Hepatobiliary 2 Flashcards
The bile that enters the duodenum is a mixture of both kinds of what?
concentrated and dilute hepatic bile
What is cholestasis?
A “back up in plumbing” when bile secretion is suppressed and backs up into systemic circulation
What can cause cholestasis?
Intrahepatic:
- cirrhosis
- primary sclerosing cholangitis
Extrahepatic:
- stones
- neoplasms
What is a common symptom of cholestasis?
Itching (increased concentrations of bile acids in plasma)
What is acute Cholecystitis?
Inflammation of gallbladder associated with obstruction of ducts from stones, causing a chemical irritation from concentrated bile
Gallbladder distention due to congestion
What is cholelithiasis? What causes it?
gallstones;
too much cholesterol and too little bile salts leads to bile stasis
Most likely causes of gallstones:
- Pregnancy
- malnutrition
- rapid weight loss
- long periods of inactivity
- obesity
- women with multiple pregnancies
- oral contraceptives
When are gallstones symptomatic?
When bile flow is obstructed
Where can gallstones refer pain to?
- right upper abdomen
- back above waist
- right shoulder
- right scapula
- midscapular region
How is hepatitis detected?
viral antigens and antibodies to antigens
How does liver injury occur in viral hepatitis? (2 ways)
- ) Direct cellular damage
2. ) Activation of host immune response
Manifestations of hepatitis:
- ) Asymptomatic infection
- ) acute hepatitis
- ) carrier without disease
- ) carrier with chronic or asymptomatic disease
- ) chronic hepatitis with or without cirrhosis
- ) fulminate with rapid onset of liver failure
Acute hepatitis (A) usually lasts 2-3 weeks with a totally recovery:
9 weeks
Chronic hepatitis (C) is more than 3-6 months duration and is the chief reason for what?
Liver transplant (often reinfected, but progresses slower)
Pancreatitis is a release of enzymes into pancreas or surrounding tissues as a result of:
obstruction, cystic fibrosis, alcohol abuse, or abdominal/surgical trauma
What relieves pancreatitis pain and why?
Leaning forward; takes impingement off celiac plexus
How to treat pancreatitis:
NPO = nothing by mouth NGT = nasogastric tube for gastric decompression and evacuation of secretions TPN = total parenteral nutrition "tube feeding" simple carbs, fats, proteins, into circulation
Treatment of chronic pancreatitis:
low fat diet, enzymes, surgery to relieve obstruction
Liver cancer has a strong link to:
Hep B and cirrhosis
Liver cancer is usually advanced when diagnosed; this means that…
metastatic tumors from liver travel to other organs commonly
Risk factors for pancreatic cancer:
- being african american
- smoking
- high caloric intake
- high fats
- diabetes
- genetics
Why does alcohol damage liver?
consumption produces “acetaldehyde” which is a toxic metabolite which damages the liver
Is fatty liver reversible?
yes! (associated with bingeing, even in healthy people)
What is alcoholic hepatitis?
inflammation and necrosis of liver cells (always serious, can be fatal)
What is cirrhosis?
functional liver tissue replaced by fibrous tissue; disruption of flow of blood and bile through liver, this leads to a loss of cells and then failure!
Most significant impacts of liver failure:
- ) elevated ammonia levels hurting cognition
- ) increased bleeding due to insufficient clotting factors
- ) glucose dysregulation
