- intestinal bacteria convert CB to urobilinogen (UBG) - UBG oxidized to urobilin (gives poo color) -recycled 90% to liver, 10% kidney - give pee color

- due to inc in UCB and/or CB - first noticed in sclera - classified based on percentage of CB

- viral hepatitis = most common! - other stuff, defects, cancers, etc

- alcoholic liver disease (most common) - postnecrotic cirrhosis - autoimmune disease - metabolic disease

- most common benign liver tumor - danger for hemorrhage

- benign tumor of liver cells - causes: oral contraceptives and steroids. - if you stop taking the stuff it can get smaller -tendency to rupture during pregnancy

Exam 2 - Liver, Gallbladder, Exocrine pancreas Flashcards by nikolai M

unconjugated bilirubin (UCB)

end product of heme degradation

- lipid soluble -> indirect bilirubin

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Conjugated bilirubin (CB)

UCB combines with albumin in blood
-blah conjugated to glucuronic acid

water soluble -> direct bilirubin

-secreted into bile ducts. stored in gallbladder. enters duodenum

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urobilinogen (UBG)

intestinal bacteria convert CB to urobilinogen (UBG)
UBG oxidized to urobilin (gives poo color)

-recycled 90% to liver, 10% kidney - give pee color

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Jaundice

due to inc in UCB and/or CB
first noticed in sclera
classified based on percentage of CB

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Causes of jaundice

viral hepatitis = most common!

- other stuff, defects, cancers, etc

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Hepatitis classifications and transmission routes

Hep A: oral-fecal, sexual
Hep B: oral-fecal, sexual, blood
Hep C: sexual, blood
Hep D: sexual , blood
Hep E: oral-fecal
**these are caused by a virus

can have autoimmune, neonatal, alcoholic hepatitis

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Viral hepatitis

acute phases:
-prodrone (initial part of infectious disease. liver gets bigger, inc enzymes, and enzymes peak before jaundice

jaundice phase
recovery phase

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Microscopic findings of viral hepatitis

-lymphocytic infiltrate (invade when there is a viral infection)

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Fulminant hepatic failure

-has to include encephalopathy within 8 weeks of liver being screwed up.

causes: 
reye syndrome (liver failure due to ASA)
-wilson disease = cant handle copper in body

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Cirrhosis

irreversible diffuse fibrosis of liver with formation of regenerative nodules

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Cirrhosis causes

alcoholic liver disease (most common)
postnecrotic cirrhosis
autoimmune disease
metabolic disease

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Cirrhosis complications

liver failure
ascites (excess fluid)
hepatorenal syndrome (back up into kidney)
hyperestrinism

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Ascites

tap the belly and see if the fluid moves to the other side

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Primary biliary cirrhosis

cirrhosis due to granulomatous destruction of bile ducts
more common in females
autoimmune

treatment: liver transplant. treat symptoms

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Cavernous hemangioma

most common benign liver tumor

- danger for hemorrhage

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Hepatic cell adenoma

benign tumor of liver cells
causes: oral contraceptives and steroids.
if you stop taking the stuff it can get smaller

-tendency to rupture during pregnancy

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What is the most common liver cancer?

Metastasis***

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Hepatocellular Carcinoma (HCC)

malignant
most common primary liver cancer (came from this organ)

causes: due to Hep B or C. lots of others

gross findings: focal, multifocal, or diffusely infiltrating
Micro findings: presence of bile in neoplastic cells

Lab:-liver enzymes will increase
*radiation/chemo not helpful

Angiosarcoma (in liver)

-caused by exposure to vinyl chloride (plastic pipes) = most common

Cholelithiasis

medical word for gallstone
2 types (cholesterol and pigmented -black or brown)

due to: saturation of bile with cholesterol or decreased bile salts/acids

-risk factors: “Fs”
Female, Forty, fertile, fat

Cholelithiasis complications

cholecystitis (most common)
common bile duct obstruction
gallbladder cancer
acute pancreatitis

Choledocholithiasis

gallstone in the common bile duct

What is Acute cholecystitis? who gets it more?

inflammation of gallbladder
more common in females in 5th and 6th decades
inc incidence in native americans

Acute cholecystitis pathogenesis

Typically

lodging of a stone
everything behind it backs up
over growth of bacteria in area (E.coli)
perforation possible

atypical: CMV in AIDS, volume depletion

Acute cholecystitis clinical findings

-pain in epigastric, RUQ (murphy sign) and it radiates to R arm. L arm pain you think heart. R arm pain you think gallbladder possibly Lab: inc WBC and enzymes imaging: Most common = UltraSound

Chronic cholecystitis

- most common symptomatic disorder of gallbladder | - Cholelithiasis with repeated attacks

Gallbladder cancer

- Adenocarcinoma - elderly women - treat: surgery - very poor prognosis

Porcelain gallbladder

- due to calcification - 50% lead to cancer - Remove it!

Primary sclerosing Cholangitis

- *70% males! - fibrosis of bile duct (in or outside of liver) - genetic predisposition - associated with IBD

Annular pancreas

- embryological buds form ring around duodenum | - results in SBO (small bowel obstruction)

Aberrant pancreatic tissue

Pancreatic tissue is in a different place in body. locations: stomach =most common. duodenum, jejunum, meckel diverticulum

There are variations to the location of the major pancreatic duct. Why is this important?

- major pancreatic duct empties into terminal CBD | - an obstruction could block both depending on the variation

Pancreatitis

inflammation of the pancreas - autodigestion (eats itself) - acute vs chronic

Acute pancreatitis

- **most common cause = alcohol (can be from binge drinking) | - pathogenesis: activation of proenzymes (many ways). releases proteases, lipases, and elastases.

What enzyme causes the proenzymes to be activated in acute pancreatitis?

Trypsin

If someone feels a stabbing pain in their back what it is?

Acute pancreatitis

What are some complications of acute pancreatitis?

-pancreatic necrosis "" pseudocyst "" abscess

Acute pancreatitis Lab stuff

- serum amylase (salavery) - serum lipase (pancreas) -****increase "SIT" serum immunoreactive tyrpsin (decreased SIT in chronic)

What is the treatment for acute pancreatitis?

- NPO = nothing per oral - fluids - pain control - NG tube to suction

Acute pancreatitis: ranson criteria

Prognostic indicator of mortality ``` >7 = 100% death 5-6 = 40% 3-4 = 15% <3 = 1% ```

Chronic pancreatitis

-majority idiopathic Pathogenesis - repeated attacks of acute - *calcified concretions Labs: decreased "SIT"!***

Pancreatic pseudocyst

- collection of digested pancreatic tissue around pancreas - have elevated amylase even if it is under control Treatment: watch it. or if big drain it

Pancreatic cancer

7th or 8th decade -smoking is most common cause Pathogenesis: -gene mutations clin find: virchow node (left supraclavicular), sister mary joseph node (belly button) REMOVE IT! whipple procedure