Disorders of Hepatobiliary and Exocrine Pancreas Function Flashcards
What are the diseases of the liver? (list)
Hepatitis Alcoholic Liver Disease Cirrhosis Liver Failure Cancer of the Liver
Define Hepatitis
invasions which causes an inflammation of the liver tissues, which damages the liver cells and ultimately cause cellular death.
Can Hepatitis lead to Cirrhosis?
yes and cirrhosis can eventually cause cancer formation
In Hepatitis disorders viruses cause what kind of injury?
Direct Cellular Injury
Discuss the Hep. A virus
- lasts from a few weeks to several months
- Does NOT lead to chronic infection
- caused by ingestion of fecal matter (contaminated food/water)
- Vaccine: yes for everyone older than 1
Discuss the Hep B Virus
- could be mild to severe, acute to chronic
- CHRONIC can lead to cirrhosis and liver cancer
- cause: body fluids (blood, semen), contaminated needles, childbirth
- Vaccine: available from infancy
Discuss Pancreatic Cancer
- 4th leading cause of cancer death in the US
- metastasizes and often doesn’t have S/S before metastasization
- one of the most deadly malignancies cancers
- Cause is UNKNOWN
- Smoking appears to be a major risk
- Second major risk may be diet
- Highly associated with diabetes and chronic pancreatitis (inflammation/irritation of tissues)
Discuss the Pancreas
-Exocrine function: produces digestive enzymes that are secreted into the duodenum (pancreatic enzymes = digestive enzymes)
{Endocrine function: secretes hormones into the blood that regulates blood glucose levels (insulin)}
Discuss the Pancreas
-Exocrine function: produces digestive enzymes that are secreted into the duodenum (pancreatic enzymes = digestive enzymes)
{Endocrine function: secretes hormones into the blood that regulates blood glucose levels (insulin)}
Discuss the Hep C virus
- most OFTEN becomes a chronic condition (leads to cirrhosis, cancer) but sometimes an acute illness
- caused by contact with blood, primarily sharing needles
- NO VACCINE
Discuss Hep D virus
- RELIES on the HEP B virus to replicate
- uncommon in US
- caused by contact with infectious blood
- NO VACCINE
Discuss the Hep E virus
- serious liver disease that usually results from an acute infection. It does NOT lead to a chronic infection
- common in the world but not US
- Caused by ingestion of fecal matter and poor sanitation
- NO VACCINE
What is the most common cause of Chemical Hepatitis?
Alcohol
Discuss Chemically-Induced Hepatitis
- also called Toxic Hepatitis
- liver metabolizes alcohol and drugs and environmental toxins. These should be broken down and (can be used) then excreted by the body but if the overwhelmed (exposed to too many chemicals) excretion will be effected and damage the liver will occur
What is damage to the liver caused by excessive consumption of alcohol, by itself, called?
Alcoholic liver disease
What is the most common cause of Chemical Hepatitis?
Alcohol
What is Pancreatitis
the inflammation of the pancreas
- Can be acute or chronic
- can often be due to a gallstone
Discuss the Pathophysiology of Pancreatitis
Because the enzymes are not being secreted the pancreatic enzymes become prematurely activated in the pancreas which leads to auto-digestion of the pancreas and pancreatic tissue.
-Trypsinogen promotes activation of other enzymes (particularly Elastase)
What is Elastase?
-one of the digestive enzymes from the pancreas that goes after blood vessels in the pancreas when activated by Trypsinogen.
What are the Risk Factors for Pancreatitis?
- alcoholism
- biliary disease
- infections
- trauma/ERCP (scope procedure to remove stones that can cause damage if not done properly)
- Penetrating ulcers
- Drug toxicity (steroids and NSAIDS)
- metabolic disorders
- Smoking
- Peptic ulcer disease
- Viruses (Hepatitis, Epstein Barre)
- Bacterial infections
- Scorpion bites
Men = alcoholics Women = biliary disease
Prevention for Pancreatitis
- Reduce Gallstone risk: balanced diet, healthy weight, exercise
- DON’T SMOKE
- DON’T DRINK
Discuss Chronic Cholecystitis
- causes milder symptoms between acute attacks
- repeated obstructions in the ducts, calculi are almost always present
- gallbladder will become fibrotic & contracted
- bile obstruction can lead to jaundice
- extrahepatic obstructive jaundice
Prevention of Gallbladder Issues
- Don’t skip meals because fasting increases the risk of STASIS in the gallbladder which leads to the formation of stones
- exercise
- diet slowly
- maintain a healthy weight
Discuss complications caused by Gallbladder issues
- pancreatitis
- abscesses
- infections
- gallbladder rupture (which can lead to peritonitis)
- biliary colic
- liver damage
- gangrean of the gallbladder
- Constant gallbladder irritation can lead to cancer
What is Cholelithiasis
- the presence of gallstones in the gallbladder or the biliary tract
- # 1 biliary problem
What are the clinical manifestations of (all) Hepatitis?
- Preicteric
- Icteric
- Posticteric
ALWAYS IN THIS SEQUENCE!
Is the liver palpable during examination?
no, unless it is enlarged
What is the Preicteric stage of hepatitis?
- BEFORE jaundice
- lasts 1-21 days
- when symptoms occur they may be vague or non-specific. (cold like)
- may have decreased sense of smell
- liver becomes ender and enlarged
What is the Icteric stage of hepatitis?
- characterized by JAUNDICE and PERITIS (itchy skin)
- lasts 2-4 weeks
- S/S include dark urine and light colored bile
Why may a hepatitis patient in the Icteric stage have dark urine?
b/c the build up of bilirubin could “spill out” of the kidneys
Why may a hepatitis patient in the Icteric stage have light colored stools?
if bile flow is obstructed
What is jaundice?
- not a disease, its a SYMPTOM/SIGN of liver dysfunction
- will have Hyperbilirubinemia (increased bilirubin in blood/ bilirubin is a by-product of RBC destruction in which the liver is suppose to get rid of but in with liver dysfunction it isn’t able to get rid of it)
- yellow tone in skin and mucus membranes (esp. eyes) because of the bilirubin build up
What is the first part of the body to experience jaundice?
the sclera of the eyes…the eyes are also the last to rid their selves of the yellow hue
What other S/S accompanies jaundice besides the yellowing of the skin?
Peritis (itchy skin)
What is the Posticteric stage of hepatitis?
-begins when jaundice DISAPPEARS
- liver enlargement may continue
- if the spleen was enlarged it will now return to normal
-fatigue and malaise
NOT EVERYONE ENTERS THIS STAGE
What is the major complaints with the posticteric stage of hepatitis?
Fatigue and Malaise
Discuss Hepatic Cirrhosis
-normal hepatic tissue is replaced with dysfunctional tissue (fibrous tissue) leads to abnormal vessels and bile ducts in the liver
(same thing in different words)
- Fibrotic bands of connective tissue impair the flow of blood and lymph DISTORTING liver FUNCTION
- CHRONIC PROGRESSIVE destruction of the liver
- # 1 cause is Hepatitis C
- # 2 cause is excessive Alcohol consumption
Discuss the progression of Hepatic Cirrhosis
- Extensive degeneration and destruction of the liver cells
- disorganized regeneration
- abnormal blood vessels and bile duct relationship
- overgrowth & fibrous tissue formation
- Irregular lobes & impaired vascular flow
What are the 3 types of Liver Cirrhosis?
- Laennec’s Cirrhosis (Alcoholic)
- Postnecrotic
- Billiary
What is Laennec’s Cirrhosis?
- caused by drinking
- potentially reversible if alcohol stops
- causes wide spread scar formation
- present with a combination of alcohol damage and malnutrition
What is Biliary Colic?
- Typically a steady gripping or gnawing pain in the upper right abdomen near the rib cage, which can be severe and can radiate to the upper back.
- Intermittent pain, NOT chronic
- Mildest and most common side effect of biliruben disease
- OTC meds won’t relieve pain
- Non specific
- commonly reoccur, but can be very sporatic
What happens during a Gallbladder attack?
- fever
- chills
- jaundice
- eructation (burping)
- floating stool
- symptoms usually occur 1-3 hours after meal, especially if fat content is high
Risk factors for Cholecystitis
- diabetics
- genetics
- obesity
- high cholesterol
- high triglycerides
- sedentary lifestyle
Discuss Choledocholithiasis
- gallstone stuck in the common bile duct
- stones can cause liver and pancreatic problems (secondary problems)
- Stones can cause the gallbladder to become distended, impeding blood flow which can cause necrosis and ischemia
Discuss Chronic Cholecystitis
- causes milder symptoms between acute attacks
- repeated obstructions in the ducts, calculi are almost always present
- gallbladder will become fibrotic & contracted
How does chronic Cholecystitis present?
- bad indigestion
- flatulence
- nausea after eating
- tachycardia
- dehydration
- fever
- steatorrhea
Steatorrhea
fatty, floating stool
What is Cholelithiasis
- the presence of gallstones in the gallbladder or the biliary tract
- # 1 biliary problem
What is Postnecrotic Cirrhosis?
- can be a complication of viral, toxic or autoimmune Hepatitis
- broad bands of scar tissue and chronic inflammation
What is Billiary Cirrhosis?
Cirrhosis caused by an obstruction/infection in the biliary (scaring and jaundice)
Describe the pathophysiology progression of Cirrhosis of the liver.
cell necrosis —> replaced by scar tissue —> disorganized regeneration —>Lobes become nodular —>decreased functioning
What are the top two causes of Hepatic Cirrhosis?
#1 - Hep C #2- Excessive Alcohol
What are risk factors for Non-Alcoholic Fatty Liver Disease?
Severe Obesity
Severe Weight loss (could be due to gastric bypass, just extreme dieting, or metabolic issue)
Hypertriglyceridemia (diet high in sugars and grains like white bread)
Diabetes
What is Non-Alcoholic Fatty Liver Disease characterized by?
Fat deposits and inflammation of the liver
Subjective S/S of Cirrhosis
fatigue weakness headache anorexia indigestion abdominal pain nausea vomiting
Objective S/S of Cirrhosis
excessive gas skin rashes itching fever reddened palms bleeding bruising anemia thrombocytopenia
What are some complications of Liver failure?
Ascites Portal HTN Hepatic encephalopathy Hepatorenal syndrome (liver and kidney failure, multiple organ failure) Esophageal varices
What is Hepatic encephalopathy?
high levels of ammonia which leads to neural damage, confusion, and even coma
(In a normal liver, the liver breaks down proteins and the ammonia from the amine group is combined with CO2 to produce Urea to be excreted through the kidneys. But when the liver is dysfunctional ammonia builds up)
What are esophageal varices cause by?
Portal hypertension
What is Hepatorenal syndrome?
multiple organ failure (liver and kidney failure)
What is the ONLY thing that causes ascites?
portal hypertension
Is ascites an early or late sign of liver disease?
late
What are the S/S of Cirrhosis
jaundice/Itchy skin ascites spider angiomas (veins) palmar erythemia (red palms) Encephalopathy (confusion, coma seizure) muscle wasting sparse body hair anemia thrombocytopenia (low WBC count) poor coagulability
Hepatocellular carcinoma
the primary tumor is a single, large mass, which can be seen invading an intrahepatic branch of the hepatic vein
Chronic Hepatitis B or Hepatitis C are most commonly associated with what form of liver cancer?
Hepatocellular Carcinoma
*Cirrhosis causes Hepatocellular Carcinoma…Chronic Inflammation causes Cirrhosis hence the chronic Hepatitises cause Hepatocellular Carcinoma
What are the two types of gallstones?
Cholesterol and Pigment Stones
Discuss Cholesterol Gallstones
common in the US
imbalance of bile salts and cholesterol (too much cholesterol)
Discuss Pigment Gallstones
associated with cirrhosis of the liver
What size gallstone is better to have?
Bigger ones because they stay put and won’t leave the gallbladder and clog up the biliary tract.
*think Pearls…. The Bigger the Better
What is Cholecystitis?
- inflammation of the gallbladder
What is acute Cholecystitis?
- sudden inflammation of the gallbladder
- most common in affluent countries (USA)
- vast majority due to gallstones
What is the characteristic S/S of Acute Cholecystitis?
right upper quadrant or Epigastric pain
What are the Two types of Acute Cholecystitis?
Calculous and Acalculous
Calculous (acute Cholecystitis)
- most common
- often in cycstic duct, common bile duct, bile neck
- STONE PRESENT
Acalculous (acute Cholecystitis)
- NO stone
- something happens to the gallbladder not related to gallstones (i.e. low profusion/shock state, anatomical problem/twisted ducts can’t excrete bile)
What causes Acalculous (Acute Cholecystitis)?
obstructive tumors anesthesia severe stress bacteria severe burns cardiac surgery Opioids/narcotics hypovolemia (profusion) MODS - multiple organ dysfunction syndrome
*HIV, Diabetes and MI patients are at high risk for acalculous acute Cholecystitis
What are the complications of Gallstones/Gallbladder inflammation?
pancreatitis abscesses infections gallbladder rupture (can cause peritonitis!) biliary colic liver damage gangrene of gallbladder
Cancer of the _____ is the 5th most common cancer of the GI tract.
Gallbladder
Gallbladder cancer is more common in who?
- women
- occurs more often in the 7th decade of life
Can gallstones cause cancer?
Gallstones are considered to play a role in the development of gallbladder cancer (inflammation eventually leads to cancer)
What are the S/S of Acute pancreatitis
- sudden onset of upper abdominal pain that:
- radiates to the back
- feels worse after eating
- somewhat relieved by leaning forward or curling into a ball
Nausea, vomiting, sweating
tenderness when touching the abdomen
Fever, ^ HR, feeling uncomfortable, elevated respiratory rate
dehydration - Decreased BP
Jaundice
Steatorrhea
Decreased or absent bowel sounds
Dull percussion over pancreas
What is the #1 cause of Chronic Pancreatitis?
Alcoholism
who is chronic pancreatitis more common in?
alcoholic men
what is the main complaint of acute pancreatitis?
sudden onset of upper abdominal pain
Does everyone go to the posticteric stage of hepatitis?
no, in this case the jaundice stays and they go into end stage liver failure
What do positive Murphy’s or Blumberg’s signs suggest?
(Rigidity/stomach guarding with deep palpations) gallbladder issues
