Disorders of the Liver, Gallbladder, and Pancreas Flashcards
1
Q
Where is the liver located in the body?
A
Mainly on the right side of the trunk, under the ribs.
2
Q
What structure attaches the liver to the diaphragm?
A
Ligaments.
3
Q
What are the major functions of the liver?
A
- Carbohydrate metabolism
- Lipid metabolism
- Protein metabolism
- Storage (glycogen, vitamins A, D, B12, Fe)
- Blood filtering
- Detoxification
- Secretion of bile and production of albumin (blood plasma protein)
4
Q
A
5
Q
What is the function of the hepatic arteries?
A
Deliver oxygen-rich blood to the liver parenchyma (from the celiac trunk).
6
Q
What is the function of the hepatic vein?
A
Returns deoxygenated blood from the liver to the inferior vena cava.
7
Q
What is the function of the portal vein?
A
Carries nutrient-rich, oxygen-poor blood from the GI tract to the liver.
8
Q
What is enterohepatic circulation?
A
Bile salts from the liver travel via the bile duct into the small intestine and then return to the liver via the portal vein.
9
Q
What is the function of the gallbladder?
A
Stores bile, which aids in fat absorption in the small intestine.
10
Q
What is bile composed of?
A
Bile pigment (bilirubin).
11
Q
What systems can liver diseases affect?
A
- Hepatocytes: Impair metabolic and synthetic functions, causing disorders in carbohydrate, protein, and fat metabolism.
- Biliary drainage system: Obstruct bile flow, interfering with bile salt and bilirubin elimination, leading to cholestatic liver damage.
12
Q
What are the common signs of liver disease?
A
- Ascites
- Jaundice (Icterus)
- Spider angioma
- Dupuytren contracture
- Muscle wasting
- Palmar erythema
- Testicular atrophy
- Splenomegaly
13
Q
What is jaundice (icterus)?
A
A symptom (not a disease) characterized by yellow discoloration of the skin and sclera of the eyes, associated with liver, gallbladder, and pancreatic conditions.
14
Q
How does liver disease impact massage therapy considerations?
A
Liver conditions negatively impact the cardiovascular system, making the heart work harder. Adjust massage as needed.
15
Q
When is massage contraindicated for liver disease?
A
If the patient has fever or jaundice.
16
Q
What modifications should be made if a patient with liver disease is cleared for massage?
A
- Be cautious with the abdomen.
- Modify positioning (avoid prone if abdominal tenderness or swelling is present).
- Use lighter pressure.
- Consider a shorter treatment to prevent patient fatigue.
17
Q
Why is the liver susceptible to drug-induced damage?
A
It is the major organ for drug metabolism and detoxification, making it vulnerable to damage from pharmaceuticals and environmental toxins.
18
Q
What types of drugs can cause liver damage?
A
Prescription medications:
• Antibiotics
• Antidepressants (amitriptyline)
• Anti-epileptics (phenytoin, valproate)
• Anesthetic agents (halothane)
• Lipid-lowering medications
• Immunosuppressive agents
• Acetaminophen
Recreational drugs:
• Ecstasy/MDMA
• Cocaine
Herbal remedies:
• Ginseng
• Pennyroyal oil
• Chaparral
Other toxins:
• Amanita phalloides (“Death Cap” mushroom)
19
Q
What types of liver damage can drugs/chemicals cause?
A
- Hepatocyte injury and death
- Cholestatic liver damage (injury to the biliary drainage system)
20
Q
Where is the liver located?
A
Mainly on the right side of the trunk, under the ribs, and attached by ligaments to the diaphragm.
21
Q
What are the major functions of the liver?
A
• Carbohydrate metabolism
• Lipid metabolism
• Protein metabolism
• Storage (glycogen, vitamins A, D, B12, Fe)
• Blood filtering
• Detoxification
• Secretion of bile
• Production of albumin (blood plasma protein)
22
Q
What are the major blood supplies to the liver?
A
• Hepatic arteries: Deliver O₂-rich blood to the liver parenchyma.
• Hepatic vein: Returns deoxygenated blood from the liver to the inferior vena cava.
• Portal vein: Carries nutrient-rich, oxygen-poor blood from the GI tract to the liver.
23
Q
What is the enterohepatic circulation of bile salts?
A
Bile salts from the liver travel via the bile duct into the small intestine and then return to the liver via the portal vein.
24
Q
What is the function of the gallbladder?
A
It stores bile, which aids in fat absorption in the small intestine.
25
What does bile consist of?
Bile pigment or bilirubin.
26
How do liver diseases affect the body?
• Diseases of hepatocytes impair metabolic and synthetic functions, affecting carbohydrate, protein, and fat metabolism.
• Diseases of the biliary drainage system obstruct bile flow, interfering with bile salt and bilirubin elimination, potentially causing cholestatic liver damage.
27
What are the signs of liver disease?
• Ascites
• Jaundice (Icterus)
• Spider angioma
• Dupuytren contracture
• Muscle wasting
• Palmar erythema
• Testicular atrophy
• Splenomegaly
28
What is jaundice (icterus)?
A symptom (not a disease) characterized by yellowish discoloration of the skin and sclera, associated with liver, gallbladder, and pancreatic conditions.
29
How should massage therapy be modified for patients with liver conditions?
• Assume negative impacts on the cardiovascular system (e.g., hypertension, congestive heart failure) and modify treatment accordingly.
• Massage is contraindicated if the patient has a fever or jaundice.
If cleared for massage:
• Be cautious with the abdomen.
• Avoid prone positioning if tenderness or swelling is present.
• Use lighter pressure.
• Shorten treatment duration to prevent fatigue.
30
Why is the liver vulnerable to drug-induced damage?
It is the major organ for drug metabolism and detoxification, making it susceptible to damage from pharmaceutical and environmental chemicals.
31
What types of drugs can cause liver damage?
• Prescription medications: Antibiotics, antidepressants (amitriptyline), anti-epileptics (phenytoin, valproate), anesthetic agents (halothane), lipid-lowering medications, immunosuppressive agents, acetaminophen.
• Recreational drugs: Ecstasy/MDMA, cocaine.
• Herbal remedies: Ginseng, pennyroyal oil, chaparral.
• Other toxins: Amanita phalloides (Death Cap mushroom).
32
What types of liver damage can drugs cause?
• Hepatocyte injury and death.
• Cholestatic liver damage (injury to the biliary drainage system).
33
What are common risk factors for liver disease?
• Genetic predisposition
• Age
• Underlying chronic liver disease
• Diet
• Alcohol consumption
• Use of multiple interacting drugs
34
How does alcohol affect the liver?
• Alcohol is rapidly absorbed by the stomach and metabolized by the liver.
• 80-90% of alcohol is metabolized by the liver, while the rest is excreted by the skin, lungs, and kidneys.
• Alcohol is extremely toxic to hepatocytes.
• 90-100% of heavy alcohol users develop fatty liver.
35
What factors influence alcohol-induced liver disease?
• Body size
• Age
• Sex
• Ethnicity
• Genetics
• Hormonal birth control (slows alcohol elimination)
36
Why are females more susceptible to ALD?
• Less alcohol dehydrogenase (ADH), leading to slower alcohol metabolism.
• Sex-dependent differences in hepatic metabolism, cytokine production, and gastric alcohol metabolism.
37
What are the characteristics of fatty liver?
• Develops in individuals consuming >60 g/day of alcohol.
• Fat accumulation in hepatocytes.
• Liver becomes yellow and enlarged.
• Usually asymptomatic but may cause malaise, weakness, anorexia, nausea, and abdominal discomfort.
• Reversible with alcohol abstinence (histologic changes normalize within 2-4 weeks).
38
What is alcoholic hepatitis?
Inflammation, degeneration, and necrosis of hepatocytes.
39
What are the symptoms of alcoholic hepatitis?
• Hepatic tenderness
• Pain
• Anorexia
• Nausea
• Fever
• Jaundice
• Ascites
• Liver failure
40
What is cirrhosis?
The end-stage of chronic liver disease, where functional hepatocytes are replaced by fibrous tissue (hepatic fibrosis) leading to diffuse fibrosis and nodular hepatocyte regeneration.
41
What are common causes of cirrhosis?
• Alcoholism
• Viral hepatitis (Hepatitis B & C)
• Toxic drug/chemical reactions
• Biliary obstruction (gallstones, strictures)
• Cystic fibrosis (children)
42
What are the signs and symptoms of cirrhosis?
• Nausea, anorexia, weight loss, muscle wasting, weakness, fatigue
• Ascites
• Abdominal pain
• Splenomegaly
• Jaundice (icterus)
• Pruritus (itching)
• Spider angioma, palmar erythema
• White nails, clubbing, "paper money skin"
• Male impotence, gynecomastia, loss of axillary & pubic hair
43
What are the major complications of cirrhosis?
• Portal hypertension
• Hepatic encephalopathy (brain edema → confusion, disorientation, coma)
• Neurotoxic effects of ammonia buildup
44
How is cirrhosis managed?
• Treat underlying cause (prednisone for autoimmune hepatitis, antivirals for hepatitis B & C, antihistamines for pruritus).
• Liver transplantation.
• Regular exercise (slows muscle wasting).
45
What is NASH?
A liver disease associated with obesity and diabetes, becoming the most common liver disease in the U.S. (affecting 2-5% of Americans).
46
What is hepatitis?
Hepatitis is a general term referring to inflammation of the liver.
47
What are the causes of hepatitis?
• Infectious: Viral, bacterial, fungal, and parasitic organisms
• Non-infectious: Alcohol, drugs, autoimmune and metabolic diseases
48
What percentage of acute hepatitis cases in the U.S. are due to viral hepatitis?
More than 50%.
49
What viruses commonly cause viral hepatitis?
Hepatitis A, B, and C (among others).
50
What type of cellular damage does viral hepatitis cause?
Direct cellular injury leads to inflammation and necrosis.
51
What immune response occurs in viral hepatitis?
The immune system responds to viral antigens, contributing to liver inflammation.
52
What symptoms occur in the prodromal phase of viral hepatitis?
• General malaise, myalgia, arthralgia
• Easy fatiguability and severe anorexia (disproportionate to illness severity)
• Gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation)
• Right upper abdominal pain and enlarged liver
• Smokers may develop a distaste for smoking
53
When does the icterus phase of viral hepatitis begin?
5-10 days after the pre-icterus phase.
54
What symptoms are present in the icterus phase?
• Jaundice
• Severe pruritus (itching)
• Liver tenderness
• Dark urine
• Pale/gray stools
55
What occurs in the convalescent phase of viral hepatitis?
• Increased sense of well-being
• Return of appetite
• Gradual reduction of jaundice
• Acute illness resolves over 2-3 weeks (varies by case)
56
Can acute viral hepatitis evolve into chronic hepatitis?
Yes, some cases progress to chronic hepatitis.
57
What are the possible outcomes for patients with chronic hepatitis?
• Some remain asymptomatic for life
• Others experience fatigue and dyspepsia
• 20% of chronic Hepatitis B or C patients develop cirrhosis
58
What is the typical recovery time for acute viral hepatitis?
• Hepatitis A: ~9 weeks
• Hepatitis B: ~16 weeks
59
What is a carrier state in hepatitis C?
The patient remains infected but disease-free.
60
What is fulminant hepatitis?
A sudden, intense complication of hepatitis B and C characterized by massive, rapid hepatic necrosis.
61
When does fulminant hepatitis develop?
6-8 weeks after initial viral hepatitis symptoms.
62
What complications can occur in fulminant hepatitis?
• Intestinal bleeding
• Cardiorespiratory insufficiency
• Kidney failure
• Elevated blood ammonia
• Increased prothrombin (clotting) time
• Hepatic encephalopathy
63
What is the prognosis of fulminant hepatic failure?
May resolve spontaneously
Over 50% of cases result in death without a liver transplant
64
Can hepatitis viruses be completely eliminated?
No, but medications can slow viral replication and manage symptoms.
65
What is ascites?
The accumulation of excess fluid in the peritoneal cavity.
66
What are common causes of ascites?
• Cirrhosis
• Neoplasm
• Congestive heart failure
• Peritonitis
67
What is portal hypertension?
Increased portal venous inflow and resistance to portal blood flow.
68
What organs drain into the portal vein?
• Small and large intestines
• Stomach
• Spleen
• Pancreas
• Gallbladder
69
How does liver disease contribute to portal hypertension?
Diseased liver increases pressure in the portal vein, leading to ascites and other complications.
70
What are some consequences of portal hypertension?
• Development of ascites
• Splenic engorgement
• Varicosities in hemorrhoidal and esophageal veins
71
What are some causes of portal hypertension?
• Thrombosis (portal or splenic vein)
• Portal vein stenosis
• Tumor
• Parasitic infection
• Tuberculosis
• Cirrhosis
• Acute alcoholic hepatitis
• Acute and fulminant hepatitis
• Right-sided heart failure
72
What symptoms may indicate portal hypertension?
• Hematemesis (vomiting blood)
• Melena (dark tarry stools from GI bleeding)
• Mental status changes (lethargy, irritability, altered sleep)
• Ascites
• Abdominal pain and fever
73
What is hepatitis?
Hepatitis is a general term referring to inflammation of the liver.
74
What are the causes of hepatitis?
• Infectious: Viral, bacterial, fungal, and parasitic organisms
• Non-infectious: Alcohol, drugs, autoimmune, and metabolic diseases
75
What percentage of acute hepatitis cases in the U.S. does viral hepatitis account for?
More than 50%.
76
What causes viral hepatitis?
Different viruses such as hepatitis A, B, and C.
77
How does viral hepatitis lead to inflammation and necrosis?
Through direct cellular injury and an immune response against viral antigens.
78
What are the three phases of viral hepatitis progression?
1. Prodromal Phase (Pre-icterus Phase)
2. Icterus Phase
3. Convalescent Phase
79
What are the symptoms of the prodromal phase of viral hepatitis?
• General malaise
• Myalgia
• Arthralgia
• Easy fatiguability
• Severe anorexia (out of proportion to illness severity)
• Gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation)
• Right upper abdominal pain and liver enlargement
• Distaste for smoking in smokers
80
When does the icterus phase begin?
5-10 days after the pre-icterus phase.
81
What are the symptoms of the icterus phase?
• Onset of jaundice
• Severe pruritus
• Liver tenderness
• Dark urine
• Pale and/or gray stools
82
What happens during the convalescent phase of viral hepatitis?
• Increased sense of well-being
• Return of appetite
• Reduced jaundice
• Acute illness subsides gradually over 2-3 weeks (but is variable)
83
What happens if acute viral hepatitis does not progress to fulminant hepatic failure?
Many cases resolve over a period of days, weeks, or months.
84
What happens in some cases when acute viral hepatitis does not fully resolve?
It may evolve into chronic hepatitis.
85
What are the possible outcomes for patients with chronic hepatitis?
Some remain asymptomatic for life.
Others experience fatigue and dyspepsia.
86
What percentage of chronic hepatitis B or C patients develop cirrhosis?
Approximately 20%.
87
What characterizes cirrhosis histologically?
Severe fibrosis and nodular regeneration.
88
What are the possible symptoms of cirrhosis?
Some patients remain asymptomatic.
Others develop life-threatening complications.
89
How long does it take for complete clinical recovery from viral hepatitis?
• Hepatitis A: ~9 weeks
• Hepatitis B: ~16 weeks
90
What is the carrier state in hepatitis C?
The patient remains infected but disease-free.
91
What is fulminant hepatitis?
A complication of hepatitis B and C characterized by massive, rapid hepatic necrosis.
92
When does fulminant hepatitis develop?
6-8 weeks after initial symptoms of viral hepatitis.
93
What are the complications of fulminant hepatitis?
• Intestinal bleeding
• Cardiorespiratory insufficiency
• Kidney failure
• Elevated blood ammonia
• Increased prothrombin (clotting) time
• Hepatic encephalopathy
94
What is the prognosis of fulminant hepatitis?
More than 50% of cases result in death unless liver transplantation is performed in time.
95
Can viruses that cause hepatitis be eliminated?
No, but medications can slow viral replication and manage symptoms.
96
What is ascites?
Accumulation of excessive fluid within the peritoneal cavity.
97
What diseases can cause ascites?
• Cirrhosis
• Neoplasm
• Congestive heart failure
• Peritonitis
98
What causes portal hypertension?
Increased portal venous inflow and increased resistance to portal blood flow.
99
What does the portal vein drain blood from?
• Small and large intestines
• Stomach
• Spleen
• Pancreas
• Gallbladder
100
101
What happens when the liver is diseased?
Backup of pressure in the portal vein leads to portal hypertension and ascites.
102
What are the effects of portal hypertension?
• Ascites
• Splenic engorgement
• Varicosities of hemorrhoidal and esophageal veins
103
What are the causes of portal hypertension?
• Thrombosis (portal or splenic vein)
• Stenosis of portal vein
• Tumor
• Parasitic infection
• Tuberculosis
• Cirrhosis
• Acute alcoholic hepatitis
• Acute and fulminant hepatitis
• Right-sided heart failure
104
What are the signs and symptoms of portal hypertension?
• Hematemesis or melena (gastroesophageal bleeding)
• Mental status changes (lethargy, irritability, altered sleep)
• Ascites
• Abdominal pain and fever
105
What is biliary dyskinesia?
A disorder of motor/muscular function of the biliary system.
106
What are the two types of biliary dyskinesia?
• Hypokinetic Gallbladder
• Hyperkinetic (Spastic) Gallbladder
107
What are the symptoms of a hypokinetic gallbladder?
• Intermittent or dull pain after eating
• Feeling of fullness in the right upper quadrant
• Dyspepsia
• Decreased gallbladder contractions and bile release
108
What are the symptoms of a hyperkinetic gallbladder?
• Occurs after physical activity (common in athletes)
• Paroxysmal pain (biliary colic) in right upper quadrant and epigastric region
• Nausea, vomiting, irritability, headache
• Increased gallbladder contractions and bile release
109
What is cholelithiasis?
The presence of stones in the gallbladder.
110
What are gallstones composed of?
Cholesterol, bilirubin, and calcium salts.
111
Do gallstones vary in size and number?
Yes, they vary in size, shape, and number.
112
What factors contribute to the development of gallstones?
• Abnormal bile composition
• Bile stasis (cholestasis)
• Inflammation of the gallbladder
113
What populations are at increased risk for gallstones?
• Females
• Older individuals (risk increases with age)
• Obese individuals
• Those with European or Native American ancestry
• Women with multiple pregnancies
• Individuals undergoing rapid weight loss (dietary changes, gastric bypass surgery)
114
Why do multiple pregnancies increase the risk of gallstones?
High progesterone levels during pregnancy reduce gallbladder contractility, leading to prolonged bile retention and higher bile concentration.
115
Why does rapid weight loss increase the risk of gallstones?
It alters bile composition and flow, increasing stone formation.
116
Is cholelithiasis always symptomatic?
No, it is usually asymptomatic. Symptoms occur when stones cause an obstruction.
117
What are the common symptoms when gallstones cause obstruction?
• Epigastric pain or discomfort after meals (lasting 1–5 hours)
• Heartburn
• Flatulence
• Food intolerance
• Collins sign: Pain radiating to the right scapular tip
118
How does pain progress during a gallstone attack?
• Pain steadily increases over 10–20 minutes.
• Pain gradually wanes as the gallbladder stops contracting and the stone falls back.
• The pain is constant and not relieved by vomiting, antacids, defecation, flatus, or positional changes.
119
What other symptoms can accompany gallstone-related pain?
• Diaphoresis (sweating)
• Nausea and vomiting
120
What is the primary treatment for symptomatic gallstones?
Cholecystectomy (surgical removal of the gallbladder).
121
What is the most common method of cholecystectomy?
Laparoscopic cholecystectomy (minimally invasive, outpatient procedure).
122
What can happen after gallbladder removal?
Some patients develop chronic diarrhea due to increased bile salts in the colon.
123
Why does chronic diarrhea occur after cholecystectomy?
Without a gallbladder, bile salts reach the colon more frequently, stimulating mucosal secretion of salt and water.
124
What is cholecystitis?
Inflammation or swelling of the gallbladder, usually due to an obstruction.
125
What is the most common cause of cholecystitis?
Gallstones obstructing the cystic duct.
126
What happens when the gallbladder is distended due to obstruction?
• Blood flow and lymphatic drainage become compromised.
• Mucosal ischemia and necrosis can occur.
127
What are other possible causes of cholecystitis besides gallstones?
• Trauma
• Infection
• Sepsis
128
How is cholecystitis diagnosed?
• Ultrasound
• Cholecystogram
129
What are the major risk factors for developing cholecystitis?
• Increasing age
• Female sex
• Obesity or rapid weight loss
• Hormonal therapy (especially in females)
• Pregnancy
130
What causes acute cholecystitis?
Stone impaction in the cystic duct, causing progressive inflammation of the gallbladder.
131
What are the main symptoms of acute cholecystitis?
• Right upper quadrant pain (often with rebound tenderness and guarding)
• Mild fever
• Anorexia
• Nausea, bloating, and vomiting
• Pain referral to the right shoulder and neck
132
What are the complications of acute cholecystitis?
• Bacterial proliferation, which can lead to pus formation in the gallbladder
• Fever and leukocytosis (elevated white blood cells)
133
What causes chronic cholecystitis?
Repeated episodes of acute cholecystitis, most often due to gallstones.
134
What are the symptoms of chronic cholecystitis?
Intolerance to fatty foods
Belching and flatulence
Episodes of pain with obstruction, referring to the right shoulder and neck
Irritability and insomnia
135
What medications are used to manage cholecystitis?
• Analgesics (for pain relief)
• Antibiotics (for infection control)
136
What procedure can be used to remove gallstones from the bile ducts?
Endoscopic Retrograde Cholangiopancreatography (ERCP)
137
What is the surgical treatment for chronic cholecystitis?
Laparoscopic cholecystectomy (removal of the gallbladder).
138
What does the endocrine function of the pancreas involve?
The secretion of hormones into the bloodstream, such as insulin and glucagon.
139
What is the meaning of "endo" in the context of pancreatic function?
"Endo" means "inside" the body, referring to the secretion of hormones into the blood.
140
What does the exocrine function of the pancreas involve?
The secretion of substances into the gastrointestinal (GI) system, such as digestive enzymes.
141
What is the meaning of "exo" in the context of pancreatic function?
"Exo" means "outside" the body, referring to the secretion of digestive enzymes into the GI tract.
142
What are the components of pancreatic juice?
• Water (H2O)
• Bicarbonate (HCO3) – neutralizes hydrochloric acid (HCl) in the duodenum
• Amylase – digests starch
• Trypsin – digests proteins
• Lipase – digests fatty acids
143
What is acute pancreatitis?
A reversible inflammatory condition of the pancreatic acinar cells, often caused by premature activation or over-secretion of pancreatic juice and obstruction of the pancreatic duct.
144
What causes acute pancreatitis?
It may occur after the ingestion of heavy meals, particularly with alcohol.
145
What are the signs and symptoms of acute pancreatitis?
• Severe, sharp, continuous epigastric and mid-abdominal pain radiating to the back
• Nausea and vomiting
• Fever
• Leukocytosis (elevated white blood cell count)
• Peritonitis
• Paralytic ileus (intestinal paralysis)
• Coma or shock in severe cases
146
What is chronic pancreatitis?
A condition characterized by permanent, irreversible damage to the pancreas, with histologic evidence of chronic inflammation, leading to fibrosis and destruction of both exocrine and endocrine tissues.
147
What are the causes of chronic pancreatitis?
• Chronic alcohol use (most common cause)
• Long-standing obstruction of the pancreatic duct (e.g., gallstones)
• Autoimmune reaction
148
What are the signs and symptoms of chronic pancreatitis?
• Persistent, recurring epigastric and upper quadrant pain
• Anorexia (loss of appetite)
• Nausea and vomiting
• Constipation
• Flatulence
• Endocrine pancreas deficiency, potentially leading to diabetes mellitus and malabsorption syndrome
149
What are the massage considerations for patients with gallbladder and pancreatic conditions?
Massage is contraindicated for acute conditions, especially if the patient has fever, jaundice, or is vomiting.
For patients cleared to receive massage:
• Be cautious around the abdomen.
• Use lighter pressure to avoid discomfort.
• Positional modifications may be necessary, such as avoiding the prone position if there is abdominal tenderness or swelling.
• Consider shorter treatment durations to avoid fatiguing the patient.
150
How does referred pain relate to gallbladder and pancreatic conditions in massage therapy?
• Collin’s sign (pain in the right scapular tip) may occur as referred pain from the gallbladder or pancreas.
• If a patient presents with musculoskeletal complaints that do not improve with massage and exercise, it may be a sign to refer out to a medical doctor for further evaluation.
