Biliary and Pancreas Flashcards
what is the role of the biliary system?
creates, moves, stores and releases bile into the duodenum
what is bile?
a dark green to yellowish fluid produced by the liver
helps emulsify lipids in food which greatly increases SA for action of lipase
what is the relationship between bile and jaundice?
a biliary obstruction will result in the accumulation of bile in the blood and presence of jaundice
describe the flow of bile
moved to the gallbladder through the R and L hepatic duct which join to form the common hepatic duct
bile then moves through the cystic duct to reach the gallblader
common hepatic duct + cystic duct = common bile duct
what is the role of the gallbladder?
stores and concentrates bile by absorbing water through the wall of the gallbladder
movement of bile to/from the gallbladder is via peristaltic action of muscles in the cystic duct
list 2 common gallbladder diseases
- gallstone (cholelithiasis)
- inflammation of gallbladder (cholecystis)
list risk factors for gallstones
- age, genetics
- decreased physical activity, obesity
- poor lipid profile
- RA
- TPN (total parenteral nutrition)
- liver disease
- gastric bypass surgery
- DM
what are gall stones?
stones that form in the gall bladder
form when composition of bile changes
cholesterol stones (80% of all cases)
bilirubin stones (20% of all cases)
T/F: 75% of gallstones are asymptomatic?
TRUE
25% become symptomatic when stones physically obstruct ducts leading to distension of bladder while muscles in the duct wall contract trying to expel stone
cystic duct most frequent site of obstruction
List symptoms of gall stones
- intense abdominal pain
- R upper quadrant pain
- just below/slightly to the R of the sternum
- abdominal tenderness and muscle guarding
- pain may radiate to shoulder and upper back or midback and scapula
List some special PT implications for gall stones
physical activity may play an important role in the prevention of symptomatic gallstone disease “just move”
the usual post op exercises for any surgical procedure apply here (if they are surgically removed)
what are some complications to gall stones?
choledocholithiasis → calculi in the common bile duct, can cause pancreatitis
what is the function of the pancreas?
- endocrine gland → secretes insulin and glucagon directly in the blood
- exocrine gland → secretes bicarbonate and a number of digestive enzymes into the pancreatic duct which conducts these to the epithlial lining of the duodenum
what is the difference between an endocrine and exocrine gland?
- endocrine → ductless gland that secretes their products, hormones, directly into blood
- exocrine → glands that secrete substances onto epithelial surface by way of a duct
describe the cellular anatomy of the pancreas
made up of Islets of Langerhands which are regions of the pancreas that contain 3 types of endocrine cells
list the 3 types of cells in the Islets of Langerhan
- Alpha cells → secrete glucagon
- Beta cells → secrete insulin
- Delta cells → secrete somatostatin (growth hormone-inhibiting hormone GHIH)
what are the actions of insulin?
- stimulates cellular uptake of glucose
- reduces circulating levels of glucose
- stimulates glycolysis and glyconeogensis
- favors the utlization of available glucose
- inhibits gluconeogensis and glycogenolysis
- inhibits storage of glucose
- stimulates cellular uptake of amino acids
- an anabolic hormone
- stimulates the uptake of glucose by fat cells and its conversion into fats
- stimulates cell growth and synthesis of new mRNAs
- favors immediate use of glucose and storage of glucose
list the actions of glucagon
- opposite effect of insulin
- released from alpha cells in response to declining insulin levels
- works to increase concentation of glucose and fatty acids in the blood stream
- catabolic hormone
what are zymogen granules?
the specialized organelle in pancreatic acinar cells for digestive enzyme storage
what enzymes are released from the pancreas as part of its exocrine function?
- proteases → digest proteins and peptides to single amino acids
- pancreatic lipases
- amylase
- ribonuclease, gelatinase, elastase, etc.
T/F: zymogens are active digestive enzymes and have catalyic action
FALSE
they are storage form of digestive enzymes and need to be activated to have a catalytic action
List some pancreatic diseases
- Acute pancreatitis
- Chronic pancreatitis
- Pancreatic cancer
- DM type I
- DM type II
what is acute pancreatitis?
occurs when there is an abnormal activation of digestive enzymes within the pancreas and results in autodigestion of the pancreas
a sudden hyper infammation in the pancreas also occurs
list some causes of acute pancreatitis
- gallstones
- chronic alcohol consumption
- idiopathic
- pancreatic cancer
- drugs
list the symptoms of acute pancreatits
- pain, N/V, anorexia
- abdominal pain
- cardinal symptom of acute pancreatitis = sharp and severe; position changes do not alleviate the pain
acute pancreatitis is a systemic disease, list some of it’s systemic effects
- hyperglycemia
- hypoxemia, atelectasis
- kidney failure
- hypovolemia and shock
- jaundice, portal vein thrombosis
how is acute pancreatitis treated?
- IV fluids
- analgesics
- NPO/stop feeding the patient to “rest” the pancreas
- severe pancreatits → admission to ICU
list some PT implications for acute pancreatitis
- presents w/back pain
- pancreatic scarring may occur and limit trunk extension
- don’t feed the patient if NPO
- bed positioning → side-lying, knee-chest position w/pillow pressed against the chest or sitting w/trunk flexed
what is chronic pancreatitis?
characterized by development of irreversible changes in pancreas secondary to chronic inflammation
list symptoms of chronic pancreatitis
- chronic abdominal pain
- opioid abuse
- decreased appetite
- wt loss
- poor QOL
- epigastic pain w/radiation to the back
- pain relieved by knee to chest or bending forward
- diabetes
what are the PT implications for chronic pancreatitis?
driven by complications
where is pancreatic cancer common?
head of pancreas (70%) → blockage of pancreatic duct
more common in African Americans than Caucasians
list some clinical presentations of pancreatic cancer
- wt loss
- pain and jaundice
- impaired posture
- impaire muscle performance and ROM
- intractable back pain
what is a Whipple procedure?
surgical removal of a tumor in the head of the pancreas, ampulla, or the first part of the duodenum
what is the difference between Type IA and IB DM?
- Type I A → autoimmune destruction of B cells resulting in an insulin deficiency
- Type I B → insulin deficiency with on evidence of autoimmune disease
T/F: diabetic ketoacidosis is a medical emergency
TRUE
it is an accelerated degradation of fatty acids → formation of ketones → lowers blood pH
List the clinical features of DM
- Polyuria
- Polyphagia
- Wt loss → excessive fat catabolism
- Ketoacidosis → secondary to increased fat catabolism
what is the most common type of DM?
Type II (accounts for 80-90% of all cases of DM)
list components of metabolic syndrome
- dyslipedmia
- HTN (increased Na retention)
- abdominal obesity
- insulin resistance
- proinflammatory state
- prothombic state
- a large waist is 35 inches or more in a women and 40 inches or more in a man
List some comorbities of poorly managed DM
- diabetic retinopathy
- diabetic neuropathy
- diabetic charcot foot syndrome
- peripheral vascular disease
- cardiovascular disease
