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understanding human disease > chap 14 - disorders of the liver and biliary tract, pancreas > Flashcards

chap 14 - disorders of the liver and biliary tract, pancreas Flashcards

1
Q

liver excrets

A

bile
- then it is stored in the gallbladder

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2
Q

pancreas secretes

A

digestive enzymes

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3
Q

portal veins and hepatic artery

A

dual blood supply

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4
Q

liver and biliary tree structure and function

A

Portal veins and hepatic artery - dual blood supply
Transport blood to liver
First- pass effect
Detoxification - breaks things down that can be harmful to our body into less harmful substances
Hepatocytes = liver cell
Liver sinusoids= leaky capillary → access to the blood
Kupffer cells = macrophages that stay in the liver all the time, they don’t circulate
Emulsifies fat - bile emulsifies → takes the lipids and breaks them down into smaller cells so that it can be broken down further

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5
Q

functions of the liver

A

Metabolism
CHO
Protein
Fat
Synthesis of bile
Detoxification
Storage
Vitamin B12
Fat Soluble Vitamins
Synthesis plasma proteins and clotting factors

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6
Q

function of the liver: clearance of waste products

A

Drug and hormone metabolism
Detoxification or inactivation
Cytochrome p450 enzymes
Synthesis of urea - comes from amino acids
Removal of bilirubin
Alcohol metabolism

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7
Q

functions of the liver: bilirubin metabolism

A

Liver only organ to remove heme waste products
Hemoglobin → Heme → Bilirubin
Iron reused
Globin chains reused
Bilirubin excreted by the liver

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8
Q

bilirubin metabolism

A

Liver conjugates bilirubin
Increases solubility
Secreted in bile
Also eliminated in urine

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9
Q

most frequent and serious problems of the liver

A

Choleliths (gallstones)
Hepatitis (liver inflammation)
Many causes - genetics, alcohol, obesity, etc.
Some forms are reversible, others are not

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10
Q

signs, symptoms, and tests for liver disorders

A

Jaundice
Often symptomatic of liver or gallbladder problem
Accumulation of bilirubin that hasn’t been excreted, can accumulate in a variety of places such as skin, eyes, tissues, gums, etc.
- biliary colic, unintentional weight loss, steatorrhea, hepatomegaly

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11
Q

biliary colic

A

Severe right upper quadrant and flank pain caused by obstruction of biliary ductal system by stones

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12
Q

unintentional weight loss

A

not absorbing food like you should
May signify serious pancreatic or liver disease

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13
Q

steatorrhea

A

Passage of smelly, greasy stools that float in water
Indicative of malabsorption of fats

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14
Q

hepatomegaly

A

Increase in size of liver
Prominent in alcoholic fatty liver and metastatic disease

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15
Q

liver tests

A

Liver Function Tests
Liver Enzymes - elevated in blood tests due to liver necrosis - they should be in the liver cells but if there is necrosis of a liver cell these enzymes will end up in the blood
Aspartate aminotransferase (AST)
Alanine Aminotransferase (ALT)
Alkaline Phosphatase (AP)
Albumin - important for plasma oncotic pressure
Clotting time - the liver makes clotting proteins

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16
Q

viral hepatitis

A

Hepatitis = Inflammation Of The Liver
Only infect the liver cells
Systemic viral disease primarily affecting liver
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D, E
Distinguished by: - know how to compare and contrast them for the exam
Mode of transmission
Carrier State
Chronic
Vaccine

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17
Q

hepatitis A

A

HAV - acute
- Primarily fecal-oral transmission, mucosal secretions
- Ingestion of infected material
- Absorption from stomach or small intestine
- Replication in liver
- Secretion into bile
- Excretion in stool or reabsorption
- Abrupt onset of symptoms
- Fever, nausea, vomiting, and loss of appetite
- Enlarged, tender liver and dark urine
- Serum AST strikingly elevated (liver enzyme)
- More common in developing nations
- about 10,000 new cases/yr in US
- Poor water
- People who don’t wash their hands → restaurants
- Poor sanitation
- No specific treatment- rest, self-limiting the body will eventually fight the virus and get better
- You do not become a carrier
- Fatalities rare
- Vaccine - yes (standard)

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18
Q

hepatitis B

A

HBV
- Can cause acute illness that manifests with fever, malaise, and jaundice (more severe then hep. a)
- Infected individual may:
- Become an asymptomatic carrier
- Develop chronic hepatitis and eventually cirrhosis (small amount of people develop chronic hepatitis)
- Transmitted through contact with infected blood, body fluids, shared needles, sex
- Fetus in utero or during vaginal delivery
- Vaccine available (standard)
- Acute and Chronic → could lead to cirrhosis and become chronic
- Can become a carrier

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19
Q

hepatitis C

A
  • Spread primarily by blood-to-blood contact
  • 80% of hepatitis C cases result in chronic hepatitis
  • Risk Factors - transmitted like hep. B
    • Contact With Blood Artwork
    • Unprotected sex(less common than B)
    • Blood Transfusion
  • No vaccine - because the virus mutates
  • Treatment
    - Direct-acting antiviral(DAA)drugs
    - Introduced in 2011
    - 12 weeks of treatment
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20
Q

hepatitis D

A

Depends on hepatitis B for replication - have to have both infections
Getting the vaccine for B will prevent both hep. B and hep. D

21
Q

hepatitis E

A

Fecal-oral transmission - like hep. A
Developing countries
Mild and self-limiting
Epidemic in India

22
Q

chemical injury to the liver

A

Many pharmaceutical drugs have been linked to liver injury
Why?
Can Be Predictable Or Idiosyncratic
Patients with severe acute or chronic liver disease are more susceptible to toxic hepatic injury
Examples
Acetaminophen
Drug of choice for people attempting suicide
Most common drug accidentally ingested in large doses by children
Large doses lead to production of metabolic by-product highly toxic to hepatocytes

23
Q

fatty liver disease

A

Fat accumulates in hepatocytes secondary to injury
Hepatic Steatosis
Most common causes are alcohol and obesity
Impaired liver function but injury is still reversible
Can lead to steatohepatitis - inflammation due to fat accumulation
Typically asymptomatic

24
Q

cholethiasis

A
  • gallstones in the gallbladder or biliary tree (anywhere along the duct)
  • Usually have multiple stones
  • About 1 million new cases/yr in US
  • 50% require surgery - removal of the gallbladder
  • Usually no symptoms until they begin to move; mid-size stones are the worst
  • Painful cramps in RUQ
    - Often after meals - the gallbladder contracts when you have a meal, it will contract the most after a fatty meal, the pain will begin as the gallbladder begins to contact in order to release bile
  • Nausea/vomiting - usually don’t vomit for no reason
    Complications include
  • Cholecystitis = inflame the gallbladder
  • Pancreatitis = inflammation of the pancreas
  • Perforation = through the gallbladder wall
  • Can be seen in an ultrasound
25
Q

types of coleiatheisis

A

cholesterol and pigmented

26
Q

complications of gallstones

A

Biliary Obstruction = obstructing the flow
Jaundice
Cholecystitis
Perforation
Infection-Peritonitis
Gallbladder cancer
Pancreatitis

27
Q

liver neoplasms

A

Types
Primary = cancer originates in the liver
Hepatocellular carcinoma
Most often due to chronic hepatitis - hepatitis C is the most common to cause chronic hepatitis
Metastatic
Most liver neoplasm has metastasized to liver from somewhere else (colon, lung, stomach,breast)
A lot of cancers in the abdominal region
Poor prognosis - because you can’t live without your liver and there is no dialysis for the liver

28
Q

primary liver neoplasm

A

cancer originates in the liver
Hepatocellular carcinoma
Most often due to chronic hepatitis - hepatitis C is the most common to cause chronic hepatitis

29
Q

metastatic liver neoplasm

A

Most liver neoplasm has metastasized to liver from somewhere else (colon, lung, stomach,breast)
A lot of cancers in the abdominal region

30
Q

liver failure

A

Acute liver failure - fulminant
Results from massive death of hepatocytes
Most common causes:
Viral hepatitis - hep. C and hep B.
Drug reactions - the liver has to detoxify drugs
Can be fatal

31
Q

cirrhosis

A

Describes end stage of most serious chronic types of liver disease
Replacing liver cells with scar tissue not hepatocytes, the scar tissue doesn’t have any function
Characterized By:
Fibrosis

32
Q

causes of cirrhosis

A

Chronic hepatitis
Chronic alcohol consumption
Biliary obstruction - gallstones
Cryptogenic = don’t know the cause, hidden cause

33
Q

treatment for cirrhosis

A

liver transplant is the only treatment

34
Q

clinical features of cirrhosis

A

Failure To Metabolize estrogen and ammonia - these are normal functions of the liver so when function is disrupted this occurs
One of the functions of the liver is to get rid of urea – ammonia accumulates if the urea isn’t removed from the body, comes from the breakdown of amino acids, ammonia is converted to urea (done by the liver) so if ammonia is converted to urea and excreted then it builds up in the body
Gynecomastia - development of breast tissue in males
Protein Synthesis failure
Edema - due to the liver is not making albumin
Excretory Failure - not getting rid of the bilirubin
Complications
Portal hypertension - hypertension in your liver, not a lot of treatment for that
The blood isn’t going through the liver like is should, like a clogged up interstate
Passive congestion and enlargement of spleen
The hepatic portal vein becomes congested with blood, blood builds up in the spleen and leads to enlargement of the spleen (splenomegaly)
Hyperammonemia and hepatic encephalopathy

35
Q

hepatic encephalopathy

A

Deterioration of brain function characterized by impaired consciousness, confusion, disorientation, and eventually coma
From accumulation of toxic substances in the blood that are normally detoxified and excreted by the liver
Toxic products include ammonia from deamination of amino acids

36
Q

alcoholic liver disease

A

Refers to a group of structural and functional changes in the liver resulting from excessive alcohol consumption
Liver is the only site that breaks down alcohol
Severity depends on amount and duration of alcohol consumption
3 stages of progression
Alcoholic fatty liver - the priority of the liver becomes detoxifying the alcohol, so it only focuses on that rather than breaking down lipids and shipping them out, then fats start to accumulate - this is why it can be reversible
Alcoholic hepatitis - may or may not be reversible
Alcoholic cirrhosis

37
Q

pancreas

A

Pancreas
Has exocrine and endocrine components
Primarily made up of glands, or acini, that secrete digestive enzymes into pancreatic duct
Islets of Langerhans produce insulin and glucagon (two main hormones of the endocrine pancreas)

38
Q

most frequent and serious problems of the pancreas

A

Pancreatic conditions
Inflammation of the pancreas
Usually associated with alcohol or gallstones(#1 cause)
Ranges from mild and self-limited to severe and fulminant
Carcinoma of the pancreas
Diabetes mellitus

39
Q

genetic diseases of the pancreas

A

Cystic Fibrosis
- Pancreas disfigured and destroyed by mucus plug:
- Blocks pancreatic ducts - if the release is blocked the pancreas starts to digest itself
- Patient suffers repeated bouts of pancreatitis
- Damage to pancreas is irreversible

40
Q

pancreatitis

A

Inflammation and autodigestion of pancreas by pancreatic digestive juices
Manifestations
Severe upper abdominal pain
Anorexia = loss of appetite
Malabsorption = you aren’t release the digestive enzymes necessary for digestion and absorption
Hemorrhagic pancreatitis
Surgical Emergency
Progress to shock
Diagnosis → leakage of the enzymes into the blood, specifically amylase and lipase, they leak into blood because the pancreas its digesting itself and it goes into the blood, these are normally found in the cells but when the cells are damage they begin to leak out

41
Q

types of pancreastitis

A

acute and chronic

42
Q

acute pancreatitis

A

Reversible inflammation
Rapid onset of symptoms
Pain
Nausea
Anorexia
Causes
Chronic alcohol abuse causes 2/3 of cases.
Half of patients have gallstones

43
Q

chronic pancreatitis

A

Irreversible
Caused by repeated bouts of acute pancreatitis
Damaging the pancreas and putting scar tissue down
Chronic alcohol abuse causes 2/3 of cases.
Half of patients have gallstonesFibrosis of pancreatic tissue
Symptoms
Malabsorption
Steatorrhea - fat in the stool due to not secreting lipase the enzyme that breaks down the fat
Hemorrhage
Complications
Diabetes - damage to the islets that release insulin

44
Q

conditions causing chronic injury to pancreas

A

Cystic fibrosis
Acute pancreatitis
Repeated attacks of gallstone pancreatitis
Obstruction of pancreatic ducts by diseases

45
Q

pancreatitis diagnosis

A

Treatment
Limit activity of gland - get all your nutrition from an IV, have to not eat in order to rest the pancreas - many people don’t want to rest which can lead to repeated bouts
Total Parenteral nutrition

46
Q

pancreatic cancer

A

Tumors in endocrine or exocrine portion
Islet tumors usually benign (endocrine)
Exocrine more common = Pancreatic ducts - pancreatic carcinoma because epithelial cells make the ducts
Poor Prognosis - late discovery leads to metastasize, no screening test, lots of organs nearby so by the time it presents it has already spread
Why So Deadly?
Most occur in head of the pancreas - a mass may lead to juandice

47
Q

risk factors for pancreatic cancer

A

African-American
Age (age associated)
Overweight or obese
Cigarette smoking
Pancreatitis - caused by alcohol and gallstones
Family history
Heavy alcohol intake

48
Q

symptoms of pancreatic cancer

A

Fatty stools
Pain in upper quadrant (wouldn’t happen till advanced)
Not a lot of symptoms associated until it is advanced

49
Q

two main symptoms/complications of pancreatic cancer

A

jaundice and weight loss

understanding human disease (25 decks)

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