Exam 2 Flashcards
Complications for chronic pancreatitis
Diabetes mellitus
Pancreatic cancer
Calcification of pancreas
Multiple cysts
Spreads through contaminated food and water, often causes an acute and self-limiting infection, but (unlike hep A) causes severe intralobular necrosis, acut cholangitis, does not cause chronic hepatitis
HEV
+ssRNA
Infectious hepatitis
IgG indicates
Chronic case
Hepatic rub, bruit, and abdominal venous hum would suggest that a patient with cirrhosis had developed a
Hepatoma
Management of acute cholecystitis
Cholecystectomy
Metastases to the liver results from
Specific venous blood flow from GI tract to v.porta which brings the blood to the liver for detoxification
Sickle cell anemia
RBC abnormal chemical structure - sickle shape
Large amount of meal or fat meal can trigger the pain
Acute cholecystitis
Pathogenesis of acute cholecystitis
Etiological agents
Decrease gallbladder motility
Delay of bile evacuation
Increase of pressure inside gallbladder, increase of bile concentration, activation of opportunistic bacteria (e.g. E. Coli)
Inflammation of gallbladder wall
Edema of gallbladder wall
Compromising of blood flow and lymphatic drainage in gallbladder wall and surrounding tissue
Ischemia and necrosis of gallbladder wall and surrounding tissue
Treatment pancreatitis
Only medical treatment
ERCP
Endoscopic retrograde cholangiopancreatography
Signs and symptoms acute pancreatitis
Sudden acute, severe pain in upper abdomen, lasts from short time to days, and resolves itself
Pain worsens after food eating
Pain may reach to across the back, level T8-L1 (band-like pain)
Pain could radiate to umbilical, both flanks, left shoulder
Pain worse when lying flat on back
Pain decreases with sitting and flexion forward
Pain is always accompanied by high BP and tachycardia
Positive cullen’s sign
Nausea
Vomiting
Fever
Right shoulder radiation
Gallbladder
Indicates inflammation of the gallbladder wall due to bile duct obstruction
Elevated ALP
There are three types of blood test for evaluation of patients with hepatitis
Liver enzymes aka aminotransferases
Anti-viral antibodies and viral genetic materials
Serum proteins
AST
ALT
GGT
Inc with _____
Bile duct obstruction only ALP increased
ALP
Complications cholelithiasis
Gallbladder gangrene Acute cholecystitis Chronic cholecystitis Perforation or rupture of gallbladder Cholangitis Acute pancreatitis
Etiology liver cancer
Chronic infectious hepatitis B, C, D Liver cirrhosis Aflatoxins Wilson’s disease Hemochromatosis Non-alcoholic fatty liver diseases Estrogen and anabolic steroids
Cancer that originates from liver cells
Primary liver cancer
Cirrhosis signs and symtpoms
Ankle swelling jaundice Palmar erythema Nail changes and clubbing of fingers Easy bruising Abnormal bleeding Confusion or problems thinking Hepatic encephalopathy
Most frequent liver cancer, which originates from hepatocytes
Hepatocellular carcinoma aka hepatoma
Spreads through blood, body fluids, sexual contacts, tattoos, mothre to child by breast feeding
HBV
+dsDNA
Serum hepatitis
Incubation period Hepatitis A
28 days (range 15-50 days)
Formation and migration of stones inside the biliary tree or common bile duct
Choledocholithiasis
Diagnosis pancreatitis
Blood amylase and lipase high Urine amylase significantly increased Blood glucose inc US CT MRI
Formation of stones in the gallbladder
Cholelithiasis aka gallstone disease
Tests for bilirubin
Considerable increase of blood total and conjugated (direct) bilirubin
Finding of bilirubin in the urine (which results in dark brown color of the urine, like dark beer)
Increased concentration of urobilirubinogen in the urine
Cholesterol long time between meals
Only eat 1 or 2 times a day
Both cullen’s and grey-turner’s signs can predict
Acute pancreatitis
Usually the clinical manifestations of pancreatic cancer come to the clinical attention in ____stage of the disease
Terminal
Acute cystitis easy pathogenesis
Quiescent
Stone blocks cystic duct. Chemical and bacterial inflammation
Stone drops back into gallbladder in 7 days or so
Resolution in 2 months or so
Acute pancreatitis when the ____ or ___ is obstructed
Hepatopancreatic duct
Pancreatic duct
Complications cholecystitis
Perforation or rupture of gallbladder
Ascending cholangitis
Local abscess
Peritonitis
Diagnosis pancreatic cancer
Blood CA-19-9
CT
Endoscopic ultrasound (EUS)
Endoscopic ultrasound with endoscopic needle biopsy
Signs and symptoms typical for acute hepatitis in overt stage
Hepatomegaly Abdominal discomfort and pain Jaundice - yellowing of the skin and eyes (icterus) Lymphadenopathy Dark colored urine White stool
Cooleys or mediterranean anemia
Thallassemia major
Predisposing factors pancreatic cancer
Chronic pancreatitis Smoking Family history Age over 60 Diet with high amount red meat, soft drinks Obestiy Partial gastrectomy as treatment of obesity H. Pylori infection
Treatment cirrhosis
Liver cirrhosis is an irreversible disease and the treatment usualy focuses on preventing of its progression and complications
Hypoalbuminemia and increased prothrombin time are the most specific tests for
Liver destruction
For determination of biochemical activity of the organ and cancer stage
PET-CT (positron-emission tomography-computer tomography)
Risk factors for cholesterol gallstones
Decreased gallbladder motility with bile stasis Obesity Family history (genetic predisposition) Rapid weight loss Long intervals between meals
Murphy’s sign is positive in cholelithiasis only when
It complicated with cholecystitis
Tumor marker frequently elevated in pancreatic or liver cancer
CA-19-9
Spherocytosis
Small eccinocytes, present with dec amount of lip
MRI is used for diagnosis of stones at
Any level of bile tree and gallbladder
Acute pancreatitis
Reversible disease, if does NOT turn into chronic pancreatitis
Presence of paget’s disease with osteoblastic activity, or metastatic prostate cancer
High ALP
Complications cholelithiasis
Acute cholecystitis when cystic duct is obstructed
Chronic cholecystitis when long-term presence of gallstones leads to fibrosis of gallbladder wall with further its calcification
Beta-cell tumor generally benign is characterized by overproduction of insulin, which can result in hypoglycemia
Insulinoma
Calculous cholecystitis
When stones in the gallbladder are formed
90%
Zollinger-Ellison syndrome causes multiple
Peptic ulceration not only in stomach and duodenum but also in jejunum
Etiology of acalculous cholecystitis
Critical illness (HIV, diabetes mellitus, myocardial infarction) Major surgery or severe trauma/burns Sepsis Long-term total parenteral nutrition Prolonged fasting Salmonella infection
Don’t forget that liver cirrhosis is the major cause of
Esophageal varicies
Virus etiology hepatitis aside from Hep a, b, etc.
Cytomagalovirus
Epstein-Barr virus
Yellow fever virus
Ebola virus and Marburg virus
Blood tests diagnosis cholelithiasis
Inc WBC
Inc common bilirubin content
Inc alkaline phosphatase
Signs and symptoms of hepatitis depend on the
Form of hepatitis (acute or chronic) and its etiological factor
Incubation period Hepatitis B
90 days (range 30-150 days)
Autoimmune diseases etiology hepatitis
Sjogren’s sydnrome
Increased alfa-fetoprotein
Is normal for infants before 1 year old
Aften 1year it decreases and is low during the entire life
Alkaline phosphatase (ALP) is an enzyme presenting in all tissues of the body, but is particularly concentrated in
Liver Bile duct Kidneys Bones Placenta
Recommendations by chiropractor for hepatitis
Rest to minimize energy demands
Avoid alochol and other hepatotoxic drugs (tylenol)
Small amount, high-calorie meal
Pain in upper abdomen that typically radiates to the back when carcinoma located in the body or tail of the pancreas
Pancreatic cancer
Acute gastritis and duodenitis
Internal bleeding with development of hypovolemic shock
Lung problems (enzymes may affect lung tissue causing it’s inflammation)
Acute pancreatitis
Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
Acute peritonitis positive cullen’s sign
Metastases to the liver
Major sources of metastases to the liver are the ones from the GI tract organs
Cirrhosis etiology alcoholism
Alocholic steatosis
Non-alcoholic steatohepatitis
2 forms of cholecystitis
Calculous
Acalcolous
Most common causes chronic hepatitis, cirrhosis, liver cancer
Hepatitis C
Most common type of pancreatic cancer
Adenocarcinoma - 95%
Only small stones are the ___ dangerous
More
The ____ the calculi, the less likely they are to enter the cystic or common ducts to produce obstruction
Larger
Cholesterol gallstones genetic
Predominantly young spanish population
Signs and symptoms of chronic cholecystitis
First symptoms are bitter taste adn taste of metal in mouth in the morning Abdominal discomfort after meals Complaints of gas accumulation Nausea Chronic diarrhea Presence of skin xanthomas
Poisons produced by the plant mold aspergillus, that grows on wheat, rice, corn, and peanuts
Aflatoxins
Usually blood test liver panel is abnormal with liver cancer because a patiente had
A previous liver disease
Etiology for chronic pancreatitis
Alcoholism
Cystic fibrosis
Pseudocysts
Idiopathic
Pain when pressuring between edges of Right SCM muscle
Georgievskiy-Myussi’s sign
Xanthomas represent
Focal accumulation of cholesterol
Most common cause of toxic hepatitis
Alcohol
ALT is normally most concentrated within ____ and in ____
Liver cells
Heart muscle cells, kidneys, pancreas
Irreversible disease characterized by atrophy, fibrosis, and calcification of pancreatic parenchyma
Chronic pancreatitis
Unexplained thrombophelbitis (Trousseau sign) of superficial veins anywhere in the body, portal vein or deep veins of the extremities
Pancreatic cancer
Represents the dilation of periumbilical collateral veins and is an important sign of portal hypertension
Caput medusae
Treatment pancreatic cancer
Surgery
Radiation therapy
Chemotherapy
Chronic hepatitis usually results from ___ form of hepatitis but sometimes develops insidiously, with ____ initial clinical manifestations
Acute
Non-sepcific
Weakness
Fatigue
Incubation period Hepatitis D
60-90 days (range 30-180 days)
Parasites hepatitis etiology
Echinococcus
Toxocara
Schistosoma
3 types of gallstones
Cholesterol stones
Pigment stones
Mixed stones
Primary liver cancer
When the tumor originates from liver cells
Serum proteins diagnosis hepatitis
IgM
IgG
Hypoalbuminemia
Increased prothrombin time
Obesity etiology hepatitis
Non-alcoholic steatosis
Protozoa etiology hepatitis
Toxoplasma
Leishmania
Accumulation of fat in the hepatocytes, may results altered fat metabolism in the liver and increase synthesis of fatty acids and triglycerides. Enlargement of the liver is accompanied by symptoms that may include anorexia, nausea and jaundice. At this point the fatty changes are generally reversible if alochol consumption ceases
Alocholic steatosis - fatty liver
The most aggressive form, with high mortality rate, cannot exist without B virus, spreads through the blood, typical for IV drug users and hemophilia patients
HDV
-ssRNA
Serum delta hepatitis
Causes chronic hepatitis, can cause cirrhosis and cancer
Hepatitis B
IgM
Indicates acute case
Tenderness when hand taps the end of right costal arch
Ortner’s sign
AST is presented not only in the liver but also in
Skeletal muscles Heart muscle Brain Lungs Pancreas
Can be released from these tissues in the case of their destruction
Classification of primary liver cancer
Hepatocellular carcinoma
Cholangiocarcinoma
Angiosarcoma
Risk factors for calculous cholecystitis
Female Obesity Rapid weight loss Pregnancy Increasing age Ethnic groups (hispanic, scandinavian) Drugs (esp hormonal therapy in women)
Alpha-1-antitrypsin deficiency
Abnormal accumulation of the protein within liver cells
More sensitive for diagnosis of porcelain gallbladder characterized by calcification of gallbladder wall, developing usually in cholelithiasis complicated by ____
Describing cholelithiasis
Chronic cholecystitis
Signs and symptoms in choledocholithiasis
Acute constant pain in upper part of abdomen
Obstructive jaundice
Murphy’s sign negative
Charcot triad
Pain worse when lying flat on bakc
Acute pancreatitis
An eosinophilic cytoplasmic inclusion, alocholic hyaline, found in liver cells
Mallory bodies
Long-term presence og gallstones
Silent stones
Initial manifestations of hepatitis may start and get better quickly = ______ or cause long-term disease = _____
Typical for acute hepatitis
Chronic hepatitis
Charcot triad
Indicates ascending cholangitis
Severe right upper quadrant pain
Jaundice
Fever
Treatment hepatitis
Medical, depends on the cause
Arises in the duodenum, pancreas, and peripancreatic soft tissue
Sollinger-Ellison syndrome
The most common type of pancreatic cancer is adenocarcinoma arising from the ___ component, from the cells that line the ducts of the pancreas
Exocrine
Aspartate aminotransferase (AST) aka serum glutamic oxaloacetic tranaminase (SGOT) is
Intracellular enzymes
AST blood concentration is significantly increased in
Acute toxic hepatitis
Acute viral hepatitis
Alcoholic liver disease
The major danger of gallstones is their ability
To move to the bile ducts resulting in duct obstruction
Diagnosis cirrhosis imaging
CT of abdomen
MRI of abdomen
Upper endoscopy for esophageal varicies
Ultrasound of the abdomen
CT-scan is used for diagnosis of _____ stones
Aka ____
Distal common bile duct stones
Porcelain gallbladder
Normal gallbladder wall vs inflamed
1 inch
2 inches
Cirrhosis etiology
Alocholism Chronic hepatitis B, C, D, F Autoimmune hepatitis Some medicines (corticosteroids) Genetic diseases (genetic hemochromatosis, Wilson’s disease)
Signs and symptoms of acute cholecystitis
Acute pain in right upper abdomen that is severe and constant, may last for days
Pain is increased with breathing
Pain radiates to right shoulder, or right scapula, or right mid back (T8-9 level)
Changing position and passing gas do NOT relieve pain
Large amount of meal or fat meal can trigger the pain
Pain occurs several hours after eating and awakens the pt during the night
Fever and chills
Nausea nad vomiting
Vomiting does NOT relieve pain (unlike peptic ulcer)
Ischemic hepatitis (shock liver) most often associated with
Heart failure
Shock
Sepsis
Gastrinoma
Zollinger-Ellison syndrome
Alanine aminotransferase (ALT) aka serum glutamic pyruvic tranaminase (SGPT) is
Intracellular enzymes
Pathogenesis of chronic cholecystitis
Occurs after repetitive mild exacerbations of acute cholecystitis and is characterized by mucosal atrophy and fibrosis of gallbladder wall
Toxic hepatitis could be caused by
Medications (tylenol, birth control pills, Lipitor, etc)
Mushroom poison
Alcohol
Metastases from the liver
To local veins and then to lungs
Advanced cases are characterized by metastases to the bone (including spine) and brain
Acalcolous cholecystitis
Without formation of stones
10%
When cholelithiasis becomes symptomatic the following signs and symptoms develop
Murphy’s sign? Tachycardia Nausea, vomiting (vomiting does NOT relieve pain) Increased production of gas Fat intolerance
As liver function worsens, symptoms may include
Ascites
Ascites with caput medusae
In acute cholecystitis vomiting ____ relive the pain
Does not
Differential diagnosis for chronic cholecystitis
Peptic ulcer
Hiatal hernia
Colitis
Chronic pancreatitis
Gold standard for diagnosis of cirrhosis is
Liver biopsy
Decreased gallbladder motility - mixed gallstones
Severe trauma (e.g. car accidents)
Severe burns
Paralysis
X-ray in cholelithiasis
15% sensitivity for radioopaque stones (pigment and mixed stones)
Spreads through sexual contacts and hemotransfusions, cross the placenta
HCV
+ssRNA
Serum non-A, non-B hepatitis
Cholelithiasis signs and symptoms - gallstone attack
Sudden acute pain in right upper quadrant lasts 30 minutes to several hours, until gallbladder relaxes
Pain radiates to back, between blades, right shoulder, behind sternum
Change of posture, defecation do NOT relieve pain
Risk factors for mixed gallstones - what part of ilium
Distal portion
This is a new discovered hepatitis virus, spreads by blood and sexual contact.
Does not appear to replicate primarily in the liver, its characteristics are in the process of study
HGV
GB virus C
Phrenic nerve sign
Georgievskiy-Myussi’s sign
More sensitive than ultrasound in diagnosis of pericholecystitic inflammation
CT-scan
Signs and symptoms of liver cancer
Clinical manifestations appear only in the late stages, and worsen with a progression of the disease
Loss of weight
Loss of appetite
Upper abdominal discomfort and pain
Liver size can be ___ in cirrhosis
Normal
Enlarged
Shrunken
Incubation period Hepatitis E
40 days (range 14-60 days)
Comlpications hepatitis
Liver cirrhosis (hep b,c,d,f, toxic, autoimmune, genetic) Hepatic failure Hepatocellular carcinoma (hepatoma)
Zollinger-Ellison syndrome diagnosis
Blood testing to detect inc gastrin levels
Upper GI endoscopy
Imaging tests to look for gastrinoma
Measurement of stomach acid - gastric pH less than 2.0; large gastric volume greater than 140mL
Thalassemia
Absence of globulin or alpha or 2beta
Physical or morphological structure
Diagnosis liver cancer
Blood test US CT MRI Liver biopsy PET-CT
Gastric pH less than 2.0
Large gastric volume >140mL
ZES (Zollinger-Ellison syndrome)
Gamma-glutamyltransferase (GGT) is found predominately in the ___ but also is present in the cell membrance of other tissues (e.g. kidneys, heart, brain)
Hepatobiliary cell membrances
Bacteria cause hepatitis
Staphylococci and streptococci - toxic shock syndromes
Leptospira (gram-negative spirochete)
Listeria (gram positive, non spore-forming rods)
Radioopaque stones
Pigment and mixed stones
Diagnosis cirrhosis
CBC - thrombocytopenia, leukopenia, neutropenia
Inc prothrombin time
Hypoalbuminemia
Aminotrasferases - AST, ALT, GGT elevated; AST usually > ALT, GGT typically much higher in alcoholic cirrhosis
ALP elevated
Bilirubin elevated
Increased prothrombin tmie indicates the
Decreased production of clotting factors
Risk factors for pigement gallstones
Young population
Hemolytic conditions (sickle cell anemia, hereditary spherocytosis, thalassemia)
Liver cirrhosis
Intraductal stasis (choledochole cyst, postsurgical biliary stricture)
Zollinger-Ellison syndrome can mmetastasize to ____leading to a significantly short life
The liver
Blood tests for acute cholecystitis
Elevated WBC
Elevated alkaline phosphatase
Elevated C-reactive protein
In men signs and symptoms cirrhosis
Impotence
Hypogonadism (shrinking of the testicles)
Gynecomastia (breast swelling)
ALT blood elevation is significantly increased in case of
Acute hepatocyte destruction or severe kidneys, pancreas damage
Cirrhosis etiology
Alocholism is major etiological factor
GGT blood concentration is significantly increased in liver diseases associated with
Hepatocyte necrosis
Cirrhosis
Alcoholic liver disease
Pain decreases with sitting and flexion forward (unlike to pain in ___ and ____)
Acute pancreatitis
Cholelithiasis
Acute cholecystitis
Spreads through fecal contamination of food and water, causes an acute and self-limiting infection, does NOT cause chronic hepatitis
HAV (hepatitis A)
+ssRNA
Infectious hepatitis
One of the real treatment options today is
Liver transplantation
Signs and symptoms liver cirrhosis
There may be no symptoms or symptoms may come on slowly, depending on how well the liver is working
Etiology hepatitis
Viral Toxic Bacteria Protozoa Parasites Fungi Autoimmune diseases Obesity Genetic Ischemic hepatitis
Risk factors for mixed gallstones
Crohn’s disease
Partial removal of ilium
Decreased gallbladder motility
Originates from the blood vessel cells in the liver
Angiosarcoma aka hemangioendothelioma
Most liver transplant recipients recieve immunosuppressive drugs (corticosteroids) for
Prevention of the graft rejeciton
Tumor markers found only in primary liver cancers as well as in other cancers and certain other disorders
Carbohydrate antigen 19-9 (CA19-9)
Carcinoembryonic antigen (CEA)
Cancer antigen 125 (CA125)
Anti-viral antibodies and viral genetic materials
Anti-HAV (for Hep A)
Anti-HBV (for Hep B)
Anti-HCV (for HEp C)
Decreased gallbladder motility with bile stasis
Age over 40
Female
Some drugs (statins, estrogen therapy)
Multiple pregnancies
Hepatitis exists in 2 forms
Acute - less than 6 months
Chronic - more than 6 months
Specific for cholecystitis but is non-sensitive especially in geriatric patients
Murphy’s sign
Pancreatitis blood amylase and lipase are ____ than normal variations
Which is better indicator
4-6 times hight
Lipase
Use for differential diagnosis between acute and chronic cholecystitis
HBS - hepatobiliary scintigraphy
Fungi etiology hepatitis
Aspergillus
Histoplasma capsulatum
Candida
Pain occurs several hours after eating and awakens pt at night
Acute cholecystitis
Lateral clinical manifestations of cirrhosis
Jaundice Esophageal varicies Ascites Hepatomegaly Splenomegaly Hemorrhoids Edema Peripheral neuropathy Changes in mental responsiveness and memory Spider angiomas. Face, neck, shoulders Anemia Thrombocytopenia Coagulation disorders Collateral veins visible on abdominal wall Palmar erythema Sexual characteristics Changes Gynecomastia Hirsuitism
Initial manifestations of acute hepatitis for first 2-4 days are NON-specific and characterized by flu-like signs and symptoms
Fever Malaise Joint aches Headache Nausea, vomiting Diarrhea
Managment of chronic cholecystitis
Diet modification
Antibiotics
Restriction of physical activity
The first symptoms of cholecystitis
Bitter taste and taste of metal in mouth in the mornings
Hemochromatosis
Iron accumulate in multiple body sites, including the liver
Pulmonary embolism because the pancreatic cancer produces
Blood clotting chemicals
Splenomegaly is often found regardless of
Liver size
Cholelithiasis diagnosis
Blood tests US CT MRI ERCP X-ray
Ankle swelling (non-pitting, non-pedal edema) due to
Hypoalbuinemia
Cholangitis when the common bile duct is obstructed before jointing the
Pancreatic duct
Gold standard examination for diagnosis of gallbaldder stones and stones in the cystic duct is
Ultrasound examination
Occupies 3rd position in frequency among the most common cancer mortality
Liver cancer
Treatment cholelithiasis
Just medical treatment including surgery
Fibrosis of gallbladder wall with further calcification
Porcelain gallbladder
A consequence of chronic liver diseases characterized by replacement of liver tissue by scarring tissue leading to loss of liver function
Liver cirrhosis
Jaundice develops when pancreatic cancer is located in
The head of the pancreas
Treatment recommendations by chiropractor cirrhosis
Avoiding alcohol consumption
Eating healthy diet that is low in salt
Vitamin and nutritional supplements
Cholesterol stones
Radiolucent
80%
Liver enzymes
Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Gamma glutamyltransferase (GGT)
Complications for acute pancreatitsi
Pancreonecrosis Pancreatic abscess Acute gastritis and duodenitis Internal bleeding with development of hypovolemic shock Lung problems
Causes chronic hepatitis, cirrhosis, liver cancer
Hepatitis D
Tumor markers blood test most important is increased
Alfa-fetoprotein
Tumor originates from the bile duct cells
Cholangiocarcinoma
Blood tests for chronic cholecystitis
Frequently shows normal values
Inflammation of the pancreas when certain enzymes that normally do not become active until they reach the small intestine, become active in the pancreas digesting this gland itself
Pancreatitis
Non-specific signs and symptoms pancreatic cancer
Clinical depression - sometimes presenting before caner is diagnosed Unexplained weight loss Anorexia Nausea, vomiting Steatorrhea
Murphy’s sign is negative with the stone in the
Bile duct - choledocholithiasis
Radiologic exam can be used for differential diagnosis between
Gallbladder
Kidney stones
Autoimmune, parasites, protozoa, obesity, genetic, ischemic etiological agents usually result in
Progression to chronic hepatitis
Increased neutrophils for acute
Cholecystitis
Metastases pancreatic cancer
- To regional lymphatic nodes
- Liver
- Lungs and pleura
High ALP can show
Liver disease Bile duct obstruction Presence of paget’s disease with osteoblastic activity Presence of pregnancy Presence of celiac disease
Xanthomas result from
Cholestasis and/or hyperlipidemia
Complications cirrhosis
Bleeding disorders
Esophageal varicies
Hepatocellular carcinoma
Hepatic encephalopathy
Etiology for acute pancreatitis
Alcohol use Gallstones Trauma of the abdomen Viral infections (mumps) Pseudocysts Medications (corticosteroids, estrogen, statins)
Anit-viral antibodies and viral genetic materials can be helpful in diagnosis of both
Acute and chronic viral hepatitis
Spreads through blood transfusion or oral fecal route
Causes chronic hepatitis
HFV
Serum, mutated B-virus
Diagnosis cholelithiasis
Blood tests are infomative in the cases of exacerbation
Cancer that begins in another area of the body (colon, breast, stomach) and then spreads to the liver
Secondary (metastatic)
Hypoalbuminemia indicates
A decreased function of hepatocytes
Measures of liver homeostasis
High concentrations develop as a result of destruction or inflammation not only in the liver, but in other tissues as well
Liver enzymes aka aminotransferases
Malignant neoplasm originating from transformed cells of the pancreas
Pancreatic cancer
Left shoulder radiation
Heart
Pancreas
This pain is ALWAYS accompanied by high blood pressure and tachycardia
Acute pancreatitis
Perforation or rupture of gallbladder with development of
Bile peritonitis and high level of mortality
Characterized by overproduction of gastrin which stimulates extreme HCl secretion
Zollinger-Ellison syndrome
Incubation period Hepatitis C
50 days (range 15-160 days)
Types of pancreatitis
Acute
Chronic
The enzyme ____ plays teh most important role in pancreatitis process
Trypsin
Pigment stones
Contain bilirubin and calcium
Radioopaque
Liver cancer - forms
Primary
Secondary - metastatic
On lateral lumbar x-ray film
Gallstones are located :
Kidney stones :
In front of lumbar spine
Overlap L2 or locate posterior to it
Changing position and passing gas do NOT relieve pain
Acute cholecystitis
Signs and symptoms liver cancer
Nausea, vomiting General weakness, fatigue Jaundice with skin itching Hepatosplenomegaly Sudden ascites Back pain
Early symptoms liver cirrhosis
Fatigue and loss of energy
Poor appetite and weight loss
Nausea and upper abodminal discomfort
Small, red, spider-like blood vessels on the skin (telangiectasia, spider angioma)
Early pancreatic cancer often does not cause symptoms or symptoms are _____
Silent disease
Non-specific
Differential diagnosis for acute cholecystitis
Acute peptic ulcer
Perforated peptic ulcer
Acute pancreatitis
Ureteral colic
Viral, bacterial, fungal, and toxic etiological agents usually result in
Acute hepatitis until further progression to chronic hepatitis EXCEPT
HAV and HEV
Signs and symptoms pancreatic cancer
Painless jaundice, may be associated with itching
Signs and symptoms typical for all forms and etiologies of hepatitis in overt stage
Weight loss
Easy bruising
Encephalopathy
Hepatosplenomegaly
Inflammation of the gallbladder wall
Cholecystitis
During the physical exam the ___ can be found with liver cancer
It develops because hepatocarcinoma has a lot of blood vessels with turbulent blood flow
Hepatic bruit
Treatment liver cancer
Cryotherapy in early stage
Chemoembolisation
Radiotherapy
Liver transplantation
Diagnosis hepatitis
Tests for bilirubin Liver enzymes Anti-viral antibodies and viral genetic materials Serum proteins Ultrasound Liver biopsy
Increased sensitivity below the right scapula (also due to phrenic nerve irritation)
Boas’ sign
Inflammation of the liver with change of its function
Hepatitis
The gallstones may be present for ____ before symptoms develop, and ___ of patients remain asymptomatic throughout their lives
Decades
70-80%
Brusing of the flank, which may be indicative of pancreatic necrosis with retro peritoneal or intraabdominal bleeding
Acute pancreatitis positive Grey-Turner’s sign
Ecchymosis of the flanks
Genetic causes of hepatitis
Alpha-1-antitrypsin deficiency
Hemochromatosis
Wilson disease
Glycogen storage disorders
The signs and symptoms of pancreatic cancer depend on
Size, location, and tissue type of tumor
Wilson disease
Copper accumulate in the liver and brain
Cholecystitis divides into
Acute
Chronic
Endocrine pancreatic tumors
Insulinoma
Zollinger-ellison syndrome
Diagnosis cholecystitis
Ortner’s sign Georgievskiy-Myussi’s sign Murphy’s sign Boas’ sign Blood tests US MRI CT HBS
Signs and symptoms for chronic pancreatitis
Acute pain is NOT resolved itself Nausea Severe vomiting Fatty stool Signs of diabetes mellitus: thirst, polyuria Weight loss Pain increases after eating and drinking
Change of position does NOT relive the pain
Band-like pain
Increased alfa-fetoprotein is found not only in primary liver cancer but also in
Cancer of testicles and ovaries
Metastatic cancer to the liver
Acute pain is NOT resolved itself
Pain increases after eating and drinking
Change in position does NOT relieve the pain
Band-like pain
Chronic pancreatitis
