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Pathophysiology > Final: Ch 30 Hepatobiliary & Exocrine Pancreas Disorders > Flashcards

Final: Ch 30 Hepatobiliary & Exocrine Pancreas Disorders Flashcards

1
Q

liver gross anatomy

A

inferior to diaphragm under ribs - can’t be palpated unless enlarged

arterial blood via hepatic artery, venous blood via portal vein

drained by hepatic vein

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2
Q

the hepatic duct and cystic duct (gallbladder) meet to form which duct

A

the common bile duct –> empties into duodenum

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3
Q

what is the functional unit of the liver

A

liver lobule

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4
Q

liver lobules are organized around a central ___, which drains to the hepatic ____

A

vein, vein

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5
Q

plates of hepatocytes are separated by ________

A

sinusoids

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6
Q

hepatocytes produce ____, which flows to the _____ duct

A

bile, bile

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7
Q

Kupfer cells are what

A

macrophages

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8
Q

metabolic functions of the liver: carbohydrates

A

glycogen storage

gluconeogenesis

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9
Q

metabolic functions of the liver: lipids

A

acetyl-CoA –> ketones (used for energy by other tissues)

acetyl-CoA –> HMG-CoA –> bile salts/cholesterol

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10
Q

most cells metabolize ____ for energy via acetyl-coA

A

fats

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11
Q

cholesterol is stored or exported as _________

A

lipoprotein

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12
Q

metabolic functions of the liver: proteins

A

synthesis - albumin, fibrinogen

use aa for gluconeogenesis

deamination –> ammonia –> urea –> renal excretion

synethesis of nonessential aa

transamination

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13
Q

ammonia is also produced in the ____ by ________

A

gut, bacteria

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14
Q

bile production and flow

A

produced in liver –> duodenum –> emulsify fat

some bile is reabsorbed into portal circulation

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15
Q

how is bilirubin formed

A

hemoglobin –> heme –> biliverdin –> free bilirubin

free bilirubin to liver bound to plasma proteins –> bile

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16
Q

jaundice

A

caused by elevated serum bilirubin

easily seen in eyes (scleral icterus)

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17
Q

prehepatic jaundice

A

RBC destruction (post-transfusion)

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18
Q

intrahepatic jaundice

A

low bilirubin uptake or conjugation by liver

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19
Q

posthepatic jaundice

A

obstructed bile flow (stones)

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20
Q

cholestasis

A

low bile production and flow

high bilirubin and cholesterol in the blood

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21
Q

intrahepatic cholestasis

A

from liver disease or shock

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22
Q

extrahepatic cholestasis

A

duct obstruction

gallstones, pancreatitis, tumor

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23
Q

symptoms of cholestasis

A

pruritus

hyperlipidemia

poor absorption of fat soluble vitamins

high serum alkaline phosphatase

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24
Q

liver function tests

A

direct and indirect bilirubins

elevated enzymes suggest hepatocyte damage

ALT (alanine aminotransferase)

AST (aspartate aminotransferase)

total protein, clotting factors, albumin (low in disease)

imaging/biopsy

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25
Q

viral hepatitis overview

A

liver injury causes necrosis

chronic carrier state also possible with HCV (or HBV)

3 stages

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26
Q

3 stages of viral hepatitis

A

prodromal

icterus

convalescence

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27
Q

prodromal stage

A

general malaise & GI symptoms

fever & chills

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28
Q

icterus stage

A

jaundice

pruritis

liver tenderness

worsening of prodromal symptoms

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29
Q

convalescence stage

A

jaundice and other symptoms disappear

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30
Q

hepatitis A

A

benign and self-limiting

ssRNA virus replicates in liver, excreted in bile

doesn’t cause chronic infection

vaccine available

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31
Q

hep A symptoms, transmission, Ab

A

N/V, malaise, abd pain, jaundice, dark urine

fecal-oral (contaminated water/milk, shellfish)

Ab give immunity and mark infection

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32
Q

hepatitis B

A

dsDNA virus that can produce acute or chronic hepatitis, cirrhosis, or acute hepatic necrosis

transmitted through blood or bodily fluids

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33
Q

hep B Dx, vaccine?

A

viral antigens and Ab measured in blood

vaccine available

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34
Q

hepatitis C

A

ssRNA virus - world’s leading cause of chronic hepatitis, cirrhosis, and liver cancer

spread through drug use/sexual contact/ blood

long incubation period

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35
Q

hep C symptoms, Dx

A

initial symptoms non-specific or asymptomatic

causes jaundice and cirrhosis but not usually acute failure

virus and Ab tests available

36
Q

hepatitis D

A

commonly superimposed on HepB infection

makes HepB infection worse

37
Q

hepatitis E

A

non-enveloped ssRNA virus

transmitted fecal-oral, contaminated water

20 million infections

38
Q

hep E is ____-______ but may develop into _______ hepatitis

A

self-limiting (resolves in 4-6 wks), fulminant hepatitis (acute liver failure)

39
Q

hep E is most prominant where

A

east and south asia

china has vaccine but it’s not available globally

40
Q

$1000 pill for Hep C cure

A

Sovaldi

84k for full treatment

41
Q

chronic viral hepatitis

A

infection persists for 3-6 mnths or more

ALT & virus levels elevated

causes chronic liver disease, cirrhosis, and cancer

from hep B, C, or D

42
Q

Rx for chronic viral hepatitis

A

inferferons and anti-viral drugs

liver transplant

43
Q

primary biliary cirrhosis

A

chronic liver disease - autoimmune destruction in small bile ducts –> liver failure

insidious onset and slow progression

44
Q

Rx for primary biliary cirrhosis

A

symptomatic only until failure then liver transplant

45
Q

secondary biliary cirrhosis

A

from prolonged duct obstruction with gallstones

46
Q

hepatic drug metabolism phase 1

A

chemical modifications by liver enzymes (cytochrome P450)

induced (EtOH) or suppressed (cimetidine H2r blocker)

47
Q

hepatic drug metabolism phase 2

A

conversion of lipid-soluble substances to water soluble form

48
Q

drug-induced liver disease

A

tylenol is hepatotoxic

some drugs are cholestatic - antipsychotics and antibiotics

49
Q

alcohol induced liver disease

A

alcohol absorbed from GI tract including stomach

2 phases of metabolism in hepatocytes

microsomal ethanol-oxidizing system (MEOS) uses cytochrome P450

50
Q

alcohol dehydrogenase

A

uses NAD to make NADH

51
Q

NAD depletion/NADH excess in alcohol induced liver disease

A

lowers gluconeogenesis –> hypoglycemia and less beta-oxidation –> fatty liver

52
Q

are the metabolic end products of alcohol breakdown toxic?

A

yes, acetaldehyde

53
Q

mechanism of damage in alcohol induced liver disease

A

unknown but there are fatty changes

hepatitis and cirrhosis result

cirrhosis compresses/disrupts hepatic vein branches –> portal HTN

54
Q

nonalcoholic fatty liver disease

A

seen w/ insulin resistance and higher liver uptake of FA

Rx: weight loss and avoid alcohol

55
Q

cirrhosis

A

end stage of chronic liver disease

diffuses fibrosis and destruction of vascular and biliary channels

leads to portal HTN, biliary stasis, and liver failure

56
Q

causes of cirrhosis

A

alcohol abuse

viral hepatitis

mineral deposits (hemochormatosis Fe, Wilson disease Cu)

non-EtOH liver disease including biliary obstruction

57
Q

symptoms of cirrhosis

A

weight loss

ascites

hepatomegaly

abd pain

jaundice

58
Q

portal HTN

A

high resistance to blood flow from liver –> high portal pressure

59
Q

pre-hepatic causes of portal HTN

A

portal vein thrombosis or compression (cancer)

60
Q

intra-hepatic causes of portal HTN

A

cirrhosis

61
Q

post-hepatic causes of portal HTN

A

Rt HF

Budd-Chiari syndrome (occlusion of hepatic vein or IVC)

62
Q

complications of portal HTN

A

ascites - high pressure low COP

splenomegaly - less blood

portosystemic shunts - venous collaterals

63
Q

high pressure of portal HTN can cause

A

esophageal varices

dilated veins around umbilicus

reverse flow - toxic to systemic circulation

64
Q

Rx of portal HTN

A

balloon tamponade

reduce GI blood flow w/ endoscopic sclerosis

vessel ligation

drugs

surgical shunt of portal vein blood to systemic circulation

65
Q

liver failure

A

most severe complication of liver disease

decreased clotting factors

lower metabolism (higher function of steroid hormones)

hepatorenal syndrome (renal failure 2ndary to hepatic failure)

66
Q

cause of liver failure

A

encephalopathy - blood bypasses liver and neurotoxins like ammonia buildup

67
Q

Rx for liver failure

A

stop alcohol

prevent infection

limit protein, give carbs

liver transplant

68
Q

2 types of liver cancer

A

primary - hepatocellular carcinoma

metastatic - most common: from colon, breast, of lung

69
Q

risk factors, symptoms for primary liver cancer

A

viral hepatitis

weakness, anorexia, fatigue –> ascites + jaundice

70
Q

Rx of primary liver cancer

A

subtotal hepatectomy

chemo/radiation are palliative

71
Q

cholelithiasis

A

gallstones: 4/5 made of cholesterol, other bile salts/bilirubin

abrupt onset but transient pain

72
Q

predisposing factors for cholelithiasis

A

excess cholesterol in bile - obesity/birth control pill

stasis of bile - liver disease/obstruction

inflammation of gallbladder - high water/bile salt absorption

73
Q

cholecystitis

A

inflammation secondary to obstruction from stones

caused by sepsis, trauma, infection

acute or chronic

74
Q

symptoms of cholecystitis

A

persistent pain

fever

n/v

75
Q

Dx/Rx of cholecystitis

A

ultrasound, CT

surgery

76
Q

choledocholithiasis

A

stones in CBD

can cause sepsis, shock, and pancreatitis

77
Q

acute pancreatitis

A

reversible inflammation caused by activation of pancreatic enzymes outside the cut

trypsinogen -> trypsin –> others activated

pancreas digests itself

78
Q

causes of acute pancreatitis

A

CBD obstruction w/ gallstones –> bile reflux to pancreas

alcohol abuse increases pancreatic secretions

79
Q

symptoms of acute pancreatitis

A

pain

fever

shock

80
Q

acute pancreatitis can cause

A

ATN

ARDS

multiple organ failure

death

81
Q

Dx of acute pancreatitis

A

high serum amylase and lipase

CT

82
Q

Rx of acute pancreatitis

A

NG suctino

pain relief (demerol lowers duct spasms)

NPO

IV fluids

83
Q

chronic pancreatitis

A

caused by alcohol abuse and not reversible

2ndary to chronic duct obstruction

84
Q

Rx of chronic pancreatitis

A

no alcohol

treat gallstones

give pancreatic enzymes

85
Q

pancreatic cancer

A

mostly adenocarcinomas

symptoms from mass and mets

jaundice and pain

86
Q

Dx/Rx of pancreatic cancer

A

Dx: high bilirubin and alk. phos, CT, ultrasound

Rx: palliative

Pathophysiology (24 decks)

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