HLTH 2501: disorders of the liver and pancreas Flashcards
what is the gallbladder commonly affected by?
formation of gallstones
colelithias
the formation of gallstones
gallstones
mass of solid material or calculi that form in the bile
cholecystitis
inflammation of the gallbladder and the cystic duct
cholangitis
inflammation related to the infection of bile duct
choledocholithias
obstruction by gallstones of the biliary tract
where do gallstones initially form?
the bile ducts, gallbladder, or the cystic duct
content found in gallstones
cholesterol, bile pigments, or mixed content including calcium salts
cholesterol stones
appear white or crystal
bilirubin stones
appear black
where are gallstones excreted?
the bile; small ones may pass through but large ones may obstruct the flow of bile, causing pain
why do gallstones form?
an excess of cholesterol and a deficit of bile salts; triggered or inflammation of infection which may form a calculus
infecting organisms for gallstones
usually are E coli
biliary colic
severe spasms of pain resulting from attempting to move the gallstone along
how might pancreatitis occur as a result of gallstones?
due to pancreatic secretions being backed up by gallstones
increased risk for gallstones
obesity, high cholesterol intake, multiparity (given birth to many children), and the use of oral contraceptives are risk for cholestrol gallstones; hemolytic anemia, alcoholic cirrhosis, or biliary tract infection are risk for bile gallstones
signs of gallstones
severe waves of pain in the URQ (radiate to the back and right shoulder), nausea, vomiting, and sometimes jaundice
when is gallstone pain triggered?
after a fatty meal
treatment for gallstones
laparoscopic surgery that removes the gallbladder and gallstones, shock wave therapy, or bile acids or drugs to break down the stone
2 other names for jaundice
icterus or hyperbilirubinemia
jaundice
yellowish colour of the skin that results from high levels of bilirubin in the blood
where does jaundice first appear?
in the sclera of the eyes
what is bilirubin a product of?
breakdown of RBCs
three disorders associated with jaundice
prehepatic jaundice, intrahepatic jaundice, and posthepatic jaundice
prehepatic jaundice
excessive destruction of RBCs; often a characteristic of hemolytic anemia or transfusion reactions; the liver is functional but cannot keep up with the additional bilirubin; common in newborns
intrahepatic jaundice
occurs in individuals with liver disease such as hepatitis or cirrhosis; a result of impaired uptake of bilirubin from the blood and decreased conjugation of it by the hepatocytes
posthepatic jaundice
caused by the obstruction of bile flow into the gallbladder or duodenum, as well as backup of bile into the blood
causes of posthepatic jaundice
congenital atresia of the bile ducts, obstruction by cholethiiass, inflammation of the liver, or tumors
unconjugated bilirubin
an indirect reading of serum levels and is elevated in prehepatic jaundice
conjugated bilirubin
associated with posthepatic jaundice
(non)conjugated bilirubin and intrahepatic jaundice
both are present due to inflammation or infection that impair hepatocyte function and obstruction of the bile canaliculi
stool of those with posthepatic jaundice
light coloured due to bile not entering the intestine because of obstruction
signs of posthepatic jaundice
irritation and pruritus due to bile salts entering the blood and tissues
treatment for jaundice
varies but can be phototherapy or UV light
hepatitis
the inflammation of the liver; causes hepatocyte function to be impaired, and in severe cases it causes inflammation and necrosis, impairing bile flow
hepatitis causes
fatty liver, an infection such as viral hepatitis, or chemical or drug toxicity
how many viral hepatitis infections are there?
A-E
two ways the liver cells are damaged
by direct action of the virus or via cell-mediated immune responses to the liver
biliary stasis
backup of bile into the blood and occurs with severe inflammation of the liver
general symptoms of hepatitis
necrosis, sometimes liver failure, scar tissue, and obstruction of bile flow
what types of hepatitis does chronic inflammation occur with?
B, C, and D; this is persistent inflammation and necrosis of the liver for more than six months
results of chronic liver inflammation
permanent liver damage (fibrosis) and cirrhosis; also an increased rate of hepatocellular cancer
fibrosis meaning
permanent liver damage
asymptomatic hepatitis’s
B, C, and D
how is hep A transmitted?
oral-fecal, often by contaminated water or shellfish
another name for hep A
infectious hepatitis
what is hep A caused by?
a small RNA virus called HAV
antibodies present in hep A
first IgM, then IgG
infection of hep A
acute and self-limiting; no carrier state
protection for hep A
vaccine and gamma globulin which provides a temporary protection to those just exposed
HIV and hep B
more than 50% of those with HIV also have hep B
another name for hep B
serum hepatitis
what is hep B caused by?
HBV, a partially double-stranded DNA virus called a Dane particle
antigens in hep B
HBcAG, HBeAg, and HBsAg
hep B incubation
has a long incubation period, making it easy to transmit
how is hep B transmitted?
by infected blood; transfusions, intravenous infections, sexual transmission, placental, tattooing, and body piercings
hep B protection
there is a vaccine for high risk groups and immune globulin as a temporary protection
hep C virus
a single-stranded RNA virus
what is hep C transmitted by
blood transufsions
risk of hep C
increases the risk of hepatocellular carcinoma
hep D virus
delta virus
antibody for hep D
HBsAg
hep D transmission
blood; high incidence in intravenous drug abusers
hep D and other heps
hep D increases the severity of hep B infection
hep E virus
a single-stranded RNA
hep E spread
the oral-fecal route
hep E common population
Asian and African countries, and pregnant women
three stages of hepatitis
pericteric or prodromal, icteric or jaundice, and posticteric or recovery
preicteric stage of hepatitis
insidious, with fatigue, anorexia, nausea, general muscle aching, fever, headache, and URQ discomfort
serum levels during the preicteric stage
high levels of aspartate aminotransferase or alanine aminotransferase
icteric stage of hepatitis
onset of jaundice (elevated bilirubin), biliary obstruction (light stool), dark urine, pruritic skin, tender and enlarged liver, mild aching pain, and prolonged blood clotting times
in what hepatitis is the icteric stage longest?
hep B
posticteric stage of hepatitis
reduction in signs; varies in length
what two stages may follow the icteric stage?
recovery or chronic infection
treatment for hepatitis viruses
gamma globulin may be helpful when given early in the infection course, a diet high in protein, carbs, and vitamins, and vaccines may prevent them
how are hep B and C treated?
may be treated with interferon alpha and lamivudine to decrease viral replciation
hepatotoxins
chemicals or drugs that may cause inflammation and necrosis in the liver; they may also cause an immune response
hepatotoxic drugs
acetaminophen, halothane pehnothizaides, and tetracycline
toxic hepatochemicals
carbon tetrachloride, toluene, or ethanol
reye sydrome
occurs when aspirin is used in the presence of viral infections, causing toxic effects of the liver
2 ways hepatocellular damage can occur
inflammation with necrosis or cholestasis
cholestasis
obstructed flow of bilw
cirrhosis
a disorder that occurs when there is progressive destruction of the liver tissue, leading to liver failure
what is cirrhosis classified on?
the structural changes that take place; either micronodular or macronodular, or the cause of the disorder
four categories of cirrhosis
alcoholic liver disease, biliary cirrhosis, postnecrotic cirrhosis, and metabolic
alcoholic liver disease
the largest group of cirrhosis
biliary cirrhosis
associated with immune disorders and those causing obstruction of bile flow
postnecrotic cirrhosis
linked to chronic hepatitis or long-term exposure to toxic materials
metabolic cirrhosis
caused by storage disorders such as hemochromatosis
how is cirrhosis damaged diagnosed?
liver biopsy and serologic tests
what does the liver look like in cirrhosis?
the liver is enlarged initially, but becomes small and shrunken as fibrosis proceeds
another name for alcoholic liver disease
portal cirrhosis
stages of alcoholic liver disease
accumulation of fat in liver cells occurs, causing fatty liver; then inflammation and cell necrosis occur, and fibrous tissue forms; then fibrotic tissue replaces normal tissue, altering the basic liver structure and changing the function
results of cirrhosis
decreased removal of bilirubin, decreased bile production, impaired digestion, decreased production of blood clotting factors, impaired glucose metabolism, inadequate storage of iron and B12, decreased inactivation of hormones, and decreased removal of toxic substances
hepatic encephalopathy
impaired brain function due to liver dysfunction and is a result of altered blood chemistry; can cause confusion, convulsions, disordineation, personality and memory changes, and possibly a coma
effects related to the obstruction of bile ducts
impaired digestion and absorption, jaundice, portal hypertension, congestion in the spleen that increases hemolysis, esophageal varices, and ascites
esophageal varices
swollen veins surrounding the esophagus and is a result of increased pressure of blood due to obstruction of bile
why does blood pressure increase with bile obstruction?
because the hepatic portal system is being blocked, aldosterone levels are increased, and albumin levels are decreased, lowering plasma osmotic pressure; causes ascites and esophageal varices
initial signs of cirrhosis
fatigue, anorexia, weight loss, anemia, diarrhea, and dull aching pain in the URQ
advanced signs of cirrhosis
ascites, edema, increased bruising, esophageal varices, jaundice, imbalance in sex hormones that leads to spider nevi, and these can lead to hemorrhage and circulatory shock
cirrhosis and infections
skin and respiratory infections commonly develop due to excessive fluids in the tissues that interfere with the diffusion of nutrients
treatment for cirrhosis
avoiding fatigue, avoiding exposure to infection, restrictions on protein and salt, along with high carb intake, diuretics, albumin transfers, ruptured esophageal treatment, and liver transplants
tumors in the liver
are usually secondary tumors, although primary malignant ones may occur, but they are rare
most common liver cancer
hepatocellular carcinoma which is common in cirrhotic livers
what may liver tumors develop as a result of?
prolonged exposure to carcinogenic chemicals
signs of liver cancer
usually mild but include anorexia, vomiting, fatigue, weight loss, hypertension, splenomegaly and hepatomegaly
treatment for liver cancer
chemotherapy, and sometimes radiofrequency or lobectomy
pancreatitis
an inflammation of the pancreas resulting from autodigestion of the tissue; can be acute or chronic
why does autodigestion of the pancreas occur?
because of premature activation of the pancreatic proenzymes within the pancreas itself; more specifically, trypsinogen is converted into trypsin, which converts other proenzymes and chemicals into their active forms
what enzymes digest the pancreatic tissue?
trypsin, protease amylase and protease lipase
effects of pancreatitis
inflammation, bleeding, and necrosis
what does the pancreas lack that makes it more susceptible to pancreatitis?
a fibrous capsule
elastase
a protease that leads to hemorrhage in pancreatitis
how are nearby tissues damaged in pancreatitis?
trypsin and other enzymes progress into surrounding tissues, as well as inflammatory chemicals such as cytokines and prostaglandins
effects of pancreatitis
hypovolemia, circulatory collapse, severe pain, bacterial peritonitis, sepsis, adult respiratory distress syndrome, acute renal failure, and possibly death
causes of pancreatitis
gallstones and alcohol abuse; gallstones obstruct the flow of bile and pancreatic secretions; alcohol stimulates an increased secretion of pancreatic enzymes
sudden signs of acute pancreatitis
follows a large meal or large amount of alcohol; severe epigastric pain that radiates to the back, signs of shock (low BP, pallor, sweating, weak pulse), low-grade fever, and abdominal distention
diagnostic tests for pancreatitis
high serum amylase and lipase levels; hypocalcemia as well due to calcium ions binds to fatty acids in necrotic areas
treatment for pancreatitis
stopping all oral intake, treating shock and electrolyte balance, and analgesics (but not morphine)
risk factor for pancreatic cancer
cigarette smoking, diett, and pancreatitis
common neoplasm of pancreatic cancer
adencarcinoma
pancreatic cancer effects
a tumour at the head of the pancreas causes obstruction of biliary and pancreatic flow, leading to weight loss and jaundice
prognosis for pancreatic cancer
very poor as is metastases quickly and is not diagnosed early on
