Disorders of Hepatobiliary and Exocrine Pancreas Function Flashcards
Liver is a highly ____________ organ
vascular (contains about 500-1000ml of blood)
What is the blood in the liver supplied by?
the hepatic artery and hepatic (portal) vein (which does not contain valves)
What does the liver serve as filter for?
-nutrients and toxins absorbed in the intestines
-blood cell debris from the spleen
-insulin and glucagon from the pancreas
Where do hepatic veins empty into?
the inferior vena cava then superior vena cava for transport into the right atrium
What do the hepatic veins supply blood with?
a lower O2 sat than arterial blood, but it does provide 75% of oxygen needs of the liver
What are the liver functions?
-metabolism of nutrients and vitamins
-synthesis of proteins and enzymes
-detoxification of drugs, hormones, and alcohol
-production/ excretion of bile and bilirubin
Liver-Metabolism Functions
-essential role in carbs metabolism and glucose homeostasis
-manufactures proteins for its own use and secretes proteins released into circulation for cellular needs
What do carbs do in liver metabolism?
-stores large amounts of glucose as glycogen through glycogenesis
-concerts glycogen back to glucose with hypoglycemia
-performs gluconeogenesis
What do proteins do in liver metabolism?
-albumin contributes to plasma colloid osmotic pressure and binds and transports some hormones, fatty acids, bilirubin and anions
-produces fibrinogen and clotting factors to promote clotting
Pathophysiology of Liver Dysfunction
-bleeding r/t inadequate clotting factor production
-infection risk r/t decreased immune globulins
-accumulation of toxins and drugs
-inadequate conjugation/excretion of bile leads to hyperbilirubinemia and jaundice
-biliary tract obstruction with possible gallstone formation
-hormone accumulation led to feminization in males
-increased ammonia because the liver is unable to convert ammonia to urea for excretion in stool and urine and it is toxic
What is the liver an important site for?
manufacture and break down of proteins
Ammonia produced by protein metabolism in the GI tract is absorbed by what?
the portal circulation and transported to the liver to be converted to urea for excretion in urine and stool
When is ammonia increased in the intestine?
with high protein foods and GI bleeding
Hepatic encephalopathy
central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma
Liver- Exocrine Function
bile production (made by hepatocytes into ducts instead of blood)
What happens once the common bile duct delivers bile into the duodenum?
digestion and absorption of fats and fat-soluble vitamins
What does decrease bile in the duodenum produce?
light clay or tannish colored stools
Bilirubin is the end product of
heme degradation
Elevated bilirubin in the blood leads to what?
jaundice in the skin and eye
Intestinal flora concerts some bilirubin to what?
urobilinogen that is excreted in stool and urine
What is jaundice caused by?
-increased breakdown of RBCs
-liver dysfunction
-blockage of bile passage within the biliary system
What is Hepatitis?
-inflammation of the liver
-can occur from specific viral infections, drugs, toxins, or an autoimmune disorder
The viruses that cause hepatitis differ by what?
-manner of transmission
-incubation period
-mechanism
-extent
-chronicity of liver damage
How can viral hepatitis cause liver damage?
by direct injury to cells and by immune responses
Liver Cirrhosis
-as the liver is damaged, cells become replaced with fatty tissue
-the new tissue does not perform functions of normal liver cells
Liver Cirrhosis- Pathophysiology
-abnormal blood vessels and bile ducts lead to hypertension inside liver
-hypertension within liver leads to compression and destruction of veins
-chronic progressive destruction of liver parenchyma is a hallmark of cirrhosis
-liver attempts to regenerate but with abnormal fibrous tissue
Portal Hypertension
-portal vein drains abdominal blood to liver
-cirrhotic structural changed obstruct blood flow through the liver
-pressure increases in portal vein system
-venous blood backs up in liver and as far as into the esophageal veins
-esophageal varices
Esophageal Varices
-can rupture at any time
-sudden and severe hemorrhage
-high mortality rate
Ascites
-accumulation of fluid and electrolytes in abdominal cavity
-fluid leaks from liver and petal veins
-hypokalemia with ascites
-associated with low serum albumin and low protein in circulating volume
-decreased circulating volume leads to hypotension
What is the function of the gallbladder?
stores and concentrates bile
What does bile contain?
water, bile salts, bile pigments, cholesterol, electrolytes
What does the gallbladder do as food enters?
it contracts then releases bile that moves into the duodenum
What are gallbladder disorders?
-cholelithiasis: gallstones
-cholecystitis: gallbladder inflammation
-cholangitis: inflammation of common bile duct
What can lack of bile salts lead to?
-light tan stools
-steatorrhea (malabsorption of fats)
-intolerance to fatty food
Cholecystitis/ Cholelithiasis- Clinical Manifestations
-RUQ pain
-indigestion after fatty foods
-light stools
-steatorrhea (fatty stools)
What is the pancreas?
-positioned transversely in posterior abdomen
-has both endocrine and exocrine functions
When does pancreas become active?
when food enters the duodenum
What does pancreas secrete?
amylase to break down starches and lipase to break down fat
Endocrine
secretes substances directly into blood stream
Exocrine
secretes substances into ducts instead of the blood
What is pancreatitis?
Auto digestion of the Pancreas
What are factors of pancreatitis?
-ethyl alcohol
-gallstones
-abdominal trauma
Pancreatitis- Pathophysiology
-food in duodenum stimulates release of digestive enzymes from the pancreas to be delivered to the duodenum for digestion
-the pancreatic duct may be obstructed by a wandering gallstone
-enzymes back up and leak into pancreas
-systemic chemical mediators released by inflammation
What is acute pancreatitis?
inflammation of the pancreas
Pancreatitis- Clinical Manifestations
-increased serum amylase and lipase
-fluid and electrolyte abnormalities: hyperglycemia and hypokalemia
-SEVERE abdominal pain
What could cause chronic pancreatitis ?
-chronic alcohol abuse
-chronic gallstone obstruction
What can happen during chronic pancreatitis?
-progressive loss of pancreas tissue
-destruction of insulin producing cells leads to diabetes
-chronic pain but symptoms less severe than acute form
-acute episodes can occur
