Disorders of the Liver and Pancreas Heptobilary

Question 1

Liver

Answer 1

“Metabolic factory” of the body

• Largest internal organ in the body; essential for life
• Functions in the manufacture, storage, transformation, and excretion of many substances involved in metabolism, production of plasma proteins and clotting factors, Breakdown of old and damaged erythrocytes, Bile production

-Receives blood from hepatic portal vein
Transport of nutrients from intestine to liver
-Hepatocytes store nutrients
Play role in carbohydrate, protein, fat metabolism

Question 2

Pancreas

Answer 2

Exocrine (contributes to digestion) and endocrine functions (insulin, glycagon, somatostatin, and pancreatic polypeptide)

Secretes digestive enzymes, electrolytes
Trypsin
Chymotrypsin
Carboxypeptidase
Ribonuclease 
Pancreatic amylase
Bicarbonate ions

Pancreatic duct joins bile duct to enter duodenum

Question 3

slide 6 has manifesations of liver disease

Answer 3

.

Question 4

Prehepatic jaundice

Answer 4

Result of excessive destruction of red blood cells

Characteristic of hemolytic anemias or transfusion reactions

Unconjugated bilirubin level elevated

Question 5

Intrahepatic jaundice

Answer 5

Occurs with disease or damage to hepatocytes

Hepatitis or cirrhosis

Both unconjugated and conjugated bilirubin levels may be elevated.

Question 6

Posthepatic jaundice

Answer 6

Caused by obstruction of bile flow into gallbladder or duodenum

Tumor, cholelithiasis

Increased conjugated bilirubin level
Light-colored stool caused by absence of bile

Question 7

Bilirubin Measurement in Jaundice

Answer 7

Direct or conjugated bilirubin can be measured in the blood.

Total bilirubin is measured in blood.

Indirect or unconjugated bilirubin = total bilirubin minus direct bilirubin

Question 8

Cirrhosis

Answer 8

Progressive destruction of the liver – leads to cellular death when 80 – 90% f the liver has been destroyed

Damaged liver regenerate as fibrotic areas instead of functional cells, causing lymph damage and alterations in live restructure, function and blood circulation

Extensive diffuse fibrosis
Interferes with blood supply
Bile may back up.

Loss of lobular organization

Degenerative changes may be asymptomatic until disease is well advanced.

Liver biopsy and serologic test to determine cause and extent of damage

Question 9

Causes of cirrhosis

Answer 9

-Alcoholic liver disease (15%)
-Biliary cirrhosis
Associated with immune disorders
-Postnecrotic cirrhosis
Linked with chronic hepatitis (26% Hep C, 15% Hep B) or long-term exposure to toxic materials
-Metabolic
Usually caused by genetic metabolic storage disorders
-

Question 10

Functional Losses with Cirrhosis

Answer 10

 Decreased removal and conjugation of bilirubin
 Decreased production of bile
 Impaired digestion and absorption of nutrients
 Decreased production of blood-clotting factors (Prothrombin/Fibrogen) & plasma Proteins (albumin)
 Impaired glucose and glycogen metabolism
 Impaired conversion of ammonia to urea
 Inadequate storage of iron and vitamin B12
 Congestion in intestinal walls and stomach
 Impairing digestion and absorption
 Development of esophageal varices **next slide
 Hemorrhage
 Development of ascites, an accumulation of fluid in the peritoneal cavity **following 2 slides
 Causes abdominal distention and pressure

 Decreased inactivation of hormones and drugs- Drug dosages must be carefully monitored to avoid toxicity.
 Decreased removal of toxic substances (ammonia & drugs)
 Reduction of bile entering the intestine- Impairs digestion and absorption
 Backup of bile in the liver- Leads to obstructive jaundice
 Blockage of blood flow through the liver- Leads to portal hypertension
 Congestion in the spleen- Increases hemolysis

Question 11

Cirrhosis: Subjective Data

Answer 11

• Personality changes, forgetfulness, disorientation
• Fatigue, drowsiness, mild tremors, or flue-like sx
• Gynecomastia, ab distention & measure abd girth

Question 12

Initial manifestations often mild and vague

of cirrhosis

Answer 12

Fatigue, anorexia, weight loss, anemia, diarrhea

Dull aching pain may be present in upper right abdominal quadrant.

Question 13

Advanced cirrhosis

Answer 13

Ascites and peripheral edema
Increased bruising
Esophageal varices (May rupture, leading to hemorrhage, circulatory shock)
Jaundice, encephalopathy

Question 14

Cirrhosis: Treatment

Answer 14

 Avoidance of alcohol or specific cause
 Avoid fatigue
 Avoid exposure to infection
 Supportive or symptomatic treatment
 Dietary restrictions (high carbohydrate intake and vitamin supplements, restrict protein, fat, & Na++)
 Balancing serum electrolytes (possibly diuretics)
 Paracentesis
 Antibiotics to reduce intestinal flora (neomycin)

Question 15

Cirrhosis: Treatment

Answer 15

-Esophageal and gastric varice:
Long-term management
Shunting procedures
Monitor for hypovolemia & bleeding

• Drug therapy Vitamin K blood clotting
• Emergency treatment if esophageal varices rupture
• Liver transplantation (suitable living donor = liver tissue is able to grow in both donner and recipient providing a complete functional liver for both)

Question 16

Hepatitis

Answer 16

Inflammation of the liver results in degeneration and necrosis.

Mild inflammation impairs hepatocyte function.

More severe inflammation and necrosis may lead to obstruction of blood & bile flow

Question 17

?

Answer 17

Alcoholic (Fatty liver)
Idiopathic (Fatty liver)
Viral hepatitis (Local infection)
Infection elsewhere in body(infectious mononucleosis or amebiasis) 
Chemical or drug toxicity

Question 18

Viral Hepatitis

Answer 18

Cell injury results in inflammation and necrosis in the liver.
-Degrees of inflammation and damage vary.

Liver is edematous and tender.

Question 19

Causative viruses

Answer 19

Hepatitis A virus (HAV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Hepatitis D virus (HDV)
Hepatitis E virus (HEV)

Question 20

*Hepatitis A (HAV)

know mainly abc and how they are transmitted

Answer 20

o Small RNA virus
o Infectious hepatitis
o Transmitted by fecal-oral route in areas of inadequate sanitation or hygiene
–Often from contaminated water or shellfish
o Sexual transmission has occurred during anal intercourse.
o Acute but self-limiting infection
o No carrier or chronic state
o Fecal shedding of virus before onset of signs
o Vaccine available for travelers, food care workers, and health care workers

Question 21

*Hepatitis B (HBV)

Answer 21

o Partially double-stranded DNA virus
o Over 50% of HIV-positive patients are positive for HBV.
o 50% of patients are asymptomatic but contagious because of carrier state.
o Chronic inflammation can occur.
o Transmission primarily by infected blood
o Sexual transmission has been noted.
o Tattooing and body piercing may transmit the virus.
o Vaccine available, routinely given to children

Question 22

*Hepatitis C (HCV)

Answer 22

 Single-stranded RNA virus
 Most common type transmitted by blood transfusion
 May exist in a carrier state
 About 50% of patients enter the chronic state.
 Increases risk of hepatocellular carcinoma
 Treated with interferon injections

Question 23

Hepatitis D (HDV)

Answer 23

o Also called delta virus
o Incomplete RNA virus
 Requires HBV to replicate and produce active infection
o HDV infection increases severity of HBV infection

Transmitted by blood

Question 24

Hepatitis E (HEV)

Answer 24

 Single-stranded RNA virus
 Transmitted by oral-fecal route
 No chronic or carrier state

Question 25

FIRST STAGE Viral Hepatitis: Manifestations Preicteric stage

Answer 25

``` Fatigue and malaise Anorexia and nausea General muscle aching Sometimes fever, H/A, mild URQ discomfort LFT elevated (AST & ALT) ```

Question 26

SECOND STAGE Viral Hepatitis: Manifestations Icteric stage *longest for Hep B

Answer 26

Onset of jaundice Stools light in color, urine becomes darker, skin puritic Liver tender and enlarged (hepatomegaly) = mild aching pain Severe cases blood clotting times prolonged

Question 27

THIRD STAGE Viral Hepatitis: Manifestations Posticteric stage—recovery stage

Answer 27

Reductions in signs Weakness persists for weeks Hep A 8-10w; Hep B 16w

Question 28

Viral Hepatitis: Treatment

Answer 28

• No method of destroying hepatitis viruses in the body • Only body defense is formation of antibodies via vaccination • Supportive measures (Rest, diet high in protein, carbohydrate, and vitamins) • Chronic hepatitis can be treated with INTERFERON. o Decreases viral replication o Effective in only 30% to 40% of individuals o Drug combination (slow-acting interferon plus antiviral drug) more effective

Question 29

Gallbladder Disorders

Answer 29

• Cholelithiasis o Formation of gallstones o Solid material (calculi) that form in bile • Cholecystitis o Inflammation of gallbladder and cystic duct • Cholangitis o Inflammation usually related to infection of bile ducts • Choledocholithiasis o Obstruction of the biliary tract by gallstones

Question 30

Gallbladder Disorders (Cont.)

Answer 30

* Gallstones vary in size and shape. * Form in bile ducts, gallbladder, or cystic duct • May consist of: o Cholesterol or bile pigment o Mixed content with calcium salts • Small stones o May be silent and excreted in bile • Larger stones o Obstruct flow of bile in cystic or common bile ducts; cause severe pain, which is often referred to subscapular area

Question 31

Risk factors for gallstones

Answer 31

``` Women twice as likely to develop stones High cholesterol in bile High cholesterol intake Obesity Multiparity Use of oral contraceptives or estrogen supplements Hemolytic anemia Alcoholic cirrhosis Biliary tract infection ```

Question 32

4F’s of gallbladder=

Answer 32

Fat, Fertile, Female, Forty

Question 33

Obstruction of a duct by a large calculi

Answer 33

o Sudden severe waves of pain  Radiating pain right shoulder/neck o Nausea and vomiting usually present o Pain continues, and jaundice develops.  Bile backs up into the liver and blood.  Risk of ruptured gallbladder if obstruction persists  Pain decreases if stone moves into duodenum o Surgical intervention may be necessary.  May be removed using laparoscopic surgery  Low-fat diet necessary following surgery

Question 34

Inflammation of the pancreas

Answer 34

Results in autodigestion of the tissue Premature activation of pancreatic proenzymes (trypsin, amylase and lipase) which digests the pancreatic tissues = massive inflammation, bleeding & necrosis

Question 35

May be acute or chronic | Acute Pancreatitis

Answer 35

Acute form considered a medical emergency

Question 36

Pancreas lacks a fibrous capsule... | Acute Pancreatitis

Answer 36

Destruction may progress into tissue surrounding the pancreas Substances released by necrotic tissue lead to widespread inflammation --Hypovolemia and circulatory collapse may follow.

Question 37

Chemical peritonitis results in bacterial peritonitis. | Acute Pancreatitis

Answer 37

Septicemia may result. Adult respiratory distress syndrome and acute renal failure are possible complications.

Question 38

Causes | Acute Pancreatitis

Answer 38

Gallstones Alcohol abuse Sudden onset may follow intake of large meal or large amount of alcohol

Question 39

Acute Pancreatitis: Manifesations

Answer 39

- -Severe epigastric or abdominal pain radiating to the back (primary symptoms) Pain increases in supine position - -Signs of shock (Caused by hypovolemia d/t inflammation and hemorrhage – low PB, palor, diaphoresis, rapid & weak pulse) - -Low-grade fever until infection develops (then temperature may then rise significantly) - -Abdominal distention and decreased bowel sounds (Decreased peristalsis and paralytic ileus)

Question 40

Diagnostic tests | Acute Pancreatitis

Answer 40

Serum amylase levels—first rise, then fall after 48 hours Serum lipid levels are elevated. Hypocalcemia Leukocytosis

Question 41

Treatment | Acute Pancreatitis

Answer 41

Oral intake is stopped. Treatment of shock and electrolyte imbalances Analgesics for pain relief – NOT MORPHINE – (causes spasm of the sphincter of Oddi)

Question 42

LIVER PROBLEM PEOPLE

Answer 42

dont have vit k so they bruise easly there is so much extra uric acid that its fucks with neuro jaundice - because the liver is not breaking down billirubin encephalopathy splenomegaly portal hypertension anemia- because liver cant store WBCs and the bofy can use b12 and iron which wont create WBCS leukopenia- low blood sells that puts them in a risk of infection gynemomastia -big titties pruritus first place you will see jaundice will be in the eyes

Question 43

every time you see high levels of bilirubin

Answer 43

think of liver

Question 44

females should always have hemoglobin levels

Answer 44

between 120-160

Question 45

hepititis is

Answer 45

really inflammation of the liver

Question 46

when the liver starts to degenerate

Answer 46

it because fibirous and it wont function as well

Question 47

for ascities

Answer 47

the diuretics will draw the fluid the from the peri cavity into the vascular system so that they can remove the fluid because thats how diuretics work

Question 48

hep difference between crhrosis

Answer 48

altered taste ad smakk fever malaisa headache

Question 49

galbladder mani

Answer 49

- sudden severe waves of pain - nausea and vomiting - if pain continues, and jundice develops - +surgical intervention may be mecessarn

Question 50

clincal manis caused by bile flow (chart)

Answer 50

- jaundice - dark urine - cramping - steatorrhea