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Advanced Pathology > Hepatobiliary and Exocrine Pancreas Disorders- Notes from Slideshow (Quiz 4) > Flashcards

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
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2
Q

Largest visceral organ in body

A

Liver

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3
Q

How much does the adult liver approximately weigh?

A

1.3 kg (3 lb)

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4
Q

lbs to kg conversion

A

1 lb = .45…..kg

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5
Q

Where is the liver located?

A
  • below diaphragm

- occupies much of R hypochondrium (RLQ)

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6
Q

Where is the R hypochondrium?

A

RLQ

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7
Q

Anatomical division of the liver

A
  • R large lobe
  • L large lobe
  • Caudate small lobe
  • Quadrate small lobe
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8
Q

Liver blood flow anatomy

A
  • hepatic portal vein
  • hepatic veins
  • hepatic artery
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9
Q

Liver accessory organs

A
  • gallbladder

- exocrine pancreas

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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
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11
Q

Where does the portal vein connect to?

A

from GI tract to the liver

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12
Q

Liver and Pancreas Function

A

Produce digestive secretions

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13
Q

Liver Functions

A
  • Synthesize
  • Metabolize
  • Degrade, eliminate, filter
  • Storage
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14
Q

Liver Functions: Synthesize

A
  • glucose
  • plasma proteins
  • blood clotting factors
  • bile salts
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15
Q

Liver Functions: Metabolize

A
  • carbs
  • protein
  • fat
  • steroid hormones
  • drugs
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16
Q

Liver Functions: Degrade, eliminate and filter

A
  • drugs
  • toxic drug byproducts
  • hormones
  • blood
  • bacteria
  • bilirubin
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17
Q

Liver Functions: Storage

A
  • minerals
  • vitamins
  • sugar
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18
Q

Function of Endocrine Pancreas

A

Supplies:

  • insulin
  • glucagon
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19
Q

Function of bile

A
  • digest fats (lipids and triglycerides)

- absorb vitamins (A, D, E, K)

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20
Q

Approximately how much bile does the liver produce

A

500-600 mL daily

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21
Q

What color is bile

A

yellow-green

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22
Q

Where is bile stored? where is it released to?

A
  • gall bladder

- small intestine

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23
Q

Condition in which the flow of bile from the liver stops or slows.

A

Cholestasis

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24
Q

Where does the bile stop flowing through in Cholestasis?

A

intrahepatic canaliculi

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25
Q

Cholestasis causes a reduction of secretion in what?

A
  • water
  • bilirubin
  • bile acids
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26
Q

Inflammatory condition of the liver

A

hepatitis

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27
Q

What causes Hepatitis?

A
  • autoimmune disorders
  • reactions to drugs/toxins
  • infectious disorders
  • hepatotropic viruses
  • direct cell injury
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28
Q

What are the infectious disorders that cause hepatitis?

A
  • malaria
  • infectious mono
  • salmonellosis
  • amebiasis
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29
Q

What do hepatotropic viruses primarily affect?

A

hepatocytes

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30
Q

What are liver cells called

A

hepatocytes

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31
Q

What are the known hepatotropic viruses

A
  • Hepatitis A virus (HAV)
  • Hepatitis B virus (HBV)
  • Hepatitis B–associated delta virus (HDV)
  • Hepatitis C virus (HCV)
  • Hepatitis E virus (HEV)
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32
Q

Anatomy of an ABNORMAL liver

A
  • liver nodules

- fatty deposits

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33
Q

Fibrosis replacement of hepatic tissue

A

Cirrhosis

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34
Q

Complication of Cirrhosis

A
  • loss of liver function

- portal HTN

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35
Q
  • Weight loss
  • Weakness
  • Anorexia
  • Diarrhea or constipation
  • Hepatomegaly
  • Jaundice
  • Abdominal pain
A

Symptoms of Cirrhosis

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36
Q

Symptoms of Cirrhosis

A
  • Weight loss
  • Weakness
  • Anorexia
  • Diarrhea or constipation
  • Hepatomegaly
  • Jaundice
  • Abdominal pain
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37
Q

Why is weight loss often masked in Cirrhosis pts?

A

Ascites

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38
Q

Carries blood from the digestive organs to the liver

A

Portal vein

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39
Q

An increase in the pressure within the portal vein

A

portal HTN

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40
Q

Pathophysiology of Cirrhosis and Portal HTN

A
  • Destruction of sinusoidal architecture
  • causes scars and nodules in liver
  • increases resistance in veins
  • portal HTN
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41
Q

Complications and Symptoms of portal HTN

A
  • Ascites
  • Esophageal varices
  • Splenomegaly
  • Portosystemic Shunts
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42
Q

An abnormal vein connecting the blood supply returning from the intestines to the vein returning blood to the heart, bypassing the liver

A

Portosystemic Shunts

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43
Q

Distensible, pear-shaped, muscular sac

A

Gall bladder

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44
Q

Where is the gallbladder located?

A

ventral surface of liver

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45
Q

What are the layers of the gallbladder? What is each layer made of?

A
  • Outer: serous peritoneal
  • Middle: smooth muscle
  • Inner: mucosal
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46
Q

What is special about the inner layer of the gallbladder?

A

continuous lining from gallbladder into the bile duct

47
Q

What is the function of the Gallbladder?

A

Store and concentrate bile

48
Q

Normal anatomy of the hepatobiliary system

A
  • gallbladder
  • left hepatic duct
  • right hepatic duct
  • common hepatic duct
  • cystic duct
  • common bile duct
  • pancreas
  • pancreatic duct
  • hepatopancreatic ampulla
49
Q

The left and right hepatic duct come together to form what?

A

common hepatic duct

50
Q

What does the cystic duct do?

A

extends to gall bladder

51
Q

The common hepatic duct and cystic duct form what?

A

common bile duct

52
Q

Disorders of the Biliary System

A
  • Cholelithiasis
  • Choledocholithiasis
  • Cholecystitis
  • Cholangitis
  • Cancer of the Gallbladder
53
Q

Chole

A

gallbladder

54
Q

Doco

A

Duct

55
Q

Lithiasis

A

Stone

56
Q

Itis

A

Inflammation

57
Q

Cholelithiasis and Choledocholithiasis

A

Gallstones

58
Q

What is the difference between Cholelithiasis and Choledocholithiasis?

A

Cholelithiasis: stones found in the biliary tract-usually the gallbladder

Choledocholithiasis: stones found in the common bile duct

59
Q

Where do stones in Choledocholithiasis USUALLY form?

A

gallbladder

60
Q

Where do stones in Choledocholithiasis SOMETIMES form?

A

spontaneously in the duct

61
Q

If a pt has had a cholecystectomy can they still get Choledocholithiasis?

A

yes

62
Q

What are the stones that spontaneously form in the duct called?

A

pigment stones

63
Q

Choledocholithiasis includes the same risk factors and epidemiology as what disorder?

A

Cholelithiasis

64
Q

When does risk of Choledocholithiasis increase?

A

With age

65
Q

Inflammation of gallbladder

A

Cholecystitis

66
Q

What causes Cholecystitis?

A

Bacterial growth

67
Q

What types of bacteria cause Cholecystitis ?

A
  • E. Coli
  • Enterococci
  • Bacteroides fragilis
  • Clostridium
68
Q

Symptoms of Cholecystitis

A
  • sometimes no symptoms

- pain

69
Q

Pathophysiology of Cholecystitis

A
  • bacteria infection
  • inflammation of peritoneum
  • increased pressure
70
Q

Where is Cholecystitis pain felt?

A
  • midepigastric region
  • RUQ
  • right scapula
  • shoulders
71
Q

Why does Cholecystitis cause pain?

A

inflammation and pressure

72
Q

Where is Cholecystitis tenderness felt?

A

abdominal

73
Q

Why does Cholecystitis cause tenderness?

A

rebound tenderness resulting from inflamed peritoneum

74
Q

Inflammation of common bile duct

A

Cholangitis

75
Q

What causes Cholangitis

A

It is a complication of choledolithiasis

76
Q

hardened deposits of bile that can form in your gallbladder

A

Gallstones

77
Q

Pathophysiology of bile movement

A
  • Food enters intestine
  • Gallbladder contracts
  • Bile sphincter relaxes
  • Bile stored in gallbladder moves into duodenum
78
Q

Most common reasons gallstones form

A
  • Abnormalities in composition of bile

- Stasis of bile

79
Q

What is usually increased in bile in order to cause gallstones?

A

Cholesterol

80
Q

What are cholesterol stones associated with?

A

obesity

81
Q

Normal anatomy of pancreatic secretion sites- be aware of locations

A
  • Islet of Langerhans
  • pancreatic acini
  • ductules
  • ducts
82
Q

What are the different secretions of the pancreas??

A
  • peptidases
  • lipases
  • amylases
  • sodium bicarbonate
  • trypsin inhibitor
83
Q

What do ductules of the pancreas do?

A

Each one releases one type of pancreatic secretion

84
Q

What are amylase and lipase

A

proteolytic enzymes

85
Q

What do amylase and lipase do?

A

break down dietary proteins

86
Q

What does amylase break down?

A

Starch

87
Q

What does lipase break down?

A

Neutral fats

88
Q

How does lipase break down neutral fats?

A

Hydrolyzes them into glycerol and fatty acids

89
Q

What happens to pancreatic enzymes when secreted?

A

They are secreted in inactive form

90
Q

When do pancreatic enzymes become active?

A

Once they reach the intestine

91
Q

Inflammation of the pancreas

A

Pancreatitis

92
Q

Types of Pancreatitis

A
  • Acute

- Chronic

93
Q

What is the difference between acute and chronic pancreatitis?

A

Acute: reversible
Chronic: irreversible

94
Q

Major causes of acute AND chronic Pancreatitis

A
  • Heavy alcohol use
  • Gallstones
  • Other
95
Q

What percentage of pts with acute OR chronic Pancreatitis got it from Heavy alcohol use?

A

40%

96
Q

What percentage of pts with acute OR chronic Pancreatitis got it from Gallstones?

A

40%

97
Q

What percentage of pts with acute OR chronic Pancreatitis got it from Other reasons?

A

20%

98
Q
  • abdominal/surgical trauma
  • medications
  • infections
  • tumors
  • genetic/anatomic variants
  • hyperlipidemia (high triglyceride)
  • high calcium levels
  • hyperparathyroidism
A

What other reasons can people get acute OR chronic Pancreatitis? (Other than Heavy alcohol use and Gallstones)

99
Q

What other reasons can people get acute OR chronic Pancreatitis? (Other than Heavy alcohol use and Gallstones)

A
  • abdominal/surgical trauma
  • medications
  • infections
  • tumors
  • genetic/anatomic variants
  • hyperlipidemia (high triglyceride)
  • high calcium levels
  • hyperparathyroidism
100
Q

Which infections more commonly cause OR chronic acute pancreatitis?

A

viral

101
Q

Which medications can cause acute OR chronic pancreatitis?

A
  • steroids

- thiazide diuretics

102
Q
  • 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
A

Symptoms of acute pancreatitis

103
Q

Symptoms of acute pancreatitis

A
  • 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
Q

Symptoms of chronic pancreatitis

A
  • Upper abdominal pain
  • Weight loss
  • Low lipase levels
  • Steatorrhea
  • Low levels of fat-soluble vitamins
105
Q

Excretion of abnormal quantities of fat with the feces

A

Steatorrhea

106
Q

Characteristic of Steatorrhea

A

Smelly/ oily stool

107
Q

What does inflammation in chronic pancreatitis consist of?

A
  • neutrophils

- edema

108
Q

What does inflammation in chronic pancreatitis consist of?

A
  • monocyte

- lymphocyte

109
Q

Result of acute pancreatitis

A

Full recovery in most pts

110
Q

Increased activation of pancreatic enzymes in acute pancreatitis cause what to happen?

A

Autodigestion

111
Q

What characteristics are associated with acute pancreatitis?

A
  • hemorrhagic fat necrosis
  • calcium soaps
  • pseudocysts
112
Q

Fluid and debris that collects in cystlike pockets in the pancreas.

A

Pseudocysts

113
Q

Complications of Pseudocysts

A

If ruptured can cause internal bleeding and infection.

114
Q

Complication of chronic pancreatitis

A

fibrosis then calcification of the parenchyma

Advanced Pathology (27 decks)

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