HLTH 2501: disorders of the liver and pancreas Flashcards
1
Q
what is the gallbladder commonly affected by?
A
formation of gallstones
2
Q
colelithias
A
the formation of gallstones
3
Q
gallstones
A
mass of solid material or calculi that form in the bile
4
Q
cholecystitis
A
inflammation of the gallbladder and the cystic duct
5
Q
cholangitis
A
inflammation related to the infection of bile duct
6
Q
choledocholithias
A
obstruction by gallstones of the biliary tract
7
Q
where do gallstones initially form?
A
the bile ducts, gallbladder, or the cystic duct
8
Q
content found in gallstones
A
cholesterol, bile pigments, or mixed content including calcium salts
9
Q
cholesterol stones
A
appear white or crystal
10
Q
bilirubin stones
A
appear black
11
Q
where are gallstones excreted?
A
the bile; small ones may pass through but large ones may obstruct the flow of bile, causing pain
12
Q
why do gallstones form?
A
an excess of cholesterol and a deficit of bile salts; triggered or inflammation of infection which may form a calculus
13
Q
infecting organisms for gallstones
A
usually are E coli
14
Q
biliary colic
A
severe spasms of pain resulting from attempting to move the gallstone along
15
Q
how might pancreatitis occur as a result of gallstones?
A
due to pancreatic secretions being backed up by gallstones
16
Q
increased risk for gallstones
A
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
17
Q
signs of gallstones
A
severe waves of pain in the URQ (radiate to the back and right shoulder), nausea, vomiting, and sometimes jaundice
18
Q
when is gallstone pain triggered?
A
after a fatty meal
19
Q
treatment for gallstones
A
laparoscopic surgery that removes the gallbladder and gallstones, shock wave therapy, or bile acids or drugs to break down the stone
20
Q
2 other names for jaundice
A
icterus or hyperbilirubinemia
21
Q
jaundice
A
yellowish colour of the skin that results from high levels of bilirubin in the blood
22
Q
where does jaundice first appear?
A
in the sclera of the eyes
23
Q
what is bilirubin a product of?
A
breakdown of RBCs
24
Q
three disorders associated with jaundice
A
prehepatic jaundice, intrahepatic jaundice, and posthepatic jaundice
25
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
26
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
27
posthepatic jaundice
caused by the obstruction of bile flow into the gallbladder or duodenum, as well as backup of bile into the blood
28
causes of posthepatic jaundice
congenital atresia of the bile ducts, obstruction by cholethiiass, inflammation of the liver, or tumors
29
unconjugated bilirubin
an indirect reading of serum levels and is elevated in prehepatic jaundice
30
conjugated bilirubin
associated with posthepatic jaundice
31
(non)conjugated bilirubin and intrahepatic jaundice
both are present due to inflammation or infection that impair hepatocyte function and obstruction of the bile canaliculi
32
stool of those with posthepatic jaundice
light coloured due to bile not entering the intestine because of obstruction
33
signs of posthepatic jaundice
irritation and pruritus due to bile salts entering the blood and tissues
34
treatment for jaundice
varies but can be phototherapy or UV light
35
hepatitis
the inflammation of the liver; causes hepatocyte function to be impaired, and in severe cases it causes inflammation and necrosis, impairing bile flow
36
hepatitis causes
fatty liver, an infection such as viral hepatitis, or chemical or drug toxicity
37
how many viral hepatitis infections are there?
A-E
38
two ways the liver cells are damaged
by direct action of the virus or via cell-mediated immune responses to the liver
39
biliary stasis
backup of bile into the blood and occurs with severe inflammation of the liver
40
general symptoms of hepatitis
necrosis, sometimes liver failure, scar tissue, and obstruction of bile flow
41
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
42
results of chronic liver inflammation
permanent liver damage (fibrosis) and cirrhosis; also an increased rate of hepatocellular cancer
43
fibrosis meaning
permanent liver damage
44
asymptomatic hepatitis's
B, C, and D
45
how is hep A transmitted?
oral-fecal, often by contaminated water or shellfish
46
another name for hep A
infectious hepatitis
47
what is hep A caused by?
a small RNA virus called HAV
48
antibodies present in hep A
first IgM, then IgG
49
infection of hep A
acute and self-limiting; no carrier state
50
protection for hep A
vaccine and gamma globulin which provides a temporary protection to those just exposed
51
HIV and hep B
more than 50% of those with HIV also have hep B
52
another name for hep B
serum hepatitis
53
what is hep B caused by?
HBV, a partially double-stranded DNA virus called a Dane particle
54
antigens in hep B
HBcAG, HBeAg, and HBsAg
55
hep B incubation
has a long incubation period, making it easy to transmit
56
how is hep B transmitted?
by infected blood; transfusions, intravenous infections, sexual transmission, placental, tattooing, and body piercings
57
hep B protection
there is a vaccine for high risk groups and immune globulin as a temporary protection
58
hep C virus
a single-stranded RNA virus
59
what is hep C transmitted by
blood transufsions
60
risk of hep C
increases the risk of hepatocellular carcinoma
61
hep D virus
delta virus
62
antibody for hep D
HBsAg
63
hep D transmission
blood; high incidence in intravenous drug abusers
64
hep D and other heps
hep D increases the severity of hep B infection
65
hep E virus
a single-stranded RNA
66
hep E spread
the oral-fecal route
67
hep E common population
Asian and African countries, and pregnant women
68
three stages of hepatitis
pericteric or prodromal, icteric or jaundice, and posticteric or recovery
69
preicteric stage of hepatitis
insidious, with fatigue, anorexia, nausea, general muscle aching, fever, headache, and URQ discomfort
70
serum levels during the preicteric stage
high levels of aspartate aminotransferase or alanine aminotransferase
71
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
72
in what hepatitis is the icteric stage longest?
hep B
73
posticteric stage of hepatitis
reduction in signs; varies in length
74
what two stages may follow the icteric stage?
recovery or chronic infection
75
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
76
how are hep B and C treated?
may be treated with interferon alpha and lamivudine to decrease viral replciation
77
hepatotoxins
chemicals or drugs that may cause inflammation and necrosis in the liver; they may also cause an immune response
78
hepatotoxic drugs
acetaminophen, halothane pehnothizaides, and tetracycline
79
toxic hepatochemicals
carbon tetrachloride, toluene, or ethanol
80
reye sydrome
occurs when aspirin is used in the presence of viral infections, causing toxic effects of the liver
81
2 ways hepatocellular damage can occur
inflammation with necrosis or cholestasis
82
cholestasis
obstructed flow of bilw
83
cirrhosis
a disorder that occurs when there is progressive destruction of the liver tissue, leading to liver failure
84
what is cirrhosis classified on?
the structural changes that take place; either micronodular or macronodular, or the cause of the disorder
85
four categories of cirrhosis
alcoholic liver disease, biliary cirrhosis, postnecrotic cirrhosis, and metabolic
86
alcoholic liver disease
the largest group of cirrhosis
87
biliary cirrhosis
associated with immune disorders and those causing obstruction of bile flow
88
postnecrotic cirrhosis
linked to chronic hepatitis or long-term exposure to toxic materials
89
metabolic cirrhosis
caused by storage disorders such as hemochromatosis
90
how is cirrhosis damaged diagnosed?
liver biopsy and serologic tests
91
what does the liver look like in cirrhosis?
the liver is enlarged initially, but becomes small and shrunken as fibrosis proceeds
92
another name for alcoholic liver disease
portal cirrhosis
93
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
94
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
95
96
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
97
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
98
esophageal varices
swollen veins surrounding the esophagus and is a result of increased pressure of blood due to obstruction of bile
99
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
100
initial signs of cirrhosis
fatigue, anorexia, weight loss, anemia, diarrhea, and dull aching pain in the URQ
101
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
102
cirrhosis and infections
skin and respiratory infections commonly develop due to excessive fluids in the tissues that interfere with the diffusion of nutrients
103
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
104
tumors in the liver
are usually secondary tumors, although primary malignant ones may occur, but they are rare
105
most common liver cancer
hepatocellular carcinoma which is common in cirrhotic livers
106
what may liver tumors develop as a result of?
prolonged exposure to carcinogenic chemicals
107
signs of liver cancer
usually mild but include anorexia, vomiting, fatigue, weight loss, hypertension, splenomegaly and hepatomegaly
108
treatment for liver cancer
chemotherapy, and sometimes radiofrequency or lobectomy
109
pancreatitis
an inflammation of the pancreas resulting from autodigestion of the tissue; can be acute or chronic
110
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
111
what enzymes digest the pancreatic tissue?
trypsin, protease amylase and protease lipase
112
effects of pancreatitis
inflammation, bleeding, and necrosis
113
what does the pancreas lack that makes it more susceptible to pancreatitis?
a fibrous capsule
114
elastase
a protease that leads to hemorrhage in pancreatitis
115
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
116
effects of pancreatitis
hypovolemia, circulatory collapse, severe pain, bacterial peritonitis, sepsis, adult respiratory distress syndrome, acute renal failure, and possibly death
117
causes of pancreatitis
gallstones and alcohol abuse; gallstones obstruct the flow of bile and pancreatic secretions; alcohol stimulates an increased secretion of pancreatic enzymes
118
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
119
diagnostic tests for pancreatitis
high serum amylase and lipase levels; hypocalcemia as well due to calcium ions binds to fatty acids in necrotic areas
120
treatment for pancreatitis
stopping all oral intake, treating shock and electrolyte balance, and analgesics (but not morphine)
121
risk factor for pancreatic cancer
cigarette smoking, diett, and pancreatitis
122
common neoplasm of pancreatic cancer
adencarcinoma
123
pancreatic cancer effects
a tumour at the head of the pancreas causes obstruction of biliary and pancreatic flow, leading to weight loss and jaundice
124
prognosis for pancreatic cancer
very poor as is metastases quickly and is not diagnosed early on
125
