NBME CBSE Practice
2 day history of abdominal pain. condi-
tion deteriorates and death in 5 days.
Biopsy: chalky white lesion in the mesen-
Acute Pancreatitis
tery
Histology: adipose cell destruction and
calcium deposition
1) recent ERCP procedures
2) drugs - azothioprine, sulfasalazine,
furosemide, valproic acid
3) infections - mumps, coxsackie, my-
Less common causes of acute pancre- coplasma
atitis 4) hypertriglycerides
5) structural abnormalities of pancreatic
duct
6) surgery
7) Hypercalcemia
decreased ceruloplasmin and increased
Wilson disease
hepatic copper contents
cirrhosis
characteristic findings of Wilson disease CNS involvement
Kayser-Fleischer rings
associated with exposure to arsenic,
thorotrast, and polyvinyl chloride. Tumor
cells express CD31 as a marker.
rare, aggressive vascular malignancy
Hepatic angiosarcoma
presents in older men(>60)
Angiosarcomas are derived from en-
dothelial cells which express PECAM 1
on their surface.
port-wine stains, involve larger dermal
blood vessels and may last a lifetime
common benign vascular lesions
microscopy: well-circumscribed prolifera-
Cavernous hemangiomas
tion of dilated vascular structures that are
lined with endothelial cells lacking atypia.
also express CD31 but patients are typi-
cally asymptomatic
Cholangiocarcinoma
, NBME CBSE Practice
Rare malignancy that originates within
the larger bile ducts (usually the common
duct or common hepatic duct)
derived from bile duct epithelium
primary sclerosing cholangitis
liver flukes
cholangiocarcinoma risk factors thorothast exposure
TX: surgery with radiation
benign tumor of the liver derived from
hepatocytes
Hepatocellular adenoma present in women of reproductive age
and associated with oral contraceptive or
anabolic steroid use.
HIV-related cancer that causes the
growth of purple/red patches on the skin
Kaposi's sarcoma (KS)
and other areas in the body
CD 31 positive
Peptic Ulcer Disease
Pathophys = gastrin-secreting neuroen-
docrine tumors (gastrinomas) within GI
tract --> hypersecretion of gastric acid
multiple peptic ulcers located beyond the
duodenal bulb
pts typically experience abdominal pain
and acid reflux. sometimes have diarrhea
Zollinger-Ellison Syndrome (ZES) as gastric acid damages intestinal ep-
ithelial cells and inactivates pancreatic
enzymes preventing proper nutrient ab-
sorption.
FOILS:
(1) Pheochromocytoma --> HTN
(2) Carcinoid Syndrome --> tricuspid and
pulmonary valve abnormalities, flushing,
bronchoconstriction, severe diarrhea
Glucagonoma
, NBME CBSE Practice
- Rare form of pancreatic alpha cell tu-
mor, Malignant
- Mild Diabetes + raised erythematous
rash affecting groin ( necrolytic migratory
erythema)
a benign tumor of the pancreas that
causes hypoglycemia by secreting addi-
tional insulin
Insulinoma
pts usually have a high circulating in-
sulin/C-peptide level and symptoms of
hypoglycemia
- Caused by neuroendocrine tumors
originating in the small intestine that
have metastasized to the liver. the tu-
mors secrete serotonin and bradykinin
-Serotonin overproduction
- Tumor of serotonin producing cells in
GIT ’ APUD (Amine Precursor Uptake
Decarboxylase) Cells
- Slow-growing but often malignant type
of neuroendocrine tumor, originating in
Carcinoid syndrome cells of neuroendocrine system
- Most commonly found in the foregut
(35.6% cases) with lung, bronchus and
trachea constituting 27.9% cases from
where they rarely metastasize (except in
case of pancreas).
- Sx = Cutaneous flushing accompanied
by sweating, GI hypermotility ’ causing
diarrhea, Bronchospasm
- Increased 5-HIAA excretion of in urine
Tx- Octreotide a somatostatin analogue
malignant delta-islet tumor -> diabetes
mellitus, malabsorption, cholelithiasis(
Somatostatinoma inhibition of CCK), achlorhydria, diar-
rhea/steatorrhea( inhibition of pancreatic
enzyme/bicarbonate secretion)
Vasoactive Intestinal Peptide (VIP)
2 day history of abdominal pain. condi-
tion deteriorates and death in 5 days.
Biopsy: chalky white lesion in the mesen-
Acute Pancreatitis
tery
Histology: adipose cell destruction and
calcium deposition
1) recent ERCP procedures
2) drugs - azothioprine, sulfasalazine,
furosemide, valproic acid
3) infections - mumps, coxsackie, my-
Less common causes of acute pancre- coplasma
atitis 4) hypertriglycerides
5) structural abnormalities of pancreatic
duct
6) surgery
7) Hypercalcemia
decreased ceruloplasmin and increased
Wilson disease
hepatic copper contents
cirrhosis
characteristic findings of Wilson disease CNS involvement
Kayser-Fleischer rings
associated with exposure to arsenic,
thorotrast, and polyvinyl chloride. Tumor
cells express CD31 as a marker.
rare, aggressive vascular malignancy
Hepatic angiosarcoma
presents in older men(>60)
Angiosarcomas are derived from en-
dothelial cells which express PECAM 1
on their surface.
port-wine stains, involve larger dermal
blood vessels and may last a lifetime
common benign vascular lesions
microscopy: well-circumscribed prolifera-
Cavernous hemangiomas
tion of dilated vascular structures that are
lined with endothelial cells lacking atypia.
also express CD31 but patients are typi-
cally asymptomatic
Cholangiocarcinoma
, NBME CBSE Practice
Rare malignancy that originates within
the larger bile ducts (usually the common
duct or common hepatic duct)
derived from bile duct epithelium
primary sclerosing cholangitis
liver flukes
cholangiocarcinoma risk factors thorothast exposure
TX: surgery with radiation
benign tumor of the liver derived from
hepatocytes
Hepatocellular adenoma present in women of reproductive age
and associated with oral contraceptive or
anabolic steroid use.
HIV-related cancer that causes the
growth of purple/red patches on the skin
Kaposi's sarcoma (KS)
and other areas in the body
CD 31 positive
Peptic Ulcer Disease
Pathophys = gastrin-secreting neuroen-
docrine tumors (gastrinomas) within GI
tract --> hypersecretion of gastric acid
multiple peptic ulcers located beyond the
duodenal bulb
pts typically experience abdominal pain
and acid reflux. sometimes have diarrhea
Zollinger-Ellison Syndrome (ZES) as gastric acid damages intestinal ep-
ithelial cells and inactivates pancreatic
enzymes preventing proper nutrient ab-
sorption.
FOILS:
(1) Pheochromocytoma --> HTN
(2) Carcinoid Syndrome --> tricuspid and
pulmonary valve abnormalities, flushing,
bronchoconstriction, severe diarrhea
Glucagonoma
, NBME CBSE Practice
- Rare form of pancreatic alpha cell tu-
mor, Malignant
- Mild Diabetes + raised erythematous
rash affecting groin ( necrolytic migratory
erythema)
a benign tumor of the pancreas that
causes hypoglycemia by secreting addi-
tional insulin
Insulinoma
pts usually have a high circulating in-
sulin/C-peptide level and symptoms of
hypoglycemia
- Caused by neuroendocrine tumors
originating in the small intestine that
have metastasized to the liver. the tu-
mors secrete serotonin and bradykinin
-Serotonin overproduction
- Tumor of serotonin producing cells in
GIT ’ APUD (Amine Precursor Uptake
Decarboxylase) Cells
- Slow-growing but often malignant type
of neuroendocrine tumor, originating in
Carcinoid syndrome cells of neuroendocrine system
- Most commonly found in the foregut
(35.6% cases) with lung, bronchus and
trachea constituting 27.9% cases from
where they rarely metastasize (except in
case of pancreas).
- Sx = Cutaneous flushing accompanied
by sweating, GI hypermotility ’ causing
diarrhea, Bronchospasm
- Increased 5-HIAA excretion of in urine
Tx- Octreotide a somatostatin analogue
malignant delta-islet tumor -> diabetes
mellitus, malabsorption, cholelithiasis(
Somatostatinoma inhibition of CCK), achlorhydria, diar-
rhea/steatorrhea( inhibition of pancreatic
enzyme/bicarbonate secretion)
Vasoactive Intestinal Peptide (VIP)
