Accessory Digestive Organs and Metabolic Disorders Flashcards
What liver syndrome is described as an absence of general functions, where cells do not function properly?
Hepatic failure
What liver syndrome is described as architectural disruption and fibrosis within nodules of hepatocytes?
Cirrhosis
True or false. Liver cirrhosis has rapid onset of symptoms.
False. Nodules of functional tissue are sufficient for maintenance; can be asymptomatic early on
What is the function of Kupffer cells?
Resident macrophages of the liver
What is the function of quiescent stellate cells?
Vitamin A storage
What are the functions of activated stellate cells (myofibroblasts)? (4)
- Proliferation
- Contraction
- Chemotaxis
- Fibrogenesis
What causes activation of stellate cells?
Release of cytokines from Kupffer cells
What is the difference between jaundice and icterus?
- Jaundice: yellowing of skin
- Icterus: yellowing of sclera
What is the function of bilirubin?
- End product of heme catabolism to be excreted
How is bilirubin excreted?
- Conjugated to glucuronic acid
- Excreted in bile
- Eventually fecal matter
What is cholestasis?
Impaired bile formation/flow
Does massive hepatocyte damage (necrosis) occur in acute or chronic hepatitis?
Acute
True or false. Acute hepatitis can be symptomatic or asymptomatic
True
What systemic viruses can cause acute hepatitis? (2)
- Yellow fever
- Mononucleosis
What are the frequencies of chronic liver disease among the hepatitis viruses?
- HepA - Never
- HepB - 5-10%
- HepC - >80%
- HepD - 10% coinfection w/ HepB; 90-100% superinfections
- HepE - Only in immunocompromised
True or false. HepA infections are never chronic
True
Spontaneous clearance of HepB surface antigen (HBsAg) occurs in ____% of chronic hepatitis cases in western countries.
1-2%
What causes HepC infections to become chronic?
- Reactivation of endogenous HCV strain
- RNA is not fully cleared
- Emergence of new mutant strain
What are the symptoms of chronic hepatitis? (9)
- Fatigue
- Malaise
- Loss of appetite
- Mild jaundice
- Hepatic tenderness
- Hepatomegaly or splenomegaly
- Hyperglobulinemia
- Hyperbilirubinemia
- Increased serum transaminase
In what zone of a hepatic nodule would you expect to see viral damage?
Zone 1
How does a necrotic liver present histologically? (2)
- Congested
- Bile accumulation
How does an acetaminophen overdose in the liver present histologically? (3)
Confluent necrosis in zone 3 surrounding the central vein
Why is acetaminophen toxic to the liver?
Metabolized to reactive intermediates that can kill cells
What is the normal use for chlorpromazine?
- Dopamine antagonist
- Treats schizophrenia
Why is chlorpromazine toxic to the liver?
- Forms insoluble complexes in bile which leads to cholestasis
- Metabolites inhibit membrane enzymes and impair cytoskeletal functions
What proof is Jack Daniel’s? (yes she said this in lecture)
80 proof
Mild ethanol injury results from moderate alcohol intake, which equates to ________
6 beers or 8 oz of 80 proof liquor in 1 session
What is steatosis?
- Fatty deposits in the liver
- Caused by mild ethanol injury
What are the effects of ethanol on hepatocytes? (4)
- Affects membrane function (chemical)
- Induces/inhibits enzymes that detoxify foreign compounds
- Enhances oxygen toxicity
- Oxidized to acetaldehyde
What are the effects of acetaldehyde on hepatocytes? (2)
- Inhibits protein export and metabolism
- Alters redox potential
What are the symptoms of preeclampsia/eclampsia? (4)
- Maternal hypertension
- proteinuria
- Peripheral edema
- Hypercoagulability
What is HELLP syndrome?
- H = hemolysis
- EL = elevated liver enzymes
- LP = low platelets
What causes preeclampsia/eclampsia?
- Hemorrhage into space of Disse
- Fibrin deposits in periportal sinusoid
- Leads to necrosis of hepatocytes
____ is the systemic retension of bilirubin and other solutes such as excess cholesterol, xenobiotics, and other waste products.
Cholestasis
What is the cause of cholestasis?
- Impaired bile flow:
- accumulation of bile in hepatocytes
- Obstruction of bile channels
- Defects in hepatocyte bile secretion
What are the symptoms of cholestasis?n (4)
- Jaundice
- Pruritis (itching)
- Skin xanthomas (cholesterol accumulation)
- Malabsorption in the intestines
What is canalicular cholestasis?
- Most common form of cholestasis as a result of sepsis
- Bile plugs within centrilobular bile canaliculi
- Activated Kupffer cells
- Mild portal inflammation
What is ductular cholestasis?
- Type of cholestasis that results from sepsis
- Dilated canals of Hering and bile ductules with bile plugs
- Edema and presence of neutrophils in stroma
- Hepatocyte death is possible
By what 3 mechanisms can sepsis cause cholestasis?
- DIrect effects due to infection within the liver (abcess or cholangitis)
- Ishcemia due to hypotension (esp. if liver is cirrhotic)
- Circulating microbial products (esp. with Gram(-) bacteria)
What is cholecystitis?
- Inflammation of the gall bladder
- Almost always associated with gall stones
How does acute cholecystitis present clinically? (4)
- Enlarged, tense gall bladder
- Wall is thickened and fluid-filled (edematous)
- Hemorrhages beneath serosa
- May be covered with fibrinous exudate (sign of more severe disease)
Insulinomas, somatostatinomas, and glucagonomas are caused by an overgrowth of what pancreatic cell types?
- Glucagonoma - alpha cells
- Insulinoma - beta cells
- Somatostatinoma - delta cells
What is steatorrhea?
Impaired pancreatic excretion
What is cholethiasis?
Impaired bile secretion
What are the symptoms of a glucagonoma?
- Hyperglycemia (due to excessive glucose mobilization)
- Characteristic rash due to malnutrition
- Excess amino acid uptake for use as fuel to produce more glucose
What infectious disease is known to cause acute pnacreatitis?
Mumps
What enzymes are activated in acute pancreatitis and can lead to autodigestion? (3)
- Trypsin (or other proteases) - normally in duodenum
- Elastase - microvascular leakage
- Lipase - fat necrosis
Aside from inappropriate activation of certain enzymes, what else can lead to autodigestion in acute pancreatitis? (2)
- Thromboses
- Hemorrhage
What is the most common cause of chronic pancreatitis? Why?
- Long-term alcohol abuse
- Increased excretion → duct obstruction
- Directly toxic to acinar cells
Describe the pathology of chronic pancreatitis. (3)
- Parenchymal fibrosis
- Reduced exocrine acini
- Duct dilation/concretions
What are the symptoms of pancreatitis? (6)
- Upper abdominal pain
- Nausea/vomiting
- Fever
- Tachycardia
- Sweating
- Icterus/jaundice
What is the treatment for pancreatitis?
- IV fluids
- No food
- Medicine for pain
