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56 Cards in this Set
- Front
- Back
Gross pathology reveals black lumps in the gallbladder.
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Pigmented cholethiasis (gallstones)
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What is acalculous cholecysitis?
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Ischemia due to cysic artery obstruction secondary to inflammation or edema which comrpomies blood flow
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Acute calculous cholecystitis
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Chemical irritation and inflammation of the obstructed gallbladder (due to gallstones)
Bile salts are often irritating exposed mucosal walls |
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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: ?
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Acute acalculous cholcystisis
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Choledocholiathiasis
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Stones within the bile ducts of the biliary tree
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Cholangitis
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Narrowing of bile duct; could be secondary to bacterial infection, inflammation, tumor or gallstone
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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: ?
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Choledocholiathiasis
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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
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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?
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Carcinoma of the gallbladder
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Von Hippel Lindau disease
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vascular neoplasms found in the retina, cerebellum or brain stem in association with congenital cysts in the pancreas, liver and kidney
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How can you histologically determine a cyst?
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Cyst lacks a true epithelial lining and is lined by fibrin and granulation tissue
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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.
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Von Hippel Lindau Disease
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Acute pancreatitis
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Reversible pancreatic parenchymal injury associated with inflammation
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What two laboratory findings wil you find in acute pancreatitis?
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Marked elevation of serum amylase levels during the first 24 hrs followed by rising serum lipase levels in 72-96 hours.
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Chronic Pancreatitis
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Inflammation of the pancreas with irreversible destruction of exocrine parenchyma, fibrosis, and in the late stages, the destruction of endocrine parenchyma.
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What is the most common cause of chronic pancreatitis?
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Long term alcohol abuse
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What happens to the pancreas of an alcoholic in chronic pancreatitis?
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Elevated protein concentrations form ductal plugs which calcify; contribute to chronic pancreatitis
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Mucinous Cystic Neoplasm
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95% arise in women associated with invasive carcinoma; often at body or tail
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Histology of Mucinous cystic Neoplasms (Mucinous Cystadenoma)
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Lined by columnar mucinous epithelium
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Serous Cystadenoma
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Benign cystic neoplasms composed of glycogen rich cuboidal cells surroudning small cysts containing clear, thin, straw colored fluid
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Intraductal Papillary Mucinous Neoplasms
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arise more frequently in men then women, involve the head of the pancreas instead of the tail
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Histology of Intraductal Papillary Mucinous Neoplasms
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Lack the dense ovarian stroma and involve a larger pancreatic duct
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Solid Pseudopapillary Neoplasm
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Large, well circumscribed pancreatic masses with solid and cystic components
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Histology of solid pseudopapillary neoplasm
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Grows in solid sheets or papillary projectoins
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Pseudocysts
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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 |
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CA 19-9 Use
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Pancreatic cancer marker
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What causes cholelithiasis?
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Supersaturation of bile with cholesterol (cholesterol stones) or bilirubin salts (pigmented stones) promotes stone formation
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A jaundice patient with a history of gallstones suggests what?
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common bile duct obstruction (choledocholiathiasis)
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biliary atresia
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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)
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annular pancreas
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pancreatic tissue completely encircles the second portion of the duodenum; can cause duodenal obstruction
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pancreas divisum
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failure of fusion of the ventral and dorsal pancreatic primordia; causes secretions to drain only through
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which enzyme is inappropriately activated in pancreatitis?
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trypsin, which goes on to activate other enzymes
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What is the function of the cationic trypsinogen gene PRSS1?
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PRSS1; codes for a failsafe site on trypin critical for its own activation; if its trypsin will be hyperactive and cause pancreatitis
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What is the function of serine protease inhibitor, kazal type 1 (SPINK1)?
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mutation leads to a defective protein that can no longer inactive trypsin, resulting in pancreatitis
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A pt has a positive urease breath test. Is the organism h. pylori or c. jejuni?
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H. pylori
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A pt has a positive H2S production test. Is the organism h. pylori or c. jejuni?
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C. Jejuni
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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?
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C. Jejuni
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Compare the morphology of h. pylori with c. jejuni?
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h. pylori: spiral w/ 3 unipolar flagella
c. jejuni: comma shaped or "gull winged" with bipolar flagella |
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How is c. jejuni transmitted?
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Zoonotic: Poultry, dogs, cattle, sheep
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What is notable about the c. jejuni incubation temperature?
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Needs 42C, compared to h. pylori which needs 37C
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Compare the disease course of c. jejuni and c. fetus?
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c. jejuni: gastroenteritis
c. fetus: systemic intravascular and extraintestinal infections |
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How might you differentiate between c. jejuni and c. fetus?
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only c. jejuni can grow at 42C, c. fetus needs 37C (similar to h. pylori)
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What does the S-protein virulence factor for c. fetus do?
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Helps the organism evade the immune system
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Tx of choice for campylobacter infections?
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Erythromycin (broad spectrum); eliminates carriage in 72 hours
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What is the function of LPS O side chain in h. pylori?
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Resembles the blood group antigens so it protects the bacteria from immune clearance
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What si the gold diagnostic standard for h. pylori?
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Histological examination of gastric biopsy
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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?
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The drugs he's taking have decreased the h. pylori load making producing false-negative results.
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Why does h. pylori being microaerophilic help it grow in the stomach
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It can grow extremely well in the ciscous mucus layer that coats the gastroepithelium
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How does the production of urease by h. pylori help it?
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A byproduct of urease activity, ammonia, neutralizes gastric acids in the local vicinity
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A mutation in h. pylori hop genes would result in what?
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An inability of h. pylori to withstand peristalsis or mucosal shedding. (i.e. these genes are adherence genes0
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What does the VacA virulence factor on h. pylori do to cells?
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(Vacuolating toxin; causes swelling of cellular compartments)
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What does the Cag virulence factor on h. pylori do to cells?
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Cytotoxin associated gene; IL8 induction via Type IV Secretion system for Cag entry attracts inflammatory cells = cell damage
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Where will h. pylori be dominant in the stomach of an individual with low acid output (for ex. someone on ppi)?
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Corpus Predominat Gastritis (body)
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Where is h. pylori normally more pronounced in most patients?
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Antral predomiantn; higher acid production in body and fundus which is inhibitory to bacterial growth, so it settles in the antrum
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Which h. pylori gastritis pattern is seen in individuals who develop gastric carcinoma and gastric ulcers?
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Multifocal atrophic gastritis (corpus, fundus, antrum)
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What is the triple combo tx for h. pylori infection?
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PPI, clarithryomycin, beta lactam (amoxicillin) for 7 to 10 days
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