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D & D exam 5 > Disorders of Hepatobiliary and Exocrine Pancreas Function > Flashcards

Disorders of Hepatobiliary and Exocrine Pancreas Function Flashcards

1
Q

What are the diseases of the liver? (list)

A 
Hepatitis
Alcoholic Liver Disease
Cirrhosis
Liver Failure
Cancer of the Liver
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2
Q

Define Hepatitis

A

invasions which causes an inflammation of the liver tissues, which damages the liver cells and ultimately cause cellular death.

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3
Q

Can Hepatitis lead to Cirrhosis?

A

yes and cirrhosis can eventually cause cancer formation

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4
Q

In Hepatitis disorders viruses cause what kind of injury?

A

Direct Cellular Injury

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5
Q

Discuss the Hep. A virus

A
  • 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
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6
Q

Discuss the Hep B Virus

A
  • 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
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7
Q

Discuss Pancreatic Cancer

A
  • 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)
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8
Q

Discuss the Pancreas

A

-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)}

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9
Q

Discuss the Pancreas

A

-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)}

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10
Q

Discuss the Hep C virus

A
  • 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
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11
Q

Discuss Hep D virus

A
  • RELIES on the HEP B virus to replicate
  • uncommon in US
  • caused by contact with infectious blood
  • NO VACCINE
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12
Q

Discuss the Hep E virus

A
  • 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
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13
Q

What is the most common cause of Chemical Hepatitis?

A

Alcohol

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14
Q

Discuss Chemically-Induced Hepatitis

A
  • 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
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15
Q

What is damage to the liver caused by excessive consumption of alcohol, by itself, called?

A

Alcoholic liver disease

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16
Q

What is the most common cause of Chemical Hepatitis?

A

Alcohol

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17
Q

What is Pancreatitis

A

the inflammation of the pancreas

  • Can be acute or chronic
  • can often be due to a gallstone
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18
Q

Discuss the Pathophysiology of Pancreatitis

A

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)

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19
Q

What is Elastase?

A

-one of the digestive enzymes from the pancreas that goes after blood vessels in the pancreas when activated by Trypsinogen.

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20
Q

What are the Risk Factors for Pancreatitis?

A
  • 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
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21
Q

Prevention for Pancreatitis

A
  • Reduce Gallstone risk: balanced diet, healthy weight, exercise
  • DON’T SMOKE
  • DON’T DRINK
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22
Q

Discuss Chronic Cholecystitis

A
  • 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
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23
Q

Prevention of Gallbladder Issues

A
  • 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
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24
Q

Discuss complications caused by Gallbladder issues

A
  • 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
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25
Q

What is Cholelithiasis

A
  • the presence of gallstones in the gallbladder or the biliary tract
  • # 1 biliary problem
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26
Q

What are the clinical manifestations of (all) Hepatitis?

A
  1. Preicteric
  2. Icteric
  3. Posticteric

ALWAYS IN THIS SEQUENCE!

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27
Q

Is the liver palpable during examination?

A

no, unless it is enlarged

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28
Q

What is the Preicteric stage of hepatitis?

A
  • 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
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29
Q

What is the Icteric stage of hepatitis?

A
  • characterized by JAUNDICE and PERITIS (itchy skin)
  • lasts 2-4 weeks
  • S/S include dark urine and light colored bile
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30
Q

Why may a hepatitis patient in the Icteric stage have dark urine?

A

b/c the build up of bilirubin could “spill out” of the kidneys

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31
Q

Why may a hepatitis patient in the Icteric stage have light colored stools?

A

if bile flow is obstructed

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32
Q

What is jaundice?

A
  • 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
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33
Q

What is the first part of the body to experience jaundice?

A

the sclera of the eyes…the eyes are also the last to rid their selves of the yellow hue

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34
Q

What other S/S accompanies jaundice besides the yellowing of the skin?

A

Peritis (itchy skin)

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35
Q

What is the Posticteric stage of hepatitis?

A

-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

36
Q

What is the major complaints with the posticteric stage of hepatitis?

A

Fatigue and Malaise

37
Q

Discuss Hepatic Cirrhosis

A

-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
38
Q

Discuss the progression of Hepatic Cirrhosis

A
  • 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
39
Q

What are the 3 types of Liver Cirrhosis?

A
  1. Laennec’s Cirrhosis (Alcoholic)
  2. Postnecrotic
  3. Billiary
40
Q

What is Laennec’s Cirrhosis?

A
  • caused by drinking
  • potentially reversible if alcohol stops
  • causes wide spread scar formation
  • present with a combination of alcohol damage and malnutrition
41
Q

What is Biliary Colic?

A
  • 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
42
Q

What happens during a Gallbladder attack?

A
  • fever
  • chills
  • jaundice
  • eructation (burping)
  • floating stool
  • symptoms usually occur 1-3 hours after meal, especially if fat content is high
43
Q

Risk factors for Cholecystitis

A
  • diabetics
  • genetics
  • obesity
  • high cholesterol
  • high triglycerides
  • sedentary lifestyle
44
Q

Discuss Choledocholithiasis

A
  • 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
45
Q

Discuss Chronic Cholecystitis

A
  • causes milder symptoms between acute attacks
  • repeated obstructions in the ducts, calculi are almost always present
  • gallbladder will become fibrotic & contracted
46
Q

How does chronic Cholecystitis present?

A
  • bad indigestion
  • flatulence
  • nausea after eating
  • tachycardia
  • dehydration
  • fever
  • steatorrhea
47
Q

Steatorrhea

A

fatty, floating stool

48
Q

What is Cholelithiasis

A
  • the presence of gallstones in the gallbladder or the biliary tract
  • # 1 biliary problem
49
Q

What is Postnecrotic Cirrhosis?

A
  • can be a complication of viral, toxic or autoimmune Hepatitis
  • broad bands of scar tissue and chronic inflammation
50
Q

What is Billiary Cirrhosis?

A

Cirrhosis caused by an obstruction/infection in the biliary (scaring and jaundice)

51
Q

Describe the pathophysiology progression of Cirrhosis of the liver.

A

cell necrosis —> replaced by scar tissue —> disorganized regeneration —>Lobes become nodular —>decreased functioning

52
Q

What are the top two causes of Hepatic Cirrhosis?

A 
#1 - Hep C
#2- Excessive Alcohol
53
Q

What are risk factors for Non-Alcoholic Fatty Liver Disease?

A

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

54
Q

What is Non-Alcoholic Fatty Liver Disease characterized by?

A

Fat deposits and inflammation of the liver

55
Q

Subjective S/S of Cirrhosis

A 
fatigue
weakness
headache
anorexia
indigestion
abdominal pain
nausea
vomiting
56
Q

Objective S/S of Cirrhosis

A 
excessive gas
skin rashes
itching
fever
reddened palms
bleeding
bruising
anemia
thrombocytopenia
57
Q

What are some complications of Liver failure?

A 
Ascites
Portal HTN
Hepatic encephalopathy
Hepatorenal syndrome (liver and kidney failure, multiple organ failure)
Esophageal varices
58
Q

What is Hepatic encephalopathy?

A

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)

59
Q

What are esophageal varices cause by?

A

Portal hypertension

60
Q

What is Hepatorenal syndrome?

A

multiple organ failure (liver and kidney failure)

61
Q

What is the ONLY thing that causes ascites?

A

portal hypertension

62
Q

Is ascites an early or late sign of liver disease?

A

late

63
Q

What are the S/S of Cirrhosis

A 
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
64
Q

Hepatocellular carcinoma

A

the primary tumor is a single, large mass, which can be seen invading an intrahepatic branch of the hepatic vein

65
Q

Chronic Hepatitis B or Hepatitis C are most commonly associated with what form of liver cancer?

A

Hepatocellular Carcinoma

*Cirrhosis causes Hepatocellular Carcinoma…Chronic Inflammation causes Cirrhosis hence the chronic Hepatitises cause Hepatocellular Carcinoma

66
Q

What are the two types of gallstones?

A

Cholesterol and Pigment Stones

67
Q

Discuss Cholesterol Gallstones

A

common in the US

imbalance of bile salts and cholesterol (too much cholesterol)

68
Q

Discuss Pigment Gallstones

A

associated with cirrhosis of the liver

69
Q

What size gallstone is better to have?

A

Bigger ones because they stay put and won’t leave the gallbladder and clog up the biliary tract.

*think Pearls…. The Bigger the Better

70
Q

What is Cholecystitis?

A
  • inflammation of the gallbladder
71
Q

What is acute Cholecystitis?

A
  • sudden inflammation of the gallbladder
  • most common in affluent countries (USA)
  • vast majority due to gallstones
72
Q

What is the characteristic S/S of Acute Cholecystitis?

A

right upper quadrant or Epigastric pain

73
Q

What are the Two types of Acute Cholecystitis?

A

Calculous and Acalculous

74
Q

Calculous (acute Cholecystitis)

A
  • most common
  • often in cycstic duct, common bile duct, bile neck
  • STONE PRESENT
75
Q

Acalculous (acute Cholecystitis)

A
  • 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)
76
Q

What causes Acalculous (Acute Cholecystitis)?

A 
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

77
Q

What are the complications of Gallstones/Gallbladder inflammation?

A 
pancreatitis
abscesses
infections
gallbladder rupture (can cause peritonitis!)
biliary colic
liver damage
gangrene of gallbladder
78
Q

Cancer of the _____ is the 5th most common cancer of the GI tract.

A

Gallbladder

79
Q

Gallbladder cancer is more common in who?

A
  • women

- occurs more often in the 7th decade of life

80
Q

Can gallstones cause cancer?

A

Gallstones are considered to play a role in the development of gallbladder cancer (inflammation eventually leads to cancer)

81
Q

What are the S/S of Acute pancreatitis

A
  • 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

82
Q

What is the #1 cause of Chronic Pancreatitis?

A

Alcoholism

83
Q

who is chronic pancreatitis more common in?

A

alcoholic men

84
Q

what is the main complaint of acute pancreatitis?

A

sudden onset of upper abdominal pain

85
Q

Does everyone go to the posticteric stage of hepatitis?

A

no, in this case the jaundice stays and they go into end stage liver failure

86
Q

What do positive Murphy’s or Blumberg’s signs suggest?

A

(Rigidity/stomach guarding with deep palpations) gallbladder issues

D & D exam 5 (5 decks)

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