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81 Cards in this Set
- Front
- Back
213
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213
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Definition of alcoholic
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80g alcohol or more/day
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Three routes of alcohol metabolism (1st step)
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(all result in acetaldehyde) 1. ADH – most used 2. Microsomal cytochrome p450 (resp. for toxicity of tylenol w/ alcohol) 3. Catalase, H2O2
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Degradation of Acetaldehyde
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ALDH1, ALDH2 --> Acetate
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ADH differences in asian
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Everyone – ADH 1-5. Asians – ADH 2 metabolizes alcohol faster. Results in more acetaldehyde
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2 main classes of ALDH
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Cytosolic (ALDH1) vs mitochondrial(ALDH2 – mutated in asians)
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Disulfiram
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Antabuse. Blocks ALDH
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Which pathway of alcohol degradation generates ROS's
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Microsomal
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Hepatotoxicity of acetaldehyde
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1. Inc lipid peroxidation 2. Bind plasma membranes 3. Block ETC 4. Inhib Nuclear Repair 5. Block microtubule 6. Inc collagen
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3 morphologies of Alc Liver Disease
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Fatty liver, Alcoholic Hepatitis, Cirrhosis
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Mech – Fatty liver
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Increased FA synthesis, uptake, and triglyceride synth w/ decreased secretion and oxidation
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Which type of fatty liver is in alcholics?
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Usually macrovesicular
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Mech – Alcohol hepatitis
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Necrosis of liver cells (pericentrally) b/c of: Hyaline dep., Acetaldehyde, Drug enzymes, PMN's
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Mallory bodies
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Hyaline deposits in the liver in alcoholic hepatitis.
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Megamitochondria
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Large (LM visible) Mitochondria in liver disease
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Clinical features of Alc Hep
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1.Malaise, anorexia, fever. 2. RUQ pain, 3. Jaundice, leukocytosis Can progress to Fulminant Hepatic Failure.
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Perivnular fibrosis
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Fibrosis around central veinds.
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Pericellular fibrosis
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Fibrosis circling single groups of liver cells
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Perisinusoidal Fibrosis
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W/in sinusoids and space of Disse.
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Iron is stored as:
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Ferritin, hemosiderin
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How much iron is required to overload the liver
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40 -80 gms
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3 common places for iron deposition
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Liver, Heart, Endocrine organs
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Hemochromatosis gene
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HFE
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Symptoms of hemochromatosis
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1. Bronze skin 2. Pigmentary micronodula cirrhosis 3. Diabetes 4. CHF 5. Endocrine organ symptoms
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Bantu Siderosis
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African iron overload.
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Diff b/t primary and secondary hemochromatosis
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Prim: iron in cytoplasm Sec: Iron in kupffer cells.
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Gene mutations (4) in a-antitrypsin deficiency
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PiF (fast) PiM (med) PiS (slow) PiZ (very slow)
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PiZZ
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Common mutation in children needing liver transplantation.
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Function of alpha1-antitrypsin
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Inhibit elastase activity of leukocytes
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Primary problem in a-1-antitrypsin def
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Elastace degrades alveolar elastic tissue of lung. Also shows globules of buildup in liver.
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Ceruloplasm
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Copper transport protein – binds free ionic copper
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Total body content of copper
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180 mg
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Wilson's disease
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Genetic defect in copper transporting ATPase. Copper builds up in hepatic cytoplasm, lysosomes
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Therapy of wilson's
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Chelation
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Common problems in wilson's
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<10: Liver 10-18 Liver& neuro >18: Neuro
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Kayser fleischer ring
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Ring around the outside of iris from >> copper.
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209
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209
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Neoplasms of the hepatocyte: (2)
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Liver cell adenoma, Hepatocellular carcinoma
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Neoplasms of the bile duct cell: (2)
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Bile-duct adenoma, cholangiocarcinoma
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Neoplasms of the hepatoic endothelial cell: (2)
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Hemangioma, Hemangiosarcoma
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Liver cell adenoma
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Large, well circumscribed liver lesion. Sheets and cords resemble normal liver.
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Diff in relationship of HCV & HBV to HCC
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HBV is stronger rel. and encorporates into genome causing HCC. HCV is via oxidative/inflammatory stress.
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Two most common gene mutations for HCC
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P53 (via aflatoxin) , P16
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Common mutations for HCC mets
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Rb, P21
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4 common features in HCC
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Hyperchromatosis, Nuclear pleomorphism, Apoptotic bodies, Necrosis (also multiple cell thick cords.)
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Two serum markers for HCG
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Alpha-fetoprotein & Gamma-carboxy-prothrombin
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Alpha-fetoprotein tolerances
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<10 good. 10-500 grey >500 HCC
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Systemmic symptoms of HCC
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Hypoglycemia, Erythrocytosis, Hypercalcemia
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Cholangiocarcinoma: Causes
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Flukes – cause chronic inflammation.
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Cholangiocarcinoma: Morphology
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Excess proliferation of glandualar structures.
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208
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208
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Start & end of intrahepatic biliary system
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Start: Bile canaliculus. End: Hepatic ducts
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Start & end of extrahepatic
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Fissure of the hepatic ducts to Duodenum
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Sphincter of Oddi
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Sphincter at the common bile duct and the duodenum
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Ampulla of vater
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Also at the common bile duct and the duodenum
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What biliary diseases are pathologic at the canaliculus?
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1. Drugs 2. Cholestasis of pregnancy 3. Benign Postoperative cholestasis 4. Benign recurrant cholestasis 5. Cholestasis of Hodgkins
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Where does primary biliary cirrhosis affect?
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Interlobular bile duct
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Where does sclerosing cholangitis affect?
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Large intrahepatic duct.
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What effect does bile obstruction have on the canaliculi?
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Villi become shorter & smaller (and dilation)
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4 main effects of cholestasis
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1. Pruritis (via bile & nuerogenic) 2. Jaundice/Xanthomas 3. Fat & fat vitamin malabsorption 4. Liver damage
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4 effects of fat malabsorption w/ cholestasis
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1. Steatorrhea 2. Bone disease 3. Coagulopathy 4. Night Blindness
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Primary biliary cirrhosis - Cause
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Idiopathic. Theory is antimitochondrial antibodies.
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Primary biliary cirrhosis – clinical
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Cholestasis, portal hypertension. Way more common in women (40-60)
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4 Histological stages of PBC
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Stage 1: Florid duct lesions Stage 2: Ductular proliferation Stage 3: Fibrosis Stage 4. Cirrhosis
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Which stage of PBC shows granulomas?
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Stage 1.
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PBC associated symptoms
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Dry eyes, dry mouth. Sometimes rheum. Arth., thyroiditis, raynaud's
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PBC lab findings
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Inc. Alk phosphotase, Inc bilirubin, Inc immunoglobins
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Primary sclerosing cholangitis Def
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Nonspecific inflammatory fibrosis of wall of biliary tree (--> stenosis, ectasia)
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Primary scleroising cholangitis – Clinical
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Fatigue, UQ pain, jaundice, prog liver failure. Typically over 50 yrs
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PSC – associated disorders
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Ulcerative colitis, Crohns, Retroperitoneal fibrosis, Reidels thyroiditis, Orbital pseudotumor
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Causes of PSC
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1. Infection (portal endotoxemia w/ UC) 2. Genetic 3. Immune – PANCA, hypergammaglobulinemia, or Tcell
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PSC Lab findings
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Inc alk phosphatase, Inc ANCA, beaded appearance of biliary tract on ERCP
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Cholelithiasis – Def
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Gall stones. More common in women, often asymptomatic (if symptoms: colic pain, cholecystitis)
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What falls out of solution in gall stones?
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Bilirubin & cholesterol
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What naturally prevents gall stones?
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Lecithin & bile
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3 steps in gallstones.
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1. Supersaturate bile. 2. Nucleation, 3. Growth.
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Risk factors for gall stones
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Obesity, High fat diet, Hyperlipidemia, Drugs, Genetic.
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3 types of gall stones
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1. Cholesterol 2. Pigment 3. Mixed
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Calculous cholecystitis
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Acute cholecystitis b/c of bacterial infection.
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Adenocarcinoma of the galladder – def
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Adenocarcinoma, typically in 6th/7th decade women.
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Courvoisier's Law
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Palpable gallbladder due to biliary obstruction, often w/ pancreatic cancer.
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