Gastrointestinal Physiopathology Week 10

Which type of Hepatitis is a water-borne infection which occurs primarily in young-middle aged adults

Hepatitis E

What is the mortality rate of pregnant women with hepatitis E?

20%

What type of virus is Hepatitis E?

RNA calicivirus

What are the 3 different types of liver disease?

Hepatic steatosis

Alcoholic hepatitis

Cirrhosis

What is the name of lipid accumulation in the liver due to chronic alcohol intake?

Macrovesicular globules

What is the appearance of a liver with hepatic steatosis?

Softer, larger, yellow, and greasy

T or F: Hepatic steatosis is irreversible, even if alcohol consumption is ceased

False (it is reversible if alcohol is stopped)

What is the term for hepatocyte swelling and necrosis due to alcohol consumption?

Alcoholic hepatitis

What is the primary finding of Alcoholic hepatitis?

Mallory bodies

What is the term for a tangled skein of cytokeratin filaments?

Mallory bodies

In what form of alcoholic liver disease do neutrophils permeate lobules?

Alcoholic hepatitis

What activates fibrosis in alcoholic hepatitis?

Activation of stellate cells

What is the irreversible form of alcoholic liver disease?

Alcoholic cirrhosis

What is the appearance of a cirrhotic liver?

Brown

Shrunken

nonfatty

weighs less than 1 kg

What mass of alcohol can produce a mild reversible change in the liver over 1-3 days?

80g / 7 oz

What population do liver cell adenomas occur in?

Women who have used oral contraceptives

How large can liver cell adenomas grow to?

30 cm

T or F: Liver cell adenomas have portal tracts, but no vascular component

False (they have vascular components, but no portal tracts)

T or F: Liver cell adenoma cells have the capacity to produce bile and can therefore be bile stained

True

What are the most common organs involved in metastatic spread?

Liver, lungs, and visceral organs

What % of hepatocellular carcinoma occurs in countries with a high rate of chronic HBV and HCV (e.g. china and Africa)?

85%

What is the U.S. incidence of hepatocellular carcinoma?

5 per 100,000 / year

What are the possible appearances of hepatoceullar?

Unifocal

Multifocal

Diffusely infiltrative

T or F: Liver cancer is usually paler than surrounding liver tissue

True

What does hepatocellular carcinoma feel like to palpation?

Nodular

What symptoms accompany hepatocellular carcinoma?

abdominal pain, malaise, fatigue, weight loss, sense of fullness

What lab findings can indicate hepatocellular carcinoma?

Alpha-Fetoprotein-False

What is the best way to detect hepatocellular carcinoma?

Rad studies, CT, or MRI

What is the term for a malignancy of the biliary tree or bile duct within or outside the liver?

Cholangiocarcinoma

What is the incidence of Cholangiocarcinoma in North America?

Very low: 0.6 per 100,000 / year

What is the appearance of the tumor of cholangiocarcinoma?

Tree-like

T or F: Cholangiocarcinoma bile stain because they produce bile

False (they do not bile stain because they don't produce bile)

How is cholangiocarcinoma suspected?

Obstruction of bile ducts or a symptomatic liver mass

What is the survival duration of a patient with cholangiocarcinoma?

6 months

What is the AKA for gallstones?

Cholelithiasis

What % of the population has gallstones?

10-20%

What is the incidence of gallstones in the U.S.?

20,000,000 with 1,000,000 new/year

What % of gallstones are asymptomatic?

80%

What % of gallstones are formed by cholesterol?

80%

What countries see a higher incidence of cholesterol stones?

North europe, and north and south america

What are the risk factors of cholesterol gallstones?

Advancing age

female sex hormones

oral contraceptives, pregnancy

obesity

rapid weight reduction

What regions are pigment gallstones more common in?

Asia, rural more than urban

What disorders increase risk of pigment gallstones?

Chronic hemolytic syndromes, biliary infection, and GI disorders (Crohn's)

What pigment forms pigment stones?

Bilirubin

What happens when cholesterol concentrations exceed the capacity of bile salts?

It nucleates into solid cholesterol monohydrate crystals

What are the 4 steps required for crystal formation

Bile is supersaturated with cholesterol

Gallbladder hypo mobility promotes nucleation

Cholesterol nucleation is accelerated

Mucus hyper secretion in gallbladder traps the crystals, aggregates them into stones

What leads to increased amounts of bilirubin and calcium salts (increasing risk of pigment stones)

Intravascular hemolysis

What colour are pigment stones?

Black or brown

What colour are cholesterol stones?

Yellow

What is the maximum size of black stones?

1.5 cm

T or F: Cholesterol (yellow) stones grow much larger than black stones

True

T or F: Black stones are radio-opaque while yellow are largely radiolucent

True

Where is the pancreas located?

Below the stomach, mostly retroperitoneal

What surrounds the head of the pancreas?

Duodenum

What type of glands make up the pancreas?

Endocrine and exocrine

What secretes the digestive enzymes of the pancreas?

Pancreatic acini

What secretes bicarbonate in the pancreas?

Ductules

What is secreted by alpha cells in the pancreas?

Glucagon

What is produced by beta cells in the pancreas?

Insulin

Where are the alpha and beta cells located?

Pancreatic islets (islets of langerhans)

What is a potent hyper-glycemic agent?

Glucagon

How many molecules of glucose are released in the blood by 1 molecule of glucagon?

100 million

What is the major target of glucagon?

Liver

What is a hypoglycaemic agent?

Insulin

What causes sugar to enter muscle and fat cells?

Insulin

What is the order of priority of sugar use in the cells?

Energy needs (first) -> glycogen formation -> fat conversion

How much pancreatic juice is produced daily?

1200-1500 mL/day

What are the contents of pancreatic juice?

Mostly water, also enzymes and bicarbonate

What do acinar cells secrete int he pancreas?

enzymes

What do epithelial cells lining the ducts of the pancreas produce?

Bicarbonate

What is the function of bicarbonate in the pancreas?

Neutralize acidic chyme

Why are pancreatic enzymes released in an inactive form?

So that they don't digest the pancreas

What converts trypsinogen to trypsin?

Enterokinase

Which enzymes are activated by trypsin?

Pancreatic enzymes, procarboxypeptidase, and chymtotrypsinogen

What are other enzymes secreted by the pancreas in active form?

Amylase, lipase, and nuclease

What do amylase, lipase, and nuclease need for optimal activity?

Ions

Which nervous system will cause the pancreas to secrete during the cephalic and gastric phases?

Parasympathetic nervous system

Which hormone is released when HCl is detected in the duodenum?

Secretin

What hormone that stimulates the pancreas is released but he duodenum when a protein or fat is detected in the duodenum?

CCK

What causes the pancreas to secrete in the cephalic and gastric phases?

The same signals the stomach uses

Which phase accounts for 20% of total secretion of pancreatic enzymes?

Cephalic phase

Which phase accounts for 5-10% of secretion of pancreatic enzymes?

Gastric phase

What causes release of pancreatic bicarbonate in the intestinal phase?

Secretin

What causes secretin release?

Acidic chyme in the duodenum

What causes 70-80% of enzyme release from the pancreas?

CCK (during the intestinal phase)

What is the product of HCl and sodium bicarbonate in the duodenum?

Sodium chloride and carbonic acid (which dissociates)

What is the pH of the duodenum after the addition of bicarbonate ion?

7-8

What happens to carbonic acid in the duodenum?

It dissociates to CO2 and H2O

What do digestive enzymes of the intestines need to work properly?

High pH

What causes 80% of pancreatitis in the U.S.?

Biliary tract disease or alcoholism

What is the range of severity of pancreatitis?

Mild and self-limiting -to- acute and life-threatening

What is present in % of acute pancreatitis are gallstones present in?

35-60%

What is the term for a blue umbilicus caused by acute pancreatitis (caused by bleeding)?

Collin's sign

What % of populations with gallstones develop acute pancreatitis?

5%

What % of pancreatitis patients are due to excessive alcohol in the U.S.?

65%

What are the non-gallstone or alcohol causes of pancreatitis?

Tumors of the ducts, medications

infections (mumps)

metabolic disease (hypertriglyceridemia)

acute ischemia

trauma

What % of pancreatitis is idiopathic?

10-20%

What is the pathogenesis of pancreatitis?

Audodigestion of the pancreas by activated enzymes

Obstruction of which ducts can cause acute pancreatitis?

Common bile duct or pancreatic duct

What is secreted in its active form when the common bile or pancreatic ducts are obstructed?

Lipase