Exam 2 LOs PDF

LOs 9/21/22 11:14 AM 092122 - Disorders of Blood Cells Hemoglobin ○ The oxygen binding protein in RBCs that allow for carrying of O2 Hematocrit ○ The same thing as the formed elements of the blood ○ Whole blood - plasma = hematocrit ○ 45% § 1% is WBC...

LOs 9/21/22 11:14 AM 092122 - Disorders of Blood Cells Hemoglobin ○ The oxygen binding protein in RBCs that allow for carrying of O2 Hematocrit ○ The same thing as the formed elements of the blood ○ Whole blood - plasma = hematocrit ○ 45% § 1% is WBC § 99% is RBCs Cell counts ○ Anemia ○ Hemorrhage § Due to blood loss ○ Red cell destruction § Hemolytic anemias § Types - SS (sickle cell) anemia and thalassemias § SS anemia □ RBCs become sickle cell shaped when they become oxygen depleted ○ Red cell production failure § Decreased production anemias § Types - iron deficiency, Vit. B12/folate deficiency, anemia of chronic disease, aplastic anemia, myelophthisic anemia § Iron deficiency □ Low mean cellular volume (microcytic) □ Hypochromic § Vit. B12 deficiency □ High mean cellular volume (macrocytic) □ Hyperchromic § Aplastic anemia □ Higher fat to cell ratio in the bone marrow Polycythemia ○ Aka erythrocytosis ○ Too many RBCs ○ Relative polycythemia § Normal RBCs but looks high due to low plasma volume § Can be due to dehydration ○ Absolute polycythemia § High RBCs § Secondary to chronic hypoxia (living at high altitudes or COPD) § Polycythemia vera (PCV) Overproduction of RBCs by the marrow Leukopenia ○ Low white cells ○ Types - neutropenia or lymphopenia Leukocytosis ○ High white cells ○ Types - neutrophilia or lymphocytosis ○ Leukemoid - leukemia like reaction ○ Left shift is an increase in immature white blood cells Leukemias ○ Malignant cells in blood and bone marrow ○ Usually NO mass ○ Acute (aggressive and immature cells) or chronic (indolent and mature cells) Lymphoma ○ Malignant cells in a discrete mass ○ Usually no circulating cells in blood ○ Hodgkin lymphoma ○ Non-hodgkin lymphoma - follicular or diffuse Plasma cell proliferations of dyscrasias ○ Means bad mixture ○ MGUS = monoclonal gammopathy of undetermined significance ○ Myeloma - diffuse disease ○ Plasmacytoma - localized disease Lymphoid malignancies ○ Impacts B/T lymphocytes as well as NK cells ○ Leukemia (ALL (peds) or CLL (elderly)), lymphoma ○ ALL § MC in children § Aggressive § Lymphoblasts ○ CLL/SLL § MC in elderly § MC leukemia § Indolent course with mature appearing lymphocytes ○ Lymphomas § Hodgkin □ 10-30yo □ Mediastinum and neck □ 75-90% cure § Non-hodgkin □ Many types □ Aggressive, but level depends on type ○ Plasma cell proliferations § Dyscrasias § MGUS □ 5% pts >70yo □ 1%/year progress to myeloma § Multiple myeloma Myeloid malignancies ○ Impacts granulocytes, RBCs, megakaryocytes, and monocytes ○ Leukemia (AML and CML), myelodysplasia (pre-leukemia), and myeloproliferative syndromes ○ AML § Acute myeloid leukemia □ Rapidly progressive □ Blasts (immature cells) □ Found in all ages but MC in >50yo ○ CML § Chronic myeloid leukemia □ Slowly progressive □ More mature cells □ MC in elderly □ Philadelphia chromosome ® Small 22 ® Reciprocal 9,22 translocation ○ Myelodysplasia § Preleukemia syndrome of myeloid lineage ○ Myeloproliferative syndromes § CML (granulocytes) § PCV (red cells) § Malignant thrombocythemia (megakaryocytes/platelets) § Primary myelofibrosis with EMH (fibrosis with malignant immature myeloid cells and neoplastic EMH) Splenomegaly ○ Caused by viral infections (EBV), lymphoma, leukemia, chronic passive congestion ○ Hypersplenism § Overactive and often enlarged spleen § Removes too many blood cells Thymic hyperplasia ○ Lymphocytic ○ Myasthenia gravis § Type II cytotoxic immune reaction § Antibody blocks Ach receptors at NMJ Thymoma ○ Tumor of the thymic epithelial cells ○ Also associated with myasthenia gravis 092722 - Disorders of Blood Vessels Triglycerides/Cholesterol lipoproteins ○ Lipoproteins are soluble in normal blood ○ HDL = high density = good ○ LDL = low density = bad § Risk of causing arteriosclerosis ○ Lowering this lowers risk of arteriosclerosis ○ Saturated and trans fats promote arteriosclerosis HTN ○ Causes damage to arteries and organs ○ Silent until complications arise ○ Accelerates arteriosclerosis ○ Treatment - diet (weight loss) and drugs ○ Primary § Unknown cause § 95% of cases § Kidneys are the key controller § Environmental factors = sodium, stress, obesity, smoking ○ Secondary § 5% of cases linked to specific causes § Causes □ Renal artery stenosis □ Cushing syndrome □ Pheochromocytoma Arteriosclerosis ○ Hardening of the arteries often caused by HTN ○ Hyaline arteriolosclerosis § This occurs in the arteries leading to the kidneys § This can occur in the afferent and/or efferent arterioles ○ Hyperplastic arteriolosclerosis § Caused by sever, chronic HTN § Seen as "onion skinning" Atherosclerosis ○ Fatty plaques that clog arteries and are at risk for rupturing and thrombus formation ○ Lifestyle disease § Unhealthy people with ETOH and smoking ○ Non-controllable RF § Old, male, post-menopausal female, genetics, vascular inflammation ○ Controllable RF § High LDL (want it low) § Low HDL (want it high - moderate ETOH can help) § HTN, metabolic syndrome, DM, physical activity, smoking ○ Obstructed blood flow is most common complication ○ OLD § Causes gradual stenosis § Stable ○ NEW § Unstable § Prone to sudden obstruction Aneurysms ○ Local dilation of artery or heart chamber ○ MC causes - atherosclerosis and HTN ○ MC site - abdominal aorta Dissections ○ MC cause - HTN ○ Longitudinal tear with hemorrhage ○ MC site - aorta ○ Types § Complete exit tear □ Full tear, massive hemorrhage, fatal § Reentry tear □ Tear for blood to go out and another for blood to enter □ May go undetected Vasculitis ○ Autoimmune § Local □ Temporal arteritis (AKA giant cell arteritis) ® Medical emergency due to possible blindness ® Giant cell is basically a macrophage with multiple nuclei □ Takayasu arteritis ® Granulomatous inflammation of aorta and branches □ Thromboangiitis obliterans ® Vessels in hands and feet of young smokers § Systemic □ Polyarteritis nodosa ○ Infectious § Rare § MC causes - syphilis meningococcus, fungi, bacteria Varicose veins ○ Due to systemic relaxation of the veins ○ Caused by increased hydrostatic pressure ○ Superficial veins are most impacted ○ Cause - stasis, poor blood flow, skin atrophy, ulceration DVT ○ Deep leg veins impacted ○ Often caused by immobility ○ Can cause pulmonary thromboembolism Pulmonary thromboembolism ○ A thromboembolism that can often break off or travel from deep veins in legs ○ Thromboembolism blocks pulmonary arteries and you die Raynaud Syndrome ○ Exaggerated vasomotor reactivity of small arteries and veins in hands and fingers ○ MC in women ○ Triggers - cold and emotional stress ○ Presentation - blanching and bluing of fingers ○ Primary - 80% of cases and not associated with other conditions ○ Secondary - lupus, systemic sclerosis, autoimmune Tumors of blood and lymphatic vessels ○ Hemangioma § Common and benign § Nevus flammeus = congenital § Spider angioma = liver disease or high estrogens § Arteriovenous malformation = not a true neoplasm but can cause seizures/bleeds in the brain ○ Lymphangioma § Benign in the lymphatics ○ Kaposi sarcoma § Caused by HHV-8 or KSHV § HIV related ○ Angiosarcoma § Associated with radiotherapy 092822 - Disorders of the Heart CHF ○ Systolic (pumping) or diastolic (filling) ○ Forward effect § Low CO and hypoxia ○ Backward effect § Upstream venous congestion ○ Tx § Weight loss § Na+ restriction § Smoking cessation § Rx Right HF ○ MC cause is LHF ○ Congestion of liver and spleen ○ Forward effect - low pulmonary perfusion ○ Backward effect - systemic venous congestion Left HF ○ MC HF ○ Forward effect - low flow, hypoxia, and organ failure ○ Backward effect - pulmonary congestion and edema CAD ○ Cause is atherosclerosis § Old atheromas are scarred and less likely to cause infarct § Young atheromas are soft, unstable, and likely to cause infartct ○ Can cause acute ischemias § Angina - stable, unstable, or unremitting § MI - cardiac death downstream of ischemia ○ Suspect in pts with chest pain ○ Dx § ECG - inverted T wave or STEMI/NSTEMI § Blood markers - CK-MB or troponin ○ Tx § Comfort, O2, bed rest § Rx goal - dissolve thrombus, lower cardiac workload, arrhythmatics § Catheterization § CABG Valvular disease ○ Stenosis and insufficiencies (regurgitation) ○ Causes § Degenerative (age) - MC - AS and mitral prolapse § Congenital bicuspid aortic valve § Rheumatic fever □ Acute - autoimmune post strep □ Can lead to rheumatic valvulitis and MS § Endocarditis □ Non-infective - fibrinous vegetations or SLE □ Infective - bacterial and often due to IVDA Myocarditis ○ Inflammation of myocardium ○ Usually viral with Coxsackie A/B ○ Presents as HF or arrhythmia Cardiomyopathy ○ Non-inflammatory and intrinsic disease of cardiac muscle ○ MC impacts LV ○ Primary - unknown cause ○ Secondary - LV hypertrophy from systemic HTN ○ Anatomic § Dilated - common, viral, genetic, alcohol § Hypertrophic - genetic, young athlete death § Restrictive - rare, genetic, amyloidosis, hemochromatosis (Iron overload) Pericardial Disease ○ Pericardial Effusion § Increased pericardial fluid □ MC causes are inflammation, metastases, HF, or trauma ○ Hemopericardium § Trauma and/or aortic dissection § May lead to cardiac tamponade and impaired diastolic filling ○ Pericarditis § Post MI - called Dressler syndrome § Infection - viral, autoimmune (lupus) § Restrictive - due to scarring and similar to tamponade Congenital Heart Disease ○ R-to-L shut § Cyanotic - blue ○ L-to-R shunt § NON-cyanotic § MC due to atrial or ventricular septal defect or persistent ductus arteriosus Arrythmias ○ Escape rhythms § Every part of the conduction system is capable of self-stimulation but at slow rates down the conduction system ○ Re-entry loop § Abnormal conduction path that loops back on itself leading to a rapid HR ○ Ectopic signals § Originate outside of SA node § A-Fib □ More common than atrial flutter □ Both fibrillation and flutter have risk of thromboembolic event § PVC □ Common and benign § Dangerous cardiac conditions □ Vtach and Vfib (fatal) General Pathology of Heart Disease ○ Pump failure - CHF ○ CAD - ischemia or AMI ○ Valvular disease § Stenosis = stiff resistance § Regurgitation = back flow ○ Shunts - abnormal flow due to additional pathways ○ Abnormal conduction - arrhythmias Tumors of the Heart ○ Metastasis that impacts the heart is more common than primary tumors ○ Atrial myxoma § Most common primary heart tumor but very rare § Benign but may fragment and embolize ○ Other types § Lipomas and rhabdomyomas 10(4/5)22 - Disorders of the Respiratory Tract Obstructive Lung Disease ○ FEV1/FVC is low § FEV1 drops but FVC is unchanged ○ Ex. COPD ○ ○ Conditions § Obstructive sleep apnea □ Upper airway condition □ MC: obese male w/ HTN and HF § Asthma □ Atopic - type 1 hypersensitivity allergy □ Non-atopic - URI, exercise induced, air pollution □ Occupational substances - wood, grain, textile dust □ Status asthmaticus - sever, prolonged bronchospasm. Life threatening Restrictive Lung Disease ○ FEV1/FVC is normal § Both values drop and ratio remains constant ○ Ex. Interstitial fibrosus of lung ○ ○ Fibrosis is often the only element and idiopathic ○ Pneumoconioses § Caused by inhaled dust/fumes (asbestosis) ○ Granulomatous interstitial disease § Sarcoidosis - systemic disease with varying extent/severity § Hypersensitivity pneumonitis - allergic alveolitis with complex pathogenesis □ Acute - immune complex mediated □ Chronic - t-cell mediated w/ chronic dust exposure COPD ○ Bronchial air-trapping ○ Low FEV1/FVC ratio ○ Associated with emphysema and chronic bronchitis Emphysema ○ 90% due to smoking ○ Can lead to pulmonary HTN and RHF ○ Alveolar parenchymal destruction Chronic Bronchitis ○ Most have emphysema ○ MC due to smoking ○ Bronchial and bronchiolar inflammation and excessive mucus production Bronchiectasis ○ Always secondary to something else (cystic fibrosis) ○ Chronic necrotizing bronchial infx leading to dilation of small bronchi Rhinitis ○ Infectious § URI § Viral (MC: rhinovirus) ○ Allergic § Hay fever § Common § Type 1 immune reaction w/ immediate hypersensitivity ○ Nasal polyps § Secondary from recurrent rhinitis --> not neoplastic Sinusitis ○ Can be acute or chronic ○ Usually bacterial but can be fungal (dangerous. In immunocompromised/DM) Sinonasal papillomas ○ Benign neoplasms that may occur post-excision ○ May have HPV etiology Pharyngitis ○ Viral and bacterial etiology ○ GAS Laryngitis ○ Often secondary to URI Laryngeal papillomas ○ Benign neoplasms that may occur post-excision ○ HPV etiology Vocal cord nodule ○ Singer's nodes ○ Due to vocal stress and smoking Laryngeal carcinoma ○ Risk factors are smoking and enhanced by ETOH Atelectasis ○ Collapse of the lung leading to poor gas exchange and increased risk of infx ○ Types § Resorption - bronchial obstruction (peanut in lungs) § Compression - external compression from pleural or sub- diaphragmatic source (fluid, air, or blood) § Contraction - due to scarring (TB) Pulmonary Edema ○ Hemodynamic § Due to LHF ○ Microvascular injury § Causes: toxic fumes, hot gas, bacterial endotoxin, IV drug abuse § May lead to ARDS ARDS ○ Acute respiratory distress syndrome ○ Alveolar or capillary injury ○ Etiology - secondary to sepsis, smoke inhalation, near drowning ○ Leads to… § Sever inflammation § Protein-rich exudate seeps into alveoli § Impaired gas transfer § Hyaline membranes - fluid dries and get stiff lungs ○ Medical emergency - 40% fatality rate Pulmonary HTN ○ AKA cor pulmonale ○ Often irreversible and fatal ○ MC cause is COPD --> pulmonary vasoconstriction --> remodeling of arterial walls (onion skinning) ○ Can lead to RHF due to cor pulmonale Thromboembolism ○ Common and often fatal ○ Originate from deep veins in legs/pelvis ○ Associated with immobilization, obesity, cancer, and pregnancy Pneumonia ○ Two anatomic types § Alveolar □ Often bacterial □ Bronchopneumonia - patchy □ Lobar pneumonia - consolidates a lobe and often due to strep pneumo § Interstitial □ Often viral ○ Syndromes § CAP - MC and caused by strep pneumo § Nosocomial - MRSA, E coli, Pseudomonas § Aspiration - debilitated pts (acute = alcohol) and can lead to lung abscesses and encephalitis - caused by oral flora or anaerobes § Chronic - TB, histoplasmosis or other deep mycoses (fungus) § Immunocompromised - opportunistic pathogens - pneumocystis (fungal) Pneumocystis jiroveci pneumonia = cotton candy Pneumocystis, GCM = crushed ping pong balls Lung tumors ○ MC tumor in lung = metastatic tumor ○ MC tumor OF lung = ??? Bronchogenic carcinoma ○ #1 cancer death in USA ○ 85-90% associated with smoking ○ 70% fatality ○ Types § Small cell carcinoma □ 15% □ Neuroendocrine □ Highly aggressive □ Paraneoplastic syndromes □ Usually treated with chemo/radiation but often palliative § Non-small cell carcinoma □ 85% □ Treated w/ surgery, chemo and radiation □ Types ® Adenocarcinoma - peripheral ® Squamous cell carcinoma - central ® Large cell carcinoma Bronchial carcinoid ○ Low grade neuroendocrine tumor ○ Less aggressive than small cell or non small cell ○ Most often cured with surgery Pleural diseases ○ Pneumothorax § Air in pleural space § MC caused by trauma or emphysema § Tension pneumothorax □ Lets air into pleural space but not out which obstructs blood return to heart ○ Pleural effusion § Fluid in pleural space § Inflammatory exudate - high in neutrophils and protein. MC due to infection or pleuritis § Non-inflammatory transudate - hemodynamic or osmotic cause. Few neutrophils and low in protein. Associated with CHF § Blood may be due to tumor or trauma (whole blood) ○ Mesothelioma § Rare malignancy § Associated with asbestos exposure Spirometry ○ FCV - forced vital capacity § Volume of air expelled from maximal expiration after maximal inspiration ○ FEV1 - forced expiratory volume in one second ○ FEV1/FVC used to evaluate disease ○ 10(11/12)22 - Disorders of the GI Tract Normal digestion ○ Carbs broken by amylase to monosaccharides absorbed in blood ○ Proteins broken by protease into amino acids absorbed into blood ○ Fats broken by lipase into TG and cholesterol absorbed in lacteals Signs/Sx ○ Anorexia - Lack of appetite ○ Emesis - N/V ○ Dysphagia - difficulty swallowing ○ Dysentery - low volume, painful, bloody diarrhea ○ Steatorrhea - fatty stools in high volume ○ Ilius - lack of peristalsis Oral Squamous Cell Carcinoma ○ Lower lip - solar damage ○ Oral - tobacco and ETOH Periodontitis ○ Most common cause of tooth loss Lip ○ Herpes § Usually HSV-1 and occasionally HSV-2 Oral ○ Aphthous ulcers § Small painful idiopathic ulcers ○ Candidiasis § Thrush § Fungal § Usually in immunocompromised ○ Leukoplakia § White patch § Can be cancerous Oropharyngeal ○ Squamous cell carcinoma - HPV virus Salivary glands ○ Sialadenitis § Inflammation of salivary glands § Chronic □ Autoimmune □ Stones ○ Neoplasia § Most are benign § Pleomorphic adenoma - most common tumor § Mucoepidermoid carcinoma - most common malignant tumor Esophageal Diseases ○ Congenital - atresia or tracheoesophageal fistula ○ Achalasia - LES spasm - dysphagia, pain, regurgitation ○ Hiatal hernia - stomach herniation through the esophageal hiatus ○ Mallory-Weiss tears - sever vomitting - retching ○ Esophageal varices - cirrhosis - risk of severe bleeding ○ Esophagitis - often due to GERD - Barrett metaplasia - risk of adenocarcinoma ○ Carcinoma - MC in males - Squamous = tobacco/ETOH, Adenocarcinoma = GERD Gastritis ○ Chronic ○ MC caused by infx from H pylori ○ Can also be caused by pernicious anemia Ulcers ○ AKA acute gastritis or erosions ○ MC caused from ETOH, NSAIDs, and stress ○ Peptic ulcer § MC caused by H pylori and NSAIDs Gastric carcinoma ○ Adenocarcinoma § Aggressive § H pylori associated chronic gastritis ○ Lymphoma § Also associated w/ h pylori chronic gastritis Hirschsprung disease ○ AKA Congenital aganglionic megacolon ○ Absence of ganglion cells in colon wall neural plexus ○ Lacks peristalsis and constriction Intestinal infections ○ Viral: rotavirus in kids, norovirus ○ Bacteria § C diff □ Pseudomembranous colitis § Enterohemorrhagic E Coli □ MC in US from food § Enterotoxigenic E Coli □ Travelers diarrhea § Tissue invasion □ Shigella, salmonella, campylobacter § Protozoa causing ifnx diarrhea □ Entamoeba histolytica - amebic dysentery □ Glardia duodenalis - contaminated water □ Cryptosporidium - opportunistic in HIV/AIDS Malabsorption syndromes ○ Lactose intolerance § Due to lack okf mucosal enzymes ○ Celiac Sprue § Caused by gluten sensitivity Inflammatory bowel disease ○ Crohn's disease/ulcerative colitis § Extraintestinal involvement and increased risk for colon carcinoma § ○ IBS § May mimic IBD § AKA spastic colon or irritable colon § No objective findings, Dx of exclusion Neoplasms of large bowel ○ Colonic polyps and carcinoma ○ Hyperplastic polyps = non-neoplastic polyps, not premalignant ○ Adenomatous polyps § Adenomas § Dysplastic = premalignant § Tubular adenoma or villous adenoma ○ Colorectal adenocarcinoma (CRC) § 2nd MC cause of cancer death § Risks □ Low fiber/high fat diet □ IBD □ 20% of a genetic predisposition ○ Staging and 5 yr survival 0 100% 1 93% § 2 72-85% III 44-83% IV 8% Colonic diverticula ○ Diverticulosis can lead to diverticulitis § Typically sigmoid colon, low fiber diet ○ Commonly associated w/ anorectal conditions § Fissures § Perirectal abscess § Fistula § Pilonidal cyst § Hemorrhoids Appendicitis ○ Acute § Often due to obstruction § 5% of population get this Peritonitis ○ Complication of acute appendicitis, diverticulitis, etc § Ascitic fluid is a risk Meckel diverticulum ○ Congenital abnormality ○ Occurs in distal ileum Vascular diseases ○ Ischemic vascular disease ○ Volvulus (twisting) ○ Angiodysplasia § Collection of vessels in mucosa or submucosa § 20% of GI bleeds ○ Hemorrhoids § Polypoid varices § Due to constipation and straining pregnancy or cirrhosis 101822 - Disorders of the Liver and Biliary Tract LFT ○ AST, ALT, LDH - show hepatocyte damage ○ AP and GGT - show bile duct disease ○ Bilirubin § Break down product of hemoglobin § Increase shows hepatocellular or bile duct disease or hemolysis § Unconjugated = indirect § Conjugated = direct ○ Low albumin = liver disease ○ PT and PTT = liver disease Clinical syndromes of liver disease ○ Jaundice § Pre-hepatic □ Unconjugated bilirubin □ Hemolysis § Hepatic □ Conjugated or unconjugated bilirubin □ Viral hepatitis, cirrhosis, drug rxns § Post-hepatic □ Conjugated bilirubin □ Bile duct obstruction or cancer § Cholestasis □ Accumulation of bile in the liver by intra or extra hepatic flow obstruction ○ Cirrhosis § Inhibits hepatic flow § Scaring and regenerative nodules of the liver § Liver can grow in early stage and then shrink in late stage (irreversible) § MC is ETOH and viral § 25% idiopathic § Obstruction of portal blood flow leads to portal HTN § Only late stage therapy is transplant § ○ Portal HTN § Pre-hepatic □ Portal vein thrombosis, scarring, or tumor § Hepatic □ Cirrhosis § Post-hepatic □ Right CHF § Sx □ Varices ® Hemorrhoids ® Portosystemic shunt = splenomegaly □ Caput medusa - periumbilical varices □ Esophageal and gastric varices ○ Hepatic Failure § 80-90% loss of function § MC cause = cirrhosis § Can lead to hepatic encephalopathy □ Ammonia and other toxins get to brain § May lead to multi system/organ failure § 80% fatality § Acute cases □ 1/2 due to acetaminophen toxicity Viral Hepatitis ○ Clinicopathologic syndromes § Acute viral □ Malaise, nausea, jaundice or A-Sx § Carrier □ A-Sx but infectious § Chronic □ Sx, damage and infectious ○ Hep A § Epidemic hepatitis § Fecal-oral transmission § Carrier and chronic not present in Hep A § Vaccination available § IgM comes first, then IgG ○ Hep B § Infected 1/3 of world population § Not all have chronic infection § Close contact transmission § Vaccination available § Test/marker for immunity is HepB surface antigen/antibody (anti- HBs is immunity but anti-HBc is infected) ○ Hep C § 50-75% progress to chronic liver disease § Close contact transmission ○ Hep B/C have high incidence of hepatocellular carcinoma when they develop cirrhosis ○ Hep D § Only infects those w/ Hep B § Coinfection - usually recover from both § Superinfection - usually get chronic of both ○ Hep E § Similar to Hep A and endemic but in India § No carrier of chronic state § 20% fatality Non-viral inflammatory liver disease ○ Bacterial/fungal - highly fatal and common in immunodeficient ○ Amebic - entamoeba hystolytica - 3rd world ○ Autoimmune - mostly female and often have other autoimmune Toxic liver injury ○ Dose related for acetaminophen and ETOH ○ Non-dose related - other drugs ○ Reye syndrome § Pediatric viral illness w/ aspirin § Highly fatal ○ ETOH § Leading cause of liver disease § 95% get steatosis = fatty liver § Only 20% get hepatitis § Only 15% get cirrhosis § Need lots of ETOH - 6-12/day for 10 yrs Metabolic liver injury ○ Non-alcoholic fatty liver disease and setatohepatitis § NAFLD and NASH § Very common and associated w/ metabolic syndrome Bile Duct diseases ○ Secondary biliary cirrhosis § Caused by prolonged obstruction § MC cause of obstruction is gallstones ○ Primary biliary cirrhosis § Autoimmune disease § MC female w/ another autoimmune disease § Have anti-mitochondrial antibodies ○ Primary sclerosing cholangitis § Affects intrahepatic and extrahepatic biliary ducts § MC associated w/ ulcerative colitis § 5% develop biliary adenocarcinoma Metastases ○ Most common tumor in liver Adenoma is rare and associated w/ oral contraceptives Hepatoblastoma is a malignant tumor in children Hepatocellular carcinoma ○ Risk w/ cirrhosis, chronic HBV and HCV ○ Increased serum AFP levels Cholangiocarcinoma ○ Risk increased w/ HCV and sclerosing cholangitis Cholecystitis ○ Inflammation of gall bladder ○ Acute § Hot and painful ○ Chronic § Slowly develops Gall Stones ○ Cholelithiasis § Gall stones ○ Choledocholithiasis § Stones in the common bile duct ○ MC cholesterol § Risk - female, obese, middle aged ○ Pigment stones § Risk - chronic hemolysis ○ May lead to cholecystitis 101922 - Disorders of the Pancreas Normal ○ Exocrine § Acinar cells § Digestive enzymes § Protease secreted in inactive form § Lipase and amylase secreted in the active form ○ Endocrine § Islets of Langerhans § Hormones into blood § Alpha cells □ Glucagon □ Raises blood glucose § Beta cells □ Insulin □ Lowers blood glucose § Delta cells □ Somatostatin □ Raises blood sugar Acute pancreatitis ○ Reversible pancreatic injury ○ Causes § MC - ETOH (2/3) § Gallstones - 1/2 ○ Sx § Pain, inflammation, necrosis, hemorrhage ○ Complications § ARDS § Shock § Renal Failure § DIC § Pancreatic pseudocyst ○ 5-20% mortality Chronic pancreatitis ○ Repeated episodes of acute pancreatitis ○ Irreversible damage ○ Same causes as acute but also associated w/ cystic fibrosis ○ Complications § Pancreatic pseudocyst § Common bile duct obstruction § Secondary DM ○ 30% 10 yr mortality DM I ○ MC in juveniles ○ Autoimmune ○ 10% of all DM ○ Some genetic influence but less than DM II ○ Decreased beta cells ○ Low blood insulin ○ Ketoacidosis is common complication DM II ○ Multifactorial ○ 90% of cases ○ Tend to be obese ○ Decreased peripheral cell insulin sensitivity ○ Slow onset ○ High genetic influence ○ Other causes § Pregnancy or steroid Rx ○ 8.6% of population DM ○ Highest complication is hyperglycemia ○ Accelerates atherosclerosis and microangiopathy seen MC in retina and kidneys Pancreatic ductal adenocarcinoma ○ 95% of all pancreatic cancers ○ Most patients have advanced disease bec it isn't found early ○ Sx § Back/abdominal pain § Painless jaundice § CBD obstruction ○ #3 cancer killer ○ Risks § Lynch syndrome § FAP - familial andenomitus p…. § Smoking, ETOH, obesity § Chronic pancreatitis Endocrine tumors ○ Islet cell tumors ○