Gastrointestinal and Liver Pathology Review

Flashcards covering key vocabulary and concepts from a lecture on gastrointestinal and liver pathology, designed to help students review and prepare for exams.

Cirrhosis

Most common cause of portal hypertension, characterized by diffuse bridging fibrosis and regenerative nodules.

SAAG (Serum Ascites Albumin Gradient)

Measure used to differentiate between portal hypertension and other causes of ascites by subtracting the albumin concentration in ascetic fluid from the serum albumin concentration.

SAAG > 1.1

Indicates ascites is likely due to portal hypertension.

SAAG < 1.1

Indicates ascites is likely NOT due to portal hypertension; other causes should be investigated. (Nephrotic syndrome, heart failure, infections, CKD or malignancy)

Hepatic Encephalopathy

Neurological manifestation of cirrhosis; a reversible neuropsychiatric dysfunction that can cause asterixis (flapping tremor) and coma.

Fetor Hepaticus

Foul-smelling breath caused by volatile organic compounds (VOCs) accumulating in the bloodstream due to severe liver disease/inability of the liver to detoxify. Odor described as garlic or rotten eggs.

Asterixis

Flapping tremor seen in hepatic encephalopathy, caused by a buildup of toxins (ammonia).

Splenomegaly

Enlargement of the spleen; important clinical manifestation in cirrhosis and portal hypertension.

Gynecomastia

Enlargement of breast tissue in males, often due to increased estrogen levels in cirrhosis.

Spider Angiomas

Skin manifestation commonly seen in USMLE exam questions for cirrhosis patients.

Symptomatic Spontaneous Bacterial Peritonitis (SBP)

A common and potentially fatal vitreous infection in patients with cirrhosis and ascites.

SBP Treatment

Ceftriaxone (third-generation cephalosporin).

SBP Diagnosis

Paracentesis with acetic fluid, absolute neutrophil count (ANC) > 250 cells/mm³.

ALT (Alanine Aminotransferase)

A liver enzyme; commonly increased in most liver diseases.

AST (Aspartate Aminotransferase)

A liver enzyme; typically increased more than ALT in alcoholic liver disease.

AST in Alcoholic Liver Disease

AST to ALT ratio > 2:1.

AST (SGOT) normal value

Normal range: 9-40

ALT (SGPT) normal value

Normal range: 7-60

Alkaline Phosphatase (ALP) normal value

Normal range: 40-120

Bilirubin normal biomarker range

Normal range < 1

Albumin normal biomarker range

Normal range: 3-5; it is decreased in advanced liver diseases.

Normal PT range

Normal range: 10-13 seconds; it is increased in advanced liver diseases.

Normal Platelet value

Normal range: 150,000 - 450,000; Platelets are decreased in advanced liver diseases due to decreased Thrombopoietin production.

Reye Syndrome

Rare, fatal childhood hepatic encephalopathy often associated with aspirin use during viral infection.

Reye Syndrome Histological Findings

Microvesicular fatty changes found in child liver biopsy.

Macrovesicular Fatty Changes

Fatty liver/hepatic steatosis.

Mallory Bodies

Histological finding in alcoholic hepatitis.

Nonalcoholic Fatty Liver Disease Histopathology

Cellular ballooning and eventual necrosis will be present on biopsy.

Autoimmune Hepatitis

Chronic inflammatory liver disease, found more commonly in women. S/s: Pruritus (itching) due to increased bilirubin.

Portosystemic Shunt

Abnormal connection between portal vein and systemic veins, bypassing liver and allowing toxins to reach the brain.

Alpha-1 Antitrypsin Deficiency

Associated with panacinar emphysema in the lower lobe of the lung.

Direct Hyperbilirubinemia

Conjugated hyperbilirubinemia; Bile does not get excreted properly.

Indirect Hyperbilirubinemia

Unconjugated hyperbilirubinemia, often due to hemolysis.

Physiological Jaundice of Newborn

Benign neonatal hyperbilirubinemia; unconjugated hyperbilirubinemia due to increased fetal RBC turnover/hemolysis; gut is not fully developed, causes decreased conversion of urobilinogen.

Acute Pancreatitis

Auto digestion of the pancreas by pancreatic enzymes. Dx: Serum amylase or serum lipase; The diagnostic test used is serum lipase. Pain radiates to the back.

Pseudocyst

Complication of pancreatitis; walled off collection of fluid comprised of granulation tissue.

Chronic Pancreatitis

Atrophy and calcification of pancreas primarily caused by alcoholic disorder. Dx: stool elastase test

Steatorrhea

Fatty stools caused by deficiency of fat-soluble vitamins (A, D, E, K).

Charkot's Triad

Seen in Acute Cholangitis: Jaundice, Fever and RUQ pain.

Reynolds Pentad

Seen in Acute Cholangitis: Jaundice, Fever, RUQ pain, Confusion and Shock.

H2 Blockers

Used to treat GERD, gastritis, peptic ulcer. Examples: cimetidine, famotidine, nizatidine

Cimetidine Adverse Effects

Potent inhibitor of cytochrome P450, antiandrogenic effects (gynecomastia, impotence, decreased libido).

PPIs Adverse Effects

Increase risk of bloodstream infection, increase risk of C. diff infections , vitamin B12 malabsorption, disrupt normal bacterial balance

Aluminum Hydroxide

Antacid that can cause constipation.

Iron & Calcium Carbonate

Iron should not be given to patients who are taking calcium carbonate or it will cause chelation and hyperchromatosis.

Misoprostol

Prostaglandin E1 analog. Decreases acid production. Used as an abortive. Decreases cyclic AMP.

Triple Therapy for H. pylori

Amoxicillin, clarithromycin, and PPI

Quadruple Therapy for H. Pylori

Triple Therapy & Bismuth

Octreotide

Long-acting somatostatin analog used for acute variceal bleeding. Alternate to TIPS procedure.

Propranolol

Beta blocker used for acute variceal bleeding.

Loperamide

Poor CNS penetration and low addictive potential in Naloxone, agonist at the receptor.

Ondansetron

A 5-HT3 receptor antagonist, used for nausea peripheral nausea and vomiting.

Orlistat

Inhibits gastric and pancreatic lipase -> Decreased breakdown and absorption dietary fats. AE's: Flatulence, abdominal pain.

Celiac Disease/Gluten Sensitive Enteropathy

Gliadin intolerance

D-Xylose Test in Celiac Disease

Test that is abnormal in gluten sensitive enteropathy but not specific

Celiac Disease Serology

Willis Atrophy. Script Hypertrophy. Positive IgA & Tissue transglutaminase, HLA DQ2, DQ8 and intraepithelial lymphocytosis

Lactose Intolerance

Lactase Defficiency, can cause Osmotic Diarrea.

Lactose Intolerance Test

Lactose Hydorgen Breath positive will rise more than 20ppm as compared to baseline.

Desalose Test results in Pancreatic Insufficiency

Normal test result, look for Steatorrhea 2/2 lack of ADEK vitamins.

Difference between SPRUE and Celiac Disease

CELIAC is a specific type of SPRUE; celiac is related to gliadin reaction whereas all other sprues have other causes.

Whipple Disease

Caused by Trophorema Wipplei, will have foamy macrophages, glycogen accumulation and the test will result will be PA

S positive.