Gallbladder Disease and Liver Disease Flashcards
Examine the location of the gallbladder, common bile duct, pancreas, pancreatic duct, and their point of entry into the small intestine.
gallbladder: just under the liver, enters into the small intestine through the cystic duct.
common bile duct: A tube that carries bile from the liver and the gallbladder through the pancreas and enters into the small intestine through the duodenum
pancreas: The pancreas is located behind the stomach in the upper left abdomen. Enters the duodenum through the pancreatic duct.
pancreatic duct: takes juice and liquids from the pancreas into the duodenum
Describe the function of the liver in terms of carbohydrate, protein, and fat metabolism.
carbohydrate metabolism: the liver stores large amounts of glucose as glycogen and can convert it back if blood sugar levels are low. The liver synthesizes glucose from amino acids, glycerol and lactic acid as a means of maintaining glucose during periods of fasting or increased need. The liver also converts carbs to triglycerides for storage in adipose tissue.
protein metabolism: The liver also plays an important role in the metabolism of proteins: liver cells change amino acids in foods so that they can be used to produce energy, or make carbohydrates or fats.
fat metabolism: the liver participates in the oxidation of free fatty acids to keto acids that supply energy for other body functions, synthesis of cholesterol, phospholipids and proteins, and formation of triglycerides from carbs and proteins.
List the major functions of bile and how jaundice occurs. List common causes of jaundice.
the major functions of bile are: emulsifying dietary fats and necessary for the formation of the micelles that transport fatty acids and fat-soluble vitamins to the surface of the intestinal mucosa for absorption.
common causes of jaundice: excessive destruction of red blood cells, impaired uptake of bilirubin by the liver cells, decrease conjugation of bilirubin, obstruction of bile flow in the canaliculi of the hepatic lobules or in the patic production of bilirubin.
Explain lab tests to monitor liver function: AST, ALT, alkaline phosphatase, total bilirubin, albumin.
ALT: ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase.
AST: AST is an enzyme that helps metabolize amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or disease, such as a blocked bile duct, or certain bone diseases.
Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anemia.
Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
Compare hepatitis A, B, C, D, E in terms of source of infection and disease manifestations.
A and B
A: caused by the HAV (RNA virus), benign, self-limited disease. Contracted primarily through the fecal-oral route then it replicates in the liver.
disease manifestations: abrupt onset
fever, malaise, nausea, anorexia, abdominal discomfort, dark urine, jaundice.
B: HBC (DNA virus), can be spread by oral, sexual contact or inoculation with infected blood or serum. manifestations include: abdominal pain, dark urine, fever, joint pain, loss of appetite, Nausea and vomiting, weakness and fatigue, yellowing of your skin and the whites of your eyes (jaundice)
Compare hepatitis A, B, C, D, E in terms of source of infection and disease manifestations.
C: single stranded RNA virus, transmission through contaminated blood (needle-stick injuries) and high risk sexual behavior (multiple partners)
disease manifestations: asymptomatic, jaundice is rare, most people will go on to have chronic hepatitis.
D: incomplete virus, requires HBV in order to replicate. Infection depends on contaminant infection with HBV. infection comes from same factors as HBV, with injecting drug users being at high risk. HBV carriers are also high risk. manifestations are similar to HBV.
E: unenvoloped single stranded RNA virus. fecal-oral transmission, manifestations similar to hepatitis A.
Define cirrhosis, alcoholic hepatitis, and nonalcoholic fatty liver disease
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.
Alcoholic Hepatitis: alcoholic hepatitis is inflammation of the liver caused by drinking alcohol.
Nonalcoholic fatty liver disease: the accumulation of liver fat in people who drink little or no alcohol.
Define portal hypertension and esophageal varices.
portal hypertension: Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.
esophageal varices: Esophageal varices are enlarged veins in the esophagus. They’re often due to obstructed blood flow through the portal vein, which carries blood from the intestine, pancreas and spleen to the liver.
Define ascites and paracentesis, and list treatment measures.
Ascites: abdominal swelling caused by accumulation of fluid, most often related to liver disease.
paracentesis: Paracentesis is a procedure that removes fluid (peritoneal fluid) from the abdomen through a slender needle.
treatment measures for ascites: Sodium restriction (20-30 mEq/d) and diuretic therapy constitute the standard medical management. Therapeutic paracentesis may be performed in patients who require rapid symptomatic relief for refractory or tense ascites.
Describe clinical manifestations of cirrhosis and manifestations of liver failure.
liver failure: hypoglycemic events, edema and ascites, bleeding, fatty stools, jaundice, gynecomastia/testicular atrophy, menstrual irregularities, encephalopathy.
cirrhosis: weight loss, weakness, anorexia, diarrhea, hepatomegaly, jaundice, abdominal pain (RUQ)
State the function of the gallbladder in nutrient digestion.
Your gallbladder is part of your digestive system. Its main function is to store bile. Bile helps your digestive system break down fats.
List risk factors in gallstone formation and cholecystitis.
gallstone
risk factors: women, obesity, multiple pregnancies, oral contraceptives, drugs that lower serum cholesterol levels, malabsorption disorders, inflammation of the gallbladder.
cholecystitis
risk factors: gallstones, spesis, severe trauma, or infection of the gallbladder.
Describe treatment options for acute cholecystitis.
removal of the gallbladder by laparoscopic cholecystectomy.
For acute pancreatitis, explain causes, clinical signs, and treatment.
causes: gallstones, or alcohol abuse.
clinical signs: abdominal pain (epigastric and can radiate to back, chest, or flank areas), fever, tachycardia, hypotension, severe abdominal tenderness, respiratory distress, abdominal distention.
tx: hospitalization if severes, pain relief, “put the pancreas to rest”–>by withholding food and fluids, restoration of lost plasma volume. gastric suction, IV fluids and electrolytes. IV colloid solutions to replace fluid blocked.
For pancreatic cancer, list risk factors, clinical manifestations, and treatment. Explain the poor prognosis.
risk factors: age, smoking, alcohol, obesity, diabetes mellitus, male gender, chronic pancreatitis, hereditary factors.
clinical manifestations: pain, jaundice, weight loss, sometimes DVT.
Tx: surgical resection if tumor is localized, radiation therapy if localized by not resectable. Chemo is being investigated.
poor prognosis–why?
This is because far more people are diagnosed as stage IV when the disease has metastasized.
