Pathology - Exam 3 - Liver, Gallbladder, Pancreas

Front 1

Most of the serum proteins (including albumin and the blood coagulation factors) are produced by the _____.

Back 1

Liver

Front 2

Production of serum proteins, metabolism of nitrogenous wastes, detoxification of drugs and poisons, and bilirubin metabolism and excretion are the four major functions of the _______.

Back 2

Liver

Front 3

If the amount of unconjugated bilirubin exceeds the capacity of albumin to bind it (> 20 mg/dl), it will cross the blood brain barrier to cause _____ which can result in brain damage or death.

Back 3

Kernicterus

Front 4

Yellow-green discoloration of the tissues known as ______.

Back 4

jaundice (icterus)

Front 5

________ can be seen with an increased destruction of red blood cells (hemolytic anemia, etc), a failure of liver cells to take up or convert unconjugated bilirubin to conjugated bilirubin (congenital or acquired), or blockage of extrahepatic bile ducts (tumors, scarring, etc).

Back 5

Hyperbilirubinemia

Front 6

A type of liver toxic injury, _______ ________, in which the degree of hepatic damage and necrosis is unpredictable.

Back 6

hypersensitivity reaction (halothane anesthetic)

Front 7

A type of liver toxic injury, ____ _____ _______, in which the degree of liver damage is directly proportional to the amount of toxin.

Back 7

dose-related phenomenon

Front 8

___________ is a more serious infection acquired by contact with blood or other bodily fluids (semen, saliva, etc.). After exposure the incubation period lasts from 1 to 6 months (average 2 months) before gradual onset of symptoms.

Back 8

Hepatitis B

Front 9

Pronounced jaundice with higher bilirubin levels and more hepatic damage is common in _________.

Back 9

Hepatitis B

Front 10

Early symptoms of __________ include malaise, fatigue, anorexia, and possible nausea and vomiting. There may then be an abrupt onset of moderate fever, an enlarged tender liver and the possible onset of jaundice.

Back 10

Hepatitis A

Front 11

In the acute phase of __________, the virus can be found in the blood and feces and the usual route of infection is by the fecal-oral route. After exposure, the incubation period lasts from 15 to 45 days before onset of acute symptoms.

Back 11

Hepatitis A

Front 12

Most cases of __________ arise as the result of exposure to contaminated blood or body secretions (transfusion, intravenous drug use, multiple sex partners, etc).

Back 12

Hepatitis C

Front 13

Most patients with __________ do not have overt symptoms and the diagnosis is made from abnormal lab results. Early diagnosis and treatment is critical since up to 85% of these patients will develop chronic hepatitis.

Back 13

Hepatitis C

Front 14

The incidence of primary hepatocellular carcinoma is also increased in patients with ________ _________.

Back 14

Chronic hepatitis

Front 15

the diagnosis of chronic hepatitis is given along with a description of the degree of ______ and _____ of liver tissue.

Back 15

necrosis and fibrosis

Front 16

In the milder forms of ________ _________, vague recurrent symptoms of malaise, weakness, loss of appetite, right upper quadrant discomfort and occasionally mild jaundice. The more aggressive forms are characterized by progressive liver destruction.

Back 16

chronic hepatitis

Front 17

________ is defined as the presence of hepatic fibrosis with evidence of regenerative parenchymal nodules. It is the end result of many different processes that cause liver necrosis.

Back 17

Cirrhosis

Front 18

_______ (_____) cirrhosis will cause fatty change in liver cells and result in a large, yellow, greasy, smooth and soft liver. With chronicity, fibrosis will occur. The liver may be almost normal in size, yellow-brown in color, with fine scars and uniform, small (0.2 - 0.3 cm) regenerative nodules of liver cells. As the cirrhosis advances, the liver becomes small and atrophic with a brown-green color.

Back 18

Laennec (alcoholic)

Front 19

The most common type of cirrhosis is ________.

Back 19

Laennec (alcoholic)

Front 20

Classic manifestations of ___________ cirrhosis include jaundice, portal hypertension (causing esophageal varices, ascites, splenomegaly, hemorrhoids), endocrine disturbances (testicular atrophy and gynecomastia) due to an inability to metabolize endogenous estrogen, and hepatic failure with ensuing coma and death.

Back 20

Laennec (alcoholic)

Front 21

______ cirrhosis can follow any cause of extensive hepatocellular necrosis and may therefore be a consequence of viral hepatitis, toxic chemical or drug damage to the liver.

Back 21

Post-necrotic

Front 22

In cases of __________ cirrhosis, the liver may be normal or shrunken, and there are irregular thick bands of scar tissue and is most closely associated with the subsequent development of hepatic malignancies.

Back 22

Post-necrotic

Front 23

_____ ______ cirrhosis is an autoimmune disease in which the intrahepatic bile ducts are destroyed to produce an obstructive type of jaundice.

Back 23

Primary biliary

Front 24

_______ _______ cirrhosis is seen in patients with extrahepatic biliary obstruction or biliary tract infections.

Back 24

Secondary biliary

Front 25

The build-up of bile acids in the serum prior to the development of jaundice is ________, and is ususally seen in primary biliary cirrhosis.

Back 25

pruritis

Front 26

________ _________ is a benign tumor of blood vessels that commonly is found beneath the capsule of the liver. Although it is usually asymptomatic, it may bleed into the peritoneal cavity causing abdominal pain.

Back 26

Cavernous hemangioma

Front 27

________ ___________ is the most common primary malignant tumor of the liver and arises from the hepatocyte. Predisposing conditions include hepatic cirrhosis or chronic hepatitis.

Back 27

Hepatocellular carcinoma

Front 28

_________ _________ are often discovered because of hepatomegaly with pain, weight loss, and liver dysfunction. The tumor may be multifocal, and tumor invasion of hepatic veins is common.

Back 28

Hepatocellular carcinomas

Front 29

_______ _______ ________ is less common and arises from bile duct epithelium. It is extremely difficult to differentiate from metastatic adenocarcinoma and requires careful examination of the patient for other possible sites of origin. It is not associated with cirrhosis. It tends to metastasize earlier and more widely.

Back 29

Bile duct carcinoma (cholangiocarcinoma)

Front 30

________ ________ are far more common than primary cancer. Typically the liver is enlarged and contains multiple nodular tumor implants.

Back 30

Metastatic tumors

Front 31

Patients with ______ _________ develop personality alterations, confusion, and mental obtundation ranging from mild lethargy to coma (hepatic encephalopathy).

Back 31

liver failure

Front 32

A characteristic flapping tremor of outstretched hands referred to as "liver flap" (asterixis) occurs in patients with ________ _________. They also fail to metabolize estrogens, which accumulate and result in hypogonadism, loss of libido, and gynecomastia in the male. Palmar erythema and spider angiomas of the skin have been attributed to increased estrogens since both are known to occur during pregnancy, but definite proof is not offered.

Back 32

liver failure

Front 33

Patients with ________ ________ do not synthesize albumin, globulins, and prothrombin properly, with a consequent increase in amino acid levels in the blood as well as the expected problems associated with deficiencies of these proteins. Inability to store glycogen may result in hypoglycemia.

Back 33

liver failure

Front 34

______ _______ patients sometimes develop a pungent sweet-sour odor known as fetor hepaticas and the urine is particularly pungent. Renal insufficiency or failure may be present (hepatorenal syndrome), the precise pathophysiology of which is obscure and under debate. In spite of renal functional insufficiency there often is no evidence of morphological changes in the kidneys.

Back 34

liver failure

Front 35

_______ _______ involves narrowing or severe stenosis of all or a portion of the intrahepatic or extrahepatic biliary tree. This leads to progressive jaundice, hepatic cirrhosis, and death within the first year of life unless it can be surgically corrected or a liver transplant is available.

Back 35

biliary atresia

Front 36

Abnormal composition of bile, bile stasis, or infections of the gallbladder may predispose to the precipitation of bile constituents to form _____________.

Back 36

cholelithiasis

Front 37

Pure deposits of cholesterol, calcium bilirubinate, and calcium carbonate may occur but the vast majority of _________ contain a mixture of these substances with cholesterol being the primary component.

Back 37

gallstones

Front 38

Obstruction of the cystic duct by a __________ will cause abdominal pain, nausea, vomiting, and may lead to acute cholecystitis.

Back 38

gallstone

Front 39

Obstruction of the common bile duct by a __________ also causes abdominal pain, nausea and vomiting but will also lead to obstructive jaundice and possible biliary cirrhosis.

Back 39

gallstone

Front 40

________ ____________ cases are due to the impaction of a gallstone within the gallbladder neck or cystic duct but some cases may arise due to bacterial infection.

Back 40

acute cholecystitis

Front 41

Clinical manifestations of ________ ________ include nausea, vomiting, severe right upper quadrant abdominal pain, fever, and elevated white blood cell counts. Possible complications include perforation and subsequent peritonitis, pancreatitis, septicemia, etc.

Back 41

acute cholecystitis

Front 42

______ _________ is almost always associated with preexisting cholelithiasis and is most frequently seen in obese middle-aged females. Clinical manifestations include recurrent attacks of epigastric pain with heartburn and excessive bowel gas (belching and flatulence).

Back 42

chronic cholecystitis

Front 43

Fortunately both benign and malignant tumors of the _________ are rare.

Back 43

gallbladder

Front 44

The malignant tumors of the __________ that do occur are closely associated with preexisting chronic cholecystitis and cholelithiasis. Clinical manifestations are often minor (anorexia, weight loss) until the tumor has grown large and spread.

Back 44

gallbladder

Front 45

______ ___________ results from sudden enzymatic necrosis of the pancreas and parapancreatic fat. The etiology is frequently unknown but known associations include gallstones and alcohol.

Back 45

acute pancreatitis

Front 46

________ __________ pathogenesis involves proteolytic destruction of pancreatic parenchyma and blood vessels by pancreatic proteases, and necrosis of parapancreatic or intraperitoneal fat by pancreatic lipases.

Back 46

acute pancreatitis

Front 47

Clinical manifestations of _______ _________ include sudden onset of severe abdominal pain (which may radiate sharply into the back) often followed rapidly by vascular collapse and shock. The mortality with the first episode is as much as 25%.

Back 47

acute pancreatitis

Front 48

______ _________ is characterized by repeated episodes of mild inflammation over a course of months to years resulting in fibrous replacement of a large quantity of pancreatic parenchyma.

Back 48

chronic pancreatitis

Front 49

Patients with ___________ _____________ have repeated attacks of moderate abdominal pain is usual, but this may be totally asymptomatic until sufficient pancreatic tissue is destroyed to produce symptoms of pancreatic insufficiency (diabetes, malabsorption, etc).

Back 49

chronic pancreatitis

Front 50

_________ __________ arises from the epithelium of pancreatic ducts and therefore is an adenocarcinoma.

Back 50

pancreatic carcinoma

Front 51

If the cancer arises in the _____ of the pancreas, there may be early symptoms of painless jaundice due to impingement upon biliary tract structures.

Back 51

head

Front 52

Cancers of the _____ _____of the pancreas, however, are usually discovered only after a long interval of silent growth with only weight loss being the prominent feature.

Back 52

body/tail