Hepatobiliary and Exocrine Pancreas Disorders- Notes from Slideshow (Quiz 4) Flashcards
1
Q
Normal anatomy of the hepatobiliary and exocrine system- be aware of where these are
A
- bile ducts
- liver
- gall bladder
- duodenum
- pancreas
- main pancreatic duct
- pancreatic ducts
- common bile duct
2
Q
Largest visceral organ in body
A
Liver
3
Q
How much does the adult liver approximately weigh?
A
1.3 kg (3 lb)
4
Q
lbs to kg conversion
A
1 lb = .45…..kg
5
Q
Where is the liver located?
A
- below diaphragm
- occupies much of R hypochondrium (RLQ)
6
Q
Where is the R hypochondrium?
A
RLQ
7
Q
Anatomical division of the liver
A
- R large lobe
- L large lobe
- Caudate small lobe
- Quadrate small lobe
8
Q
Liver blood flow anatomy
A
- hepatic portal vein
- hepatic veins
- hepatic artery
9
Q
Liver accessory organs
A
- gallbladder
- exocrine pancreas
10
Q
Normal Liver anatomy- be aware of where these are
A
- right lobe
- left lobe
- falciform ligament
- gallbladder
- common bile duct
- teres ligament
- inferior vena cava
- aorta
- left triangular ligament
- fissure for teres ligament
- proper hepatic artery
- quadrate lobe
- portal vein
- caudate lobe
- caudate process
- hepatic veins
- coronary ligament
- right triangular ligament
11
Q
Where does the portal vein connect to?
A
from GI tract to the liver
12
Q
Liver and Pancreas Function
A
Produce digestive secretions
13
Q
Liver Functions
A
- Synthesize
- Metabolize
- Degrade, eliminate, filter
- Storage
14
Q
Liver Functions: Synthesize
A
- glucose
- plasma proteins
- blood clotting factors
- bile salts
15
Q
Liver Functions: Metabolize
A
- carbs
- protein
- fat
- steroid hormones
- drugs
16
Q
Liver Functions: Degrade, eliminate and filter
A
- drugs
- toxic drug byproducts
- hormones
- blood
- bacteria
- bilirubin
17
Q
Liver Functions: Storage
A
- minerals
- vitamins
- sugar
18
Q
Function of Endocrine Pancreas
A
Supplies:
- insulin
- glucagon
19
Q
Function of bile
A
- digest fats (lipids and triglycerides)
- absorb vitamins (A, D, E, K)
20
Q
Approximately how much bile does the liver produce
A
500-600 mL daily
21
Q
What color is bile
A
yellow-green
22
Q
Where is bile stored? where is it released to?
A
- gall bladder
- small intestine
23
Q
Condition in which the flow of bile from the liver stops or slows.
A
Cholestasis
24
Q
Where does the bile stop flowing through in Cholestasis?
A
intrahepatic canaliculi
25
Cholestasis causes a reduction of secretion in what?
- water
- bilirubin
- bile acids
26
Inflammatory condition of the liver
hepatitis
27
What causes Hepatitis?
- autoimmune disorders
- reactions to drugs/toxins
- infectious disorders
- hepatotropic viruses
- direct cell injury
28
What are the infectious disorders that cause hepatitis?
- malaria
- infectious mono
- salmonellosis
- amebiasis
29
What do hepatotropic viruses primarily affect?
hepatocytes
30
What are liver cells called
hepatocytes
31
What are the known hepatotropic viruses
- Hepatitis A virus (HAV)
- Hepatitis B virus (HBV)
- Hepatitis B–associated delta virus (HDV)
- Hepatitis C virus (HCV)
- Hepatitis E virus (HEV)
32
Anatomy of an ABNORMAL liver
- liver nodules
| - fatty deposits
33
Fibrosis replacement of hepatic tissue
Cirrhosis
34
Complication of Cirrhosis
- loss of liver function
| - portal HTN
35
- Weight loss
- Weakness
- Anorexia
- Diarrhea or constipation
- Hepatomegaly
- Jaundice
- Abdominal pain
Symptoms of Cirrhosis
36
Symptoms of Cirrhosis
- Weight loss
- Weakness
- Anorexia
- Diarrhea or constipation
- Hepatomegaly
- Jaundice
- Abdominal pain
37
Why is weight loss often masked in Cirrhosis pts?
Ascites
38
Carries blood from the digestive organs to the liver
Portal vein
39
An increase in the pressure within the portal vein
portal HTN
40
Pathophysiology of Cirrhosis and Portal HTN
- Destruction of sinusoidal architecture
- causes scars and nodules in liver
- increases resistance in veins
- portal HTN
41
Complications and Symptoms of portal HTN
- Ascites
- Esophageal varices
- Splenomegaly
- Portosystemic Shunts
42
An abnormal vein connecting the blood supply returning from the intestines to the vein returning blood to the heart, bypassing the liver
Portosystemic Shunts
43
Distensible, pear-shaped, muscular sac
Gall bladder
44
Where is the gallbladder located?
ventral surface of liver
45
What are the layers of the gallbladder? What is each layer made of?
- Outer: serous peritoneal
- Middle: smooth muscle
- Inner: mucosal
46
What is special about the inner layer of the gallbladder?
continuous lining from gallbladder into the bile duct
47
What is the function of the Gallbladder?
Store and concentrate bile
48
Normal anatomy of the hepatobiliary system
- gallbladder
- left hepatic duct
- right hepatic duct
- common hepatic duct
- cystic duct
- common bile duct
- pancreas
- pancreatic duct
- hepatopancreatic ampulla
49
The left and right hepatic duct come together to form what?
common hepatic duct
50
What does the cystic duct do?
extends to gall bladder
51
The common hepatic duct and cystic duct form what?
common bile duct
52
Disorders of the Biliary System
- Cholelithiasis
- Choledocholithiasis
- Cholecystitis
- Cholangitis
- Cancer of the Gallbladder
53
Chole
gallbladder
54
Doco
Duct
55
Lithiasis
Stone
56
Itis
Inflammation
57
Cholelithiasis and Choledocholithiasis
Gallstones
58
What is the difference between Cholelithiasis and Choledocholithiasis?
Cholelithiasis: stones found in the biliary tract-usually the gallbladder
Choledocholithiasis: stones found in the common bile duct
59
Where do stones in Choledocholithiasis USUALLY form?
gallbladder
60
Where do stones in Choledocholithiasis SOMETIMES form?
spontaneously in the duct
61
If a pt has had a cholecystectomy can they still get Choledocholithiasis?
yes
62
What are the stones that spontaneously form in the duct called?
pigment stones
63
Choledocholithiasis includes the same risk factors and epidemiology as what disorder?
Cholelithiasis
64
When does risk of Choledocholithiasis increase?
With age
65
Inflammation of gallbladder
Cholecystitis
66
What causes Cholecystitis?
Bacterial growth
67
What types of bacteria cause Cholecystitis ?
- E. Coli
- Enterococci
- Bacteroides fragilis
- Clostridium
68
Symptoms of Cholecystitis
- sometimes no symptoms
| - pain
69
Pathophysiology of Cholecystitis
- bacteria infection
- inflammation of peritoneum
- increased pressure
70
Where is Cholecystitis pain felt?
- midepigastric region
- RUQ
- right scapula
- shoulders
71
Why does Cholecystitis cause pain?
inflammation and pressure
72
Where is Cholecystitis tenderness felt?
abdominal
73
Why does Cholecystitis cause tenderness?
rebound tenderness resulting from inflamed peritoneum
74
Inflammation of common bile duct
Cholangitis
75
What causes Cholangitis
It is a complication of choledolithiasis
76
hardened deposits of bile that can form in your gallbladder
Gallstones
77
Pathophysiology of bile movement
- Food enters intestine
- Gallbladder contracts
- Bile sphincter relaxes
- Bile stored in gallbladder moves into duodenum
78
Most common reasons gallstones form
- Abnormalities in composition of bile
| - Stasis of bile
79
What is usually increased in bile in order to cause gallstones?
Cholesterol
80
What are cholesterol stones associated with?
obesity
81
Normal anatomy of pancreatic secretion sites- be aware of locations
- Islet of Langerhans
- pancreatic acini
- ductules
- ducts
82
What are the different secretions of the pancreas??
- peptidases
- lipases
- amylases
- sodium bicarbonate
- trypsin inhibitor
83
What do ductules of the pancreas do?
Each one releases one type of pancreatic secretion
84
What are amylase and lipase
proteolytic enzymes
85
What do amylase and lipase do?
break down dietary proteins
86
What does amylase break down?
Starch
87
What does lipase break down?
Neutral fats
88
How does lipase break down neutral fats?
Hydrolyzes them into glycerol and fatty acids
89
What happens to pancreatic enzymes when secreted?
They are secreted in inactive form
90
When do pancreatic enzymes become active?
Once they reach the intestine
91
Inflammation of the pancreas
Pancreatitis
92
Types of Pancreatitis
- Acute
| - Chronic
93
What is the difference between acute and chronic pancreatitis?
Acute: reversible
Chronic: irreversible
94
Major causes of acute AND chronic Pancreatitis
- Heavy alcohol use
- Gallstones
- Other
95
What percentage of pts with acute OR chronic Pancreatitis got it from Heavy alcohol use?
40%
96
What percentage of pts with acute OR chronic Pancreatitis got it from Gallstones?
40%
97
What percentage of pts with acute OR chronic Pancreatitis got it from Other reasons?
20%
98
- abdominal/surgical trauma
- medications
- infections
- tumors
- genetic/anatomic variants
- hyperlipidemia (high triglyceride)
- high calcium levels
- hyperparathyroidism
What other reasons can people get acute OR chronic Pancreatitis? (Other than Heavy alcohol use and Gallstones)
99
What other reasons can people get acute OR chronic Pancreatitis? (Other than Heavy alcohol use and Gallstones)
- abdominal/surgical trauma
- medications
- infections
- tumors
- genetic/anatomic variants
- hyperlipidemia (high triglyceride)
- high calcium levels
- hyperparathyroidism
100
Which infections more commonly cause OR chronic acute pancreatitis?
viral
101
Which medications can cause acute OR chronic pancreatitis?
- steroids
| - thiazide diuretics
102
- Acute/severe upper abdominal pain that radiates to back and worsens when eating
- N&V
- Elevated pancreatic enzymes (amylase and lipase)
- Fever
- Increased HR
- Abdomen tenderness
Symptoms of acute pancreatitis
103
Symptoms of acute pancreatitis
- Acute/severe upper abdominal pain that radiates to back and worsens when eating
- N&V
- Elevated pancreatic enzymes (amylase and lipase)
- Fever
- Increased HR
- Abdomen tenderness
104
Symptoms of chronic pancreatitis
- Upper abdominal pain
- Weight loss
- Low lipase levels
- Steatorrhea
- Low levels of fat-soluble vitamins
105
Excretion of abnormal quantities of fat with the feces
Steatorrhea
106
Characteristic of Steatorrhea
Smelly/ oily stool
107
What does inflammation in chronic pancreatitis consist of?
- neutrophils
| - edema
108
What does inflammation in chronic pancreatitis consist of?
- monocyte
| - lymphocyte
109
Result of acute pancreatitis
Full recovery in most pts
110
Increased activation of pancreatic enzymes in acute pancreatitis cause what to happen?
Autodigestion
111
What characteristics are associated with acute pancreatitis?
- hemorrhagic fat necrosis
- calcium soaps
- pseudocysts
112
Fluid and debris that collects in cystlike pockets in the pancreas.
Pseudocysts
113
Complications of Pseudocysts
If ruptured can cause internal bleeding and infection.
114
Complication of chronic pancreatitis
fibrosis then calcification of the parenchyma
