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Pathophysiology I > Chapter 30: Disorders of Hepatobiliary and Exocrine Pancreas Function > Flashcards

Chapter 30: Disorders of Hepatobiliary and Exocrine Pancreas Function Flashcards

1
Q

Describe what Jaundice is

A

It is excessive or elevated levels of bilirubin in the blood

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2
Q

Why is bilirubin often first seen in the eyes?

A

because it is drawn to elastic fibers which are abundant in the eyes

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3
Q

List and briefly describe the three types of jaundice.

A

1) PRE-HEPATIC: excessive destruction of RBCs
2) INTRA-HEPATIC: impaired uptake or conjugation of bilirubin by liver cells
3) POST-HEPATIC: obstruction of outflow of bile

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4
Q

What are some things that can cause pre-hepatic jaundice?

A

hemolytic blood transfusion

Hereditary and acquired hemolytic disorders

Autoimmune hemolytic anemia

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5
Q

What type of jaundice is physiological jaundice of a newborn?

A

Pre-hepatic jaundice

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6
Q

What are the (2) manifestations of pre-hepatic jaundice?

A

mild jaundice

elevated unconjugated bilirubin

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7
Q

What are the 2 general causes of intra-hepatic jaundice. List some things that can cause these.

A

lack of enzymes
damage

hepatitis, cirrhosis, liver Ca, meds

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8
Q

List the 4 manifestations of intra-hepatic jaundice

A

1) mild jaundice
2) elevated bilirubin
3) dark urine
4) elevated serum alkaline phosphate (d/t dmg to cells lining bile duct)

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9
Q

list 4 causes of post-hepatic jaundice

A

1) structural disorders
2) congenital atresia
3) cholelithiasis
4) tumors

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10
Q

List the 7 manifestations of post-hepatic jaundice

A

1) elevated conjugated bilirubin
2) inc alkaline phosphatase
3) inc AST
4) clay coloured stool
5) dark urine
6) pruritis
7) jaundice

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11
Q

Define cholestasis

A

impaired bile formation and flow

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12
Q

Define cholangitis

A

inflammation of the common bile duct

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13
Q

Define cholecystitis

A

inflammation of gall bladder

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14
Q

Define cholelithiasis

A

gallstones

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15
Q

Define choledocholithiasis

A

presence of at least one gallstone in the common bile duct

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16
Q

What is hepatitis?

A

acute or chronic inflammation of the liver cells

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17
Q

What are the 5 types of hepatitis?

A

ACUTE VIRAL: a, b, c, d, e

Chronic viral

Autoimmune

Acute fulminant

Chronic

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18
Q

What are the three phases of hepatitis?

A

1) prodromal
2) icterus
3) convalescent

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19
Q

Describe the manifestations for the prodromal stage of hepatitis (stage 1)

A

Malaise, fatigue, anorexia, myalgia, arthralgia, chills, fever

GI: diarrhea/constipation, N and V, mild right abd pain

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20
Q

Describe the 4 manifestations of the icterus stage of hepatitis (stage 2)

A

Jaundice (less so with HCV)
dark urine
severe pruritis
liver tenderness

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21
Q

What occurs in the convalescent stage of hepatitis?

A

complete recovery if type A or B

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22
Q

What can be said about the symptoms of HAV (hep A) (duration)

A

benign and self-limiting

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23
Q

Where does HAV survive and what type of countries is it an endemic in?

A

in sea, fresh, and waste water and soil

endemic in countries with poor hygiene/sanitation

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24
Q

What is the mode of transmission for HCA. Describe when it is excreted and its incubation time.

A

Fecal to oral

excreted 2-3 weeks before symptom onset

incubation of 2-30 days

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25
Q

List the (7) manifestations of HCA

A 
fever
malaise
nausea
anorexia
abd discomfort
dark urine
Jaundice (70 percent of time)
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26
Q

What age is HCA asymptomatic for?

A

<6 yrs old

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27
Q

Can HCA cause chronic hepatitis?

A

no

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28
Q

What can HCA progress to?

A

Fulminant hepatitis

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29
Q

What is the treatment for HCA and HCB?

A

vaccination

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30
Q

What ratio of people are infected with HBV?

A

1/3

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31
Q

List 3 activities that can lead to transmission of HBV

A

perinatal transmission
IV drug use
Unprotected sex

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32
Q

How is HBV transmitted?

A

blood
perinatal
oral/sex contact

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33
Q

What can infection with HBV progress to?

A

can result in carrier state

can progress to acute, chronic, or fulminant

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34
Q

When was HCV discovered?

A

1989

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35
Q

How is HCV transmitted? (2)

A

Blood (transfusion, IV, needle stick, tattoo, piercing)

High risk sexual behaviour

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36
Q

What group is at decreased risk for HCV?

A

young female

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37
Q

What is the incubation period of HCV?

A

2-26 wks

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38
Q

Describe the manifestations for HCV

A

can be asymptomatic to mild nonspecific resulting in difficulty detecting

Jaundice and Dark urine for some

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39
Q

What does HCV usually develop into?

A

Chronic hepatitis

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40
Q

Describe what Acute Fulminant Hepatitis is.

A

Progression from acute hepatitis to encephalopathy in 2-3 weeks with no sign of chronic hepatitis

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41
Q

List the causes of fulminant hepatitis (5)

A

Acetaminophen toxicity (45 percent)

other idiosyncratic drug reactions

poisonous mushrooms

fatty liver disease in pregnancy

HAV more than other types

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42
Q

List the 5 manifestations of fulminant hepatitis (think of impaired liver function)

A

GI symptoms

Hemorrhage (can’t produce factors)

Jaundice

Inc serum ammonia
- leads to CNS symptoms and hepatic encephalopathy

Cerebral edema (possibly due to dec plasma protein production)

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43
Q

How is fulminant hepatitis treated?

A

symptomatic management and transplant

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44
Q

What is hepatic encephalopathy caused by?

A

by the accumulation of neurotoxins (like ammonia) d/t the liver not being able to remove them

45
Q

List the manifestations of hepatic encephalopathy (6)

A

1) signs of liver failure
2) asterisis (flapping tremor of hand)
3) personality changes
4) speech difficulty
5) dec mental alertness
6) coma and seizure

46
Q

How long does hepatitis need to go on for before it is diagnosed as chronic

A

> 6 months

47
Q

What is the most common cause of chronic hepatitis?

48
Q

List the 4 manifestations of chronic hepatitis

A

Fatigue
Anorexia
Jaundice
elevated ATF

49
Q

What are the 2 complications of chronic hepatitis?

A

Cirrhosis

Ca

50
Q

What is the leading cause of acute liver failure in NA?

A

Drug induced liver disease

accidental acetaminophen OD

51
Q

What are the three conditions associated with alcohol induced liver disease?

A

Fatty liver disease

Alcoholic hepatitis

Alcoholic cirrhosis

52
Q

Describe what Fatty liver disease is (sub category of alcohol induced liver disease)

A

Accumulation of fat in hepatocytes

53
Q

List the 2 manifestations of fatty liver disease (sub category of alcohol induced liver disease). Are these manifestations reversible?

A

Steatosis (fatty liver)

hepatomegaly

reversible if alcohol consumption is stopped

54
Q

Describe what alcoholic hepatitis is.

A

Inflammation and necrosis of liver cells d/t alcohol

55
Q

What are the 6 manifestations of alcoholic hepatitis (think of normal hepatitis manifestations)

A 
Jaundice
pain
fever
anorexia
ascites
encephalopathy
56
Q

What is alcoholic cirrhosis?

A

scar tissue build up due to chronic alcohol abuse

nodules compress blood flow

57
Q

What are some causes of Cirrhosis?

A

alcohol
viral hepatitis
biliary disease
non-alcoholic fatty liver disease

58
Q

Describe the manifestations of Cirrhosis (8)

A

Asymptomatic until late

1) wt loss
2) wkness
3) anorexia
4) diarrhea
5) sometimes constipation
6) hepatomegaly
7) jaundice
8) pain

59
Q

What two manifestations of cirrhosis are the late manifestations?

A

Pain and jaundice

60
Q

List some complications of Cirrhosis (10)

A

Portal HTN

splenomegaly

bleeding

thrombocytopenia

insulin resistance

hemorrhoids

caput medusa

testosterone/estrogen imbalances

spider angiomas/palmer erythema

encephalopathy

61
Q

What is caput medusa?

A

swelling of the vessels in the umbilical area

62
Q

What are the (3) RF for non-alcoholic fatty liver disease?

A

OBESITY: DM type 2, hyperlipidemia, insulin resistance

rapid wt loss

TPN

63
Q

Describe and list the 5 manifestations of non-alcoholic fatty liver disease

A

Usually asymptomatic

RUQ pain
INC AST, ALT, INR
Dec albumin

64
Q

What can non-alcoholic fatty liver disease progress to?

A

cirrhosis and end stage liver disease

65
Q

What is portal hypertension?

A

inc BP in the portal vein

66
Q

the causes of portal hypertension are grouped into categories by location. List these causes.

A

PRE-HEPATIC:

  • obstructive thrombosis
  • portal vein narrowing
  • splenomegaly

INTRA-HEPATIC:
- cirrhosis

POST-HEPATIC:

  • R sided heart failure
  • hepatic outflow obstruction
67
Q

What are the three complications of portal hypertension?

A

ASCITES

SPLENOMEGALY / HYPERSPLENISM

INC VENOUS PRESSURE IN abd, rectum, esophagus

68
Q

At what stage of portal hypertension does ascites occur?

A

late stage

69
Q

How much and what type of fluid accumulates in ascites?

A

500 mL of serous fluid

70
Q

List 3 causes of ascites

A

Portal HTN

Sodium/water retention by kidneys

Impaired albumin syntheses by liver

71
Q

What can ascites progress to?

A

peritonitis

72
Q

Explain what occurs in splenomegaly (or hypersplenism)

A

RBC life span is reduced resulting in:

anemia
thrombocytopenia
leukopenia

73
Q

What does increased venous pressure in the abdomen, rectum and esophagus lead to?

A

Esophageal varices (enlarged veins in lower esophagus

Caput medusa

Hemorrhoids

74
Q

What percentage of liver function must be lost to be diagnosed with liver failure?

A

80-90 percent

75
Q

The manifestations of liver failure are grouped into 5 categories. List them and describe the symptoms

A

GI: fetor hepaticus (musty sweat breath)

HEMATOLOGICAL: anemia, thrombocytopenia, coagulation defects, leukopenia

INTEGUMENT: purpura, bruising, vascular spiders, telangiectasis, spider angiomas and nevi, palmar erythema, clubbing, jaundice

ENDOCRINE: increased androgens/estrogens, dec aldosterone

HEPATORENAL SYNDROME: Progressive azotemia, oliguria

Hepatic encephalopathy

76
Q

Is the liver a popular site of secondary metastasis?

77
Q

What are the two types of Liver Ca

A

HEPATOCELLULAR CARCINOMA: involves most liver cells

CHOLANGIOCARCINOMA: bile duct cells

78
Q

What is the key sign of liver Ca in adults?

A

elevated AFP (alpha fetoprotein)

79
Q

What is the approach to treatment for liver Ca?

A

Palliative

80
Q

What are the RF or causes for Hepatocellular Carcinoma (4)

A

Chronic viral hepatitis

ETOH

NFLD (non-alcoholic liver disease)

Environmental exposure

81
Q

List some of the (9) manifestations for hepatocellular carcinoma

A 
Weakness
Anorexia
Wt loss
Fatigue
Bloating
Dull abd ache
Ascites
Jaundice
Hepatomegally
82
Q

What are the two risk factors for cholangiocarcinoma

A

Long-standing inflammation

Injury to bile duct epithelium

83
Q

List the 5 manifestations for cholangiocarcinoma

A 
pain
wt loss
anorexia
abd swelling
jaundice
84
Q

What are the (5) risk factors for cholangelithiasis?

A

Female

Multiparity (multiple child births)

Oral contraceptives

Obesity

Genetics

85
Q

List 3 etiological causes of cholangelithiasis

A

ABNORMAL COMPOSITION OF BILE: starvation, rapid wt loss, pregnancy

CHOLESTASIS: not moving, settles out

CHOLANGECYSTITIS: inflammation of gall bladder

86
Q

Are the manifestations asymptomatic for cholelithiasis?

A

yes, unless obstruction occurs

87
Q

What is the complication that can occur from Cholelithiasis?

A

BILIARY COLIC: gallstone lodging in the common bile duct or travelling through ducts causing spasms

88
Q

Describe and list the symptoms of biliary colic (2)

A

Abrupt and persistent symptoms

RUQ/epigastric pain
- may be referred to R midscapula

Bilirubinemia (excess bilirubin in blood)

89
Q

What are the two types of Acute Cholecystitis? Briefly describe each and give the percentage prevalence for each.

A

Acute Calculous Cholecystitis (85 percent)

  • impacted stones in cystic duct
  • lipases released, bile salts dmg epithelium
Acalculous Cholecystitis (15 percent)
- d/t ischemia, edema, bile stasis, obstruction
90
Q

What can Alcalculous Cholecystitis (type of acute cholecystitis) progress to?

A

Gangrene and perforation

91
Q

List 5 causes of Acalculous Cholecystitis (type of acute cholecystitis).

A 
Sepsis
Trauma
Burns
DM
MSOF (multiple system organ failure)
92
Q

List the 4 manifestations of Acute Cholecystitis

A

RQ or Epigastric pain (acute onset and persistant)

Mild fever

Anorexia

N and V

93
Q

For what type of acute cholecystitis can symptoms be relieved?

A

Calculous Cholecystitis

94
Q

Describe acute pancreatitis

A

It is reversible inflammation d/t early activation of pancreatic enzymes

trypsin first which activates others

95
Q

What is the age group that acute pancreatitis tends to occur during

A

> 40 yrs old

96
Q

What are the causes of pancreatitis (there are 2 main ones and others)

A

GALLSTONES
ALCOHOL ABUSE

hyperlipidemia
hypercalcemia
viral infections
trauma
medications (thiazide, diuretics)
97
Q

There are 6 categories of symptoms for pancreatitis. List them and some of the manifestations under them.

A 
GI:
LQ/epigastric/periumbilical
distension and abd tenderness
N and V
*hypoactive BS*
steatorrhea

CNS: fever, thirst, agitation, confusion

CVS: tachycardia, hypotension, massive fluid loss

RESPORITORY: tachypnea, hypoxia, dyspnea

RENAL: oliguria

INTEGUMMENT:
Cullen's sign
Turner's sign
Jaundice
cool/clammy skin
98
Q

List 4 serum concentrations that can be tested to diagnose pancreatitis

A

Inc Pancreatic enzymes (trypisin, amylase, lipase, elastase)

High BG: poor carb metabolism

Hypocalcemia: fat necrosis releases fat which binds to calcium

Elevated Bilirubin: d/t hepatobiliary obstruction

99
Q

List 4 complications of pancreatitis

A

SEPSIS
ARDS
ACUTE TUBERCULAR NECROSIS
MSOF

100
Q

What is Chronic Pancreatitis

A

Progressive PERMANENT destruction of exocrine pancreas

101
Q

Is chronic pancreatitis reversible?

102
Q

Describe the manifestations of Chronic Pancreatitis

A

Same as acute, but less severe

103
Q

What is the 4th leading cause of cancer death?

A

Pancreatic Ca

104
Q

What is the 5 yr survival rate for pancreatic Ca?

A

4-5 percent

105
Q

List 5 RF for pancreatic Ca

A 
age
smoking
DM
Chronic Pancreatitis
genetics
106
Q

List the 4 manifestations of pancreatic Ca

A

Dull epigastric pain (radiates back, worse in supine and when eating, relief when sitting forward)

Jaundice
Pruritis
Wt loss

107
Q

What is the complication of pancreatic Ca

A

THROMBOPHLEBITIS: swelling of a vessel d/t clotting

108
Q

What is the surgical treatment for pancreatic Ca called? Describe this surgical treatment

A

WHIPPLE PROCEDURE:

  • RESECTION of proximal pancreas, duodenum, distal stomach, distal bile duct
  • ANASTOMOSIS of pancreatic and common bile duct and stomach to duodenum
109
Q

What condition results from the whipple procedure?

A

insulin dependent diabetes

Pathophysiology I (16 decks)

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