Disorders of Exocrine Pancreas and Hepatobiliary Flashcards
Gallbladder
stores bile
Exocrine Pancreas
aids in digestion of CHO, fats, proteins
produces enzymes & bicarbonate
Liver in Digestion
produces bile, synthesizes plasma proteins, metabolizes & eliminates drugs/toxins and stores vitamins glucose/blood
cholelithiasis
gallbladder stone formation
most common gallbladder disorder
can cause choledocholithiasis, cholangitis, cholecystitis and cancer
cholelithiasis pathogenesis
typically formed in gallbladder
move to bile ducts
obstruct and cause inflammation
usually formed from cholesterol or pigment
cholelithiasis risk factors (five fs)
female fair fat fertile forty estrogen replacement therapy oral contraceptives
cholelithiasis s/s early vs acute
e: vague, indigestion, mild gastric distress after fatty meals
a: severe/sudden onset of radiating pain (midepigastric, extends to RUQ/R subscapular region)
bile reflux into liver s/s
jaundice
pain
hepatocyte damage
bile duct obstruction
pancreatitis
stetorrhea
pruritus
cholelithiasis tx
asymptomatic: ursodiol/diet
symptomatic: cholecystectomy
cholangitis
inflammation of common bile duct
gallstone impacted into bile/duct inflammation > bacteremia/speticemia/secondary pancreatits
cholangitis s/s
RUQ pain ab tenderness fever jaundice pruritus dark-colored urine clay colored stools (^ bilirubin)
cholangitis tx
lithotomy analgesic antihistamines nutrition abx antiemetics
cholecystitis
acute/chronic inflammation of gallbladder
stone/digestive juices cause inflammation
> bile builds up
> increased pressure
> chemical damage
> tissue ischemia
> damage to gallbladder walls & mucosa
> perforation & necrosis
cholecystitis etiology
cystic duct stone
trauma
infection
sepsis
cholecystits s/s
intolerance of fat in diet epigastric pain (eating) flatulence belching colicky pain steatorrhea jaundice pruritus
cholecystits tx
cholecystectomy
abx (metronidazole)
Gallbladder cancer
usually on surface lining or epithelium
gallbladder cancer etiology
gallbladder damage (stones, toxins, bacteria, parasites) main RF = gallstones
gallbladder cancer s/s Early vs Late
often subtle/coexisting cholethiasis
intense RUQ pain, jaundice, weight loss, palpable gallbladder
Gallbladder cancer tx
cholecystectomy whipple resection (remove surrounding diseased tissues)
Pancreas disorders types
head
midsection
tail
acute pancreatitis etiology
alcohol abuse gallstones viral infections trauma ab surgery hyperlipidemia acetaminophen/thiazide diuretics
acute pancreatitis alcohol-induced
ethanol metabolized
> toxic metabolites released
> tissue injury/sphincter obstruction
acute pancreatitis gallstone-induced
obstruction
> trapped digestive enzymes
>autodigestion of pancreatic tissue
>acute inflammatory response
acute pancreatitis s/s
ab pain tachycardia hypotension fever jaundice paresthesia cullen sign (bruising around umbilicus) turner sign (bluish flank area) steatorrhea
acute pancreatitis critical s/s
low urine output
hypoxemia
restlessness
confusion
acute pancreatitis tx
based on condition & response
pain relief
fluid replacement
NPO
chronic pancreatitis
obstruction or strictures of pancreatic duct usually alcohol abuse calculi (stones) tumors or cysts smoking cystic fibrosis primary scelorosing cholangitis toxicity IBD genetics
chronic pancreatitis s/s
anorexia
malabsorption of fats/proteins
dull constant ab pain (LUQ or epigastric)
chronic pancreatitis tx
eliminate alcohol/smoking
low-fat diet
oral enzyme replacement
insulin
pancreatic cysts
previous damage to pancreas
benign (pseudocysts/serious cystadenomas) vs malignant (potentially mucinous)
pancreatic cysts s/s
usually asymptomatic pain (epigastric radiating to back) nausea vomiting jaundice ab fullness
pancreatic cysts tx
benign: monitoring
malignant: surgery
pancreatic cancer
spreads quickly
invades lymphatic system
lack of well-defined pancreatic capsule
pancreatic cancer RF
smoking obesity diet diabetes chronic pancreatitis genetic predisposition
pancreatic cancer s/s
symptoms are slow
late: portal vein hypertension, ascites, hepatomegaly, splenomegaly, esophageal varices
pancreatic cancer tx
surgery
chemotherapy
radiation
common liver disorder s/s
vague ab pain
indigestion
hepatomegaly
advanced: jaundice, ascites
Liver cancer
5th most common
poor survival rate world wide (2nd most common cause of death for men)
liver cancer RF
cirrhosis hemochromatosis hep b or c excess alcohol excess coffee obesity oral contraceptive use
liver cancer patho
immune cells: inflammation > deregulation of liver cell proliferation
insulin related: insulin resistance > cytokines > hepatic steatosis & inflammation
gene malfunction: malfunction limits ability to manage toxins & carcinogens
liver cancer s/s
weakness weight loss bloating jaundice disturbances in clotting factors/hormones increase alk-phos, GGT, AST, ALT
liver cancer tx
surgery
radiofrequency ablation
cryotherapy
percutaneous ablation
cirrhosis and causes
late stage scarring of liver alcohol (most common) chronic viral hepatitis chronic obstruction of bile ducts genetic disease (wilson disease, hemochromatosis, glycogen storage disease, autoimmune hepatitis)
acute liver damage
alcoholic hepatitis
chronic liver damage
cirrhosis
steatosis
steatohepatitis
fibrosis
causes of liver disease
cellular damage
inflammation
obstruction
alcohol and the liver
progressive deterioration of liver cells
accumulation of fat in liver
early: steatosis
progressive: cirrhosis
hepatocytes replaced by scar tissue
liver metabolic fx are impaired
secondary conditions: portal htn, splenomegaly, systemic effects
contributing factors to severity of alcohol induced liver damage
patter of drinking (amount/number of years) immunity hmoral disorders genetic biochemical makeup overall nutrition, diet, health
splenomegaly progression
steatosis (usually asymptomatic ^ AST,ALT) > hepatomegaly > RUQ ab discomfort > nausea > esophageal varices
ascites progression
portal hypertension (may lead to gen edema) >dyspnea r/t ascites & portal htn > weakness >anorexia/weight loss >asterixis
abnormal liver function tests
rplonged prothrombin time bruising bleeding jaundice gynecomastia spider angioma caput medusa
early s/s of alcohol induced cirrhosis
increased serum amnoia
restlessness
agitation
progressive impairment in judgement
alcohol induced cirrhosis tx
abstinence (most important) improving overall health/nutrition liver transplant (only if pt maintains sobriety) prevention/tx of complications (bleeding/esophageal varices/swollen rectal veins/ascites)
