Chapter 38 Disorders of Hepatobiliary and Exocrine Pancreas Function

Question 1

What is the largest visceral organ??

Answer 1

the liver

Question 2

What quadrant is the liver located in?

Answer 2

right hypochondrium

Question 3

How many lobes does the liver have?

Answer 3

4

Question 4

Describe the flow of blood into and out of the liver

Answer 4

Blood supply of the liver is delivered through the hepatic artery. Hepatic artery brings oxygenated blood and then the portal vein collects deoxygenated blood from the abdominal contents and filters it. The hepatic portal vein and hepatic veins drain the liver

Question 5

What does the liver do?

Answer 5

Synthesizes glucose, plasma proteins, and blood clotting factors. Produces bile salts. Stores glycogen and synthesizes glucose . Metabolizes carbs, fats, and proteins. Breaks down drugs, hormones and hemes. Stores fat soluble vitamins like vitamin A

Question 6

Why is it important that the liver eliminates heme?

Answer 6

heme is converted to bilirubin, and if not eliminated it will build up and create toxic levels.

Question 7

Does the pancreas act as an endocrine or exocrine gland?

Answer 7

both

Question 8

What is the pancreas’ endocrine function?

Answer 8

supplies insulin and glucagon that is needed in cell metabolism

Question 9

What is the pancreas’ exocrine function?

Answer 9

produces bicarbonate and digestive enzymes to buffer the acid from the stomach

Question 10

What is jaundice?

Answer 10

abnormally high accumulation of bilirubin in the blood

Question 11

What is the pre-haptic cause of jaundice?

Answer 11

excessive hemolysis of red blood cells which then releases more heme in the blood

Question 12

What is the intrahepatic cause of jaundice?

Answer 12

impaired intake of bilirubin by the liver cells

Question 13

What is the post hepatic cause of jaundice?

Answer 13

occurs when bile flow is obstructed between the liver and the intestine

Question 14

What diagnostic tests can you get to evaluate liver function?

Answer 14

• serum aminotransferase levels AST ALT
  -serum bilirubin
  -ggt
  -alkaline phosphates
• ultrasonography
• CT scans
• MRI
  -Angiography
• Liver biopsies

Question 15

What do high levels of ALT and AST indicate?

Answer 15

Indication that the liver is inflamed or damaged and it is releasing cells into the blood

Question 16

What would high levels of bilirubin, GGT or alkaline phosphate indicate?

Answer 16

it means the liver isn’t secreting bile properly

Question 17

Why would you get an angiography to assess liver function?

Answer 17

to visualize the hepatic or portal circulation

Question 18

Name 4 drug induced liver diseases?

Answer 18

-direct hepatotoxic injury
- idiosyncratic reactions
- cholestatic reactions
- chronic hepatitis

Question 19

What is Direct Hepatotoxic Injury?

Answer 19

Usually the result of drug metabolism and toxic metabolites.

Question 20

What drugs are common in direct hepatotoxic injuries?

Answer 20

acetaminophen and isoniazid

Question 21

What are idiosyncratic reactions?

Answer 21

they are genetic predispositions and potentially allergic reactions

Question 22

what are cholestatic reactions?

Answer 22

result in decreased secretion of bile or blockage of the biliary tree and the bile ducts coming from the liver, so the bile builds up and results in jaundice.

Question 23

What is Chronic Hepatitis?

Answer 23

inflammation of the liver, usually subclinical and can cause cirrhosis

Question 24

What are some causes of hepatitis?

Answer 24

• reactions to drugs and toxins
• infections and viruses
• autoimmune

Question 25

What hepatotropic viruses infect liver cells?

Answer 25

Hepatitis A, B and C

Question 26

What infectious diseases/disorders can cause hepatitis?

Answer 26

malaria, mono, salmonellosis

Question 27

What happens in an autoimmune caused case of hepatitis?

Answer 27

Can come from a previous infection where the immune system begins to attack the liver because they think it is the cause of the infection.

Question 28

What is alcohol induced liver disease?

Answer 28

Starts as a fatty liver where fat accumulates in the hepatocytes which makes the liver get bigger. Inflammation occurs and then necrosis of the liver cells, then scar tissue replaces the hepatic tissue and there is loss of liver function

Question 29

What is the treatment for alcoholic liver disease?

Answer 29

a transplant

Question 30

How does alcohol get metabolized in the liver?

Answer 30

alcohol is absorbed into the bloodstream from the stomach then 80-90% is broken down by the liver. Alcohol provides calories that cannot be stored or broken down. The alcohol produces acetaldehyde which is toxic to liver cells and then steals NAD from the other cells so there is no NAD left for glucose metabolism which in turn increases the amount of lactic acid in the blood

Question 31

What is stage 2 of alcoholic liver disease?

Answer 31

Alcoholic hepatitis

Question 32

What is stage 3 of alcoholic liver disease?

Answer 32

alcoholic cirrhosis

Question 33

Describe the 3rd stage of alcoholic liver disease

Answer 33

Fibrosis and formation of nodules in the liver tissue

Question 34

____ interferes with blood and bile flow of the liver

Answer 34

cirrohsis

Question 35

What are the clinical manifestations of cirrhosis of the liver?

Answer 35

weight loss, weakness, anorexia, abdominal pain, hepatomegaly, jaundice, portal hypertension, ascites

Question 36

What is ascites?

Answer 36

abnormal build up of fluid in the abdomen

Question 37

What is portal hypertension?

Answer 37

build up of pressure in the portal vein due to it trying to pump blood through as the vein gets stiffer from scar tissue, so it results in an increase in pressure that will eventually backup and produce ascites

Question 38

What are the causes of portal hypertension?

Answer 38

Cirrhosis, thrombus, cancer

Question 39

What can portal hypertension lead to?

Answer 39

ascites, splenomegaly and esophageal varices (very dilated submucosal veins), hemorrhage

Question 40

What is the most severe cause of liver disease?

Answer 40

liver failure

Question 41

What can liver failure manifest as?

Answer 41

hematologic disorders, endocrine disorders, skin disorders, hepatorenal syndrome, hepatic encephalopathy

Question 42

Name a few hematologic disorders

Answer 42

anemia, thrombocytopenia, coagulation defects

Question 43

What are some endocrine disorders?

Answer 43

Disorders causing decreased synthesis of steroid hormones causing amenorrhea, and atrophy of the testes

Question 44

What is hepatorenal syndrome?

Answer 44

decreased renal blood flow and azotemia

Question 45

what is azotemia?

Answer 45

high nitrogen levels in the blood

Question 46

What causes hepatic encephalopathy?

Answer 46

liver failure, but specifically a build up of neurotoxins

Question 47

What can happen in a pt with hepatic encephalopathy?

Answer 47

confusion, coma, convulsions, asterixis (flapping tremor)

Question 48

what are the treatments available for liver failure

Answer 48

liver transplant, instructing pt after transplant to limit/eliminate alcohol use and to provide sufficient carb and calories to prevent protein breakdown

Question 49

What are the 2 examples of primary liver cancer?

Answer 49

hepatocellular carcinoma and cholangiocarcinoma

Question 50

What is hepatocellular carcinoma?

Answer 50

primary cancer of the liver

Question 51

What is hepatocellular carcinoma associated with?

Answer 51

viral hepatitis and aflatoxins

Question 52

What is cholangiocarcinoma

Answer 52

primary cancer of the liver -- specifically of bile duct cells

Question 53

What are metastatic tumors in relation to liver cancer? Where do they come from?

Answer 53

tumors that have spread from lungs, colon, breast, urogenital areas... once most cancers metastasize they will end up travelling to the liver because everything usually ends up at the liver at one point

Question 54

Are primary liver cancer tumors more common than metastatic tumors of the liver?

Answer 54

no metastatic tumors are more common

Question 55

What is cholelithiasis?

Answer 55

gallstones

Question 56

What causes cholelithiasis?

Answer 56

Bile that isnt very water soluble that sits in the gallbladder for long periods

Question 57

What are things that can contribute to a person developing cholelithiasis?

Answer 57

obesity, increasing age, presence of estrogen (more common in women).

Question 58

What is acute/chronic pancreatitis?

Answer 58

premature activation of enzymes that causes tissue damage and inflammation

Question 59

What are the manifestations of pancreatitis?

Answer 59

pain, fluid loss, abdominal distention, resp distress

Question 60

What is the treatment for pancreatitis?

Answer 60

correcting the underlying cause, IV fluids, electrolyte and pain relief

Question 61

What are the risk factors for developing pancreatic cancer?

Answer 61

age over 50 years, smoking

Question 62

What are the manifestations of pancreatic cancer?

Answer 62

adenocarcinomas of the ductal epithelium, jaundice (due to obstructs blocking bile flow)

Question 63

How do you diagnose pancreatic cancer?

Answer 63

serum bilirubin and alkaline phosphatase and diagnostic imaging