h. pylori: spiral w/ 3 unipolar flagella

c. jejuni: comma shaped or "gull winged" with bipolar flagella
How is c. jejuni transmitted?
Zoonotic: Poultry, dogs, cattle, sheep
What is notable about the c. jejuni incubation temperature?
Needs 42C, compared to h. pylori which needs 37C
Compare the disease course of c. jejuni and c. fetus?
c. jejuni: gastroenteritis

c. fetus: systemic intravascular and extraintestinal infections
How might you differentiate between c. jejuni and c. fetus?
only c. jejuni can grow at 42C, c. fetus needs 37C (similar to h. pylori)
What does the S-protein virulence factor for c. fetus do?
Helps the organism evade the immune system
Tx of choice for campylobacter infections?
Erythromycin (broad spectrum); eliminates carriage in 72 hours
What is the function of LPS O side chain in h. pylori?
Resembles the blood group antigens so it protects the bacteria from immune clearance
What si the gold diagnostic standard for h. pylori?
Histological examination of gastric biopsy
A patient taking antibiotics, pepto bismal, and PPI has stomach ulcers but comes back negative for h. pylori via rapid urease test. What might be happening?
The drugs he's taking have decreased the h. pylori load making producing false-negative results.
Why does h. pylori being microaerophilic help it grow in the stomach
It can grow extremely well in the ciscous mucus layer that coats the gastroepithelium
How does the production of urease by h. pylori help it?
A byproduct of urease activity, ammonia, neutralizes gastric acids in the local vicinity
A mutation in h. pylori hop genes would result in what?
An inability of h. pylori to withstand peristalsis or mucosal shedding. (i.e. these genes are adherence genes0
What does the VacA virulence factor on h. pylori do to cells?
(Vacuolating toxin; causes swelling of cellular compartments)
What does the Cag virulence factor on h. pylori do to cells?
Cytotoxin associated gene; IL8 induction via Type IV Secretion system for Cag entry attracts inflammatory cells = cell damage
Where will h. pylori be dominant in the stomach of an individual with low acid output (for ex. someone on ppi)?
Corpus Predominat Gastritis (body)
Where is h. pylori normally more pronounced in most patients?
Antral predomiantn; higher acid production in body and fundus which is inhibitory to bacterial growth, so it settles in the antrum
Which h. pylori gastritis pattern is seen in individuals who develop gastric carcinoma and gastric ulcers?
Multifocal atrophic gastritis (corpus, fundus, antrum)
What is the triple combo tx for h. pylori infection?
PPI, clarithryomycin, beta lactam (amoxicillin) for 7 to 10 days