Hepatobiliary Disease Flashcards
liver functions
BG regulation, digestion, endocrine, hematologic, excretory
jaundice
excess bilirubin in blood
prehepatic: hemolytic anemia
hepatic jaundice: liver dysfunction, viral hepatitis, drugs, cirrhosis
post-hepatic: biliary obstruction, gallstones, pancreatic cancer
Fatty liver disease
steatosis: reversible fat accumulation in hepatocytes
RF: ETOH, DM, obesity, high TG
Cirrhosis
patterned fibrosis of the entire liver with nodules + dense fibrous tissue that is irreversible and can lead to variable results (portal HTN or decreased liver function)
causes of cirrhosis
HCV, Alcohol Liver Disease, Both, Cryptogenic Cirrhosis (NAFLD risk factors)
portal HTN
decreased hepatic blood flow, congested GI drainage, splenomegaly
anorexia, varices, ascites
ascites
more than 500 ml of fluid in peritoneal cavity from the blood (most common complication of cirrhosis)
indicates advanced liver disease
increases hydrostatic pressure and decreases oncotic pressure
hepatic failure
80-90% loss of liver function
jaundice, portal HTN, Ascites, Fetor Hepaticus (breath), hypoalbuminemuria, hypoglycemia, hyperammoniumuria, bleeding disorders
M: gynecomastia, impotence, testes atrophy, female hair
F: irregular menses, palmar erythema, spider angiomas
causes of hepatic failure
chronic liver disease (ETOH or hepatitis), hepatic necrosis from Fulminant Viral Hepatitis, hepatic dysfunction without necrosis from pregnancy, tetracycline, Reyes syndrome
Fulminant Viral Hepatic Failure
rapid progression to hepatic failure and encephalopathy (weeks)
most commonly caused by APAP (46%)
effects of alcohol liver injury
direct cell toxicity, toxic metabolic products (ALDH), and altering lipid metabolism
inflammation, fat storage, collagen synthesis, neutrophils initiation
Acute Viral Hepatitis
symptomatic pre jaundice: malaise, fatigue, N, anorexia
symptomatic jaundice: symptoms fade
convalescence: jaundice fades, infectivity declines, antibodies found in blood
carrier in C > B
HAV
oral-fecal contamination
HBV and HCV
needle stick or sexually transmitted
HDV
co-infection with HBV
HEV
oral-fecal contamination
chronic hepatitis
dx with liver biopsy
enlarged tender liver, splenomegaly and red palms and spider angiomas
reyes syndrome
very rare fatty liver and encephalopathy in children due to aspirin + viral infection in children under 15 years old
hepatomegaly + hypoglycemia (stupor, coma, vomit, convulsions)
Tx: infusions of glucose, plasma, mannitol
hepatocellular carcinoma
usually metastatic cancer from colon, lungs, breast
Alpha-Fetoprotein (70% cases)
hepatolenticular degeneration
copper excretion dysfunction + toxic accumulation of copper in liver, brain, etc
Autosomal Recessive Disease
Low serum ceruloplasm (transporter)
Leads to disruption of neurotransmission and Kayser Fleischer Rings (deposits in cornea)
gallbladder
located below the liver + concentrates/stores bile which emulsifies fat in food
stimulated by fat in duodenum
gallstones
supersaturated bile from stomach contents or physical dysfunctions (75% is cholesterol issue)
RF: high estrogen, obesity, over 40 years old, comorbidities (DM, cirrhosis)
Gallbladder attack: blocks the exit of bile duct and leads to spasm
pancreas
exocrine products to duodenum: proteases, amylase, lipase, protease inhibitor
Endocrine products to blood: insulin + glucagon
pancreatic disease
usually exocrine component affected
digestive function de to premature activation of PI or obstruction of bile duct
pancreatic malignancies
usually asymptomatic for years but because it is isolated organ, it grows undetected
80% mortality rate
pancreatitis
bleeding, tissue damage, infection, blood-borne distribution of digestive enzymes
Acute: usually resolves + 50% related to gallstones
Chronic: progressive destruction of pancreas + 60% related to ETOH
