Hepatic, Pancreatic & Biliary- PT 1 Flashcards
Location of the liver
Just below the respiratory diaphragm Predominantly on the right side (head) with a portion crossing mid line (tail)
Most superior part of liver
Dome of the right lobe
True/False- The liver is a large organ that spans many vertebral levels
True
Where is the peak of the dome of liver located during expiration?
At around T8-T9
Posterior location of the liver
approximately T9 to L1 at mid line which varies in persons. Moves up a level or two with inhalation Moves down with exhalation
Location of the fundus of gallbladder (head)
Below the edge of the liver, in contact with the anterior abdominal wall at the tip of the 9th right coastal cartilage
Functions of the Liver – >500 separate functions, but most importantly:
- Regulates blood composition, including the amounts of glucose (sugar), protein, and fat that enter the bloodstream.
- Removes bilirubin and other toxins from the blood.
- Processes most of the nutrients absorbed by the intestines during digestion and converts those nutrients into forms that can be used by the body.
- Stores nutrients- Vitamin A, Iron, and other minerals.
- Makes cholesterol, vitamin A, substances that help blood clot, and certain proteins.
- Sole source of albumin and other plasma proteins
- Filters all blood from the GI tract (“first pass”) – catches Drugs, Chemicals, Toxins, Bile Acids
What is Bile?
greenish/brown fluid, made from cholesterol in liver, stored in gall bladder, which breaks down fats into fatty acids in the GI tract
What is Bilirubin?
A by-product of the breakdown of red blood cells.
Function of the Gall bladder
Produce, Transport, and Store Bile
True/False- You cannot live without your gall bladder?
False- You can live without it, especially if the bile starts turning into stones that clog the ducts
Exocrine functions of the Pancreas
Exocrine cells produce digestive enzymes to help with the digestion of food. “These exocrine cells release their enzymes into a series of progressively larger tubes (called ducts) that eventually join together to form the main pancreatic duct. The main pancreatic duct runs the length of the pancreas and drains the fluid produced by the exocrine cells into the duodenum, the first part of the small bowel.”
Location of the Pancreas
Behind the stomach, anterior to L1-L3 vertebral bodies. It is about 6 inches long, wide at the head then tapered through the body to the other end (tail)
Parts of the gall bladder
Fundus Body Infundibulum Neck
Cholelithiasis
- Presence or formation of gallstones.
- Can be asymptomatic,
- Detected incidentally during medical imaging
- Problems arise if a stone leaves the gallbladder and causes obstruction somewhere else in the biliary system
Cholecystisis
Inflammation of gallbladder Occurs when the gallstone enters the cystic duct and becomes lodged there.
Obstruction of either the hepatic or common bile duct by a stone or spasm results in:
- Blockage of the bile from exiting the liver where it is formed.
- Jaundice is the first symptom If an infection develops and backs up into the liver, a condition called Cholangitis can occur- potentially life threatening condition.
Cholangitis
An infection that develops when bile is backed up inside of the liver- potentially life threatening condition.
Hepatic &; Biliary S&S (all)
Most acute conditions include: Hepatitis, Drug-induced Hepatitis, and Ingestion of Hepatotoxins
Pain referral patterns RiMS -
- Right shoulder regions,
- Mid back, and
- Scapular
Skin changes – jaundice, when bilirubin 5-6 mg/dL; may see in sclera of eye first (bilirubin 2-3 mg/dL)
Hepatic &; Biliary S&S:- Most acute conditions include: (3)
- Hepatitis
- Drug-induced Hepatitis, and
- Ingestion of Hepatotoxins
Hepatic & Biliary S&S:- Pain referral patterns (RiMS) -
- Right shoulder regions
- Mid back, and
- Scapular
Hepatic & Biliary S&S:- Skin changes
Jaundice, when bilirubin 5-6 mg/dL; may see in sclera of eye first (bilirubin 2-3 mg/dL)
Primary pain patterns from the liver, gallbladder, and common bile duct.
- Presents typically in mid epigastrium or right upper quadrant of the abdomen
- Innervation of the liver and biliary system is through the autonomic nervous system from T5-T11
- Referred pain from the liver occurs in the thoracic spine from approx. T7-T10 and/or to the right of mid line, possibly affecting the R shoulder (R phrenic nerve)
- Referred pain from the gallbladder can affect the R shoulder by the same mechanism The gallbladder can also refer pain to the R inter scapular (T4 or T5 to T8) or R sub scapular area
Innervation of the liver and biliary system
Through the autonomic nervous system from T5-T11
