Krause ch 29 Liver and Pancreas Flashcards
largest gland of body
liver
liver supplied with blood from these two sources:
hepatic artery and portal vein
thick viscous fluid secreted from liver, stored in gallbladder, released into duodenum when fatty foods enter duodenum
bile
main fxns of liver:
1) metabolism CHO, pro, fat 2) storage and activation of vit and min 3) form and excrete bile 4) convert ammonia to urea 5) metabolize steroids 6) detox 7) filter/flood chamber
hepatocytes detox ammonia by converting to ___
urea
how does liver work as filter/flood chamber?
remove bacteria/debris from blood thru phagocytic Kupffer cells
this is gold standard to assess hepatic inflammation
liver biopsy
4 phases of acute viral hepatitis
1) incubation 2) preicteric 3) icteric (jaundice) 4) convalescent/recovery
NAFLD most associated with these conditions:
obesity, type 2 diabetes, dyslipidemia, metabolic syndrome
NASH is associated with hepatocyte ____ with or without fibrous tissue in the liver
injury
treatment for NAFLD include wt loss, insulin-sensitizing drugs, and this vitamin:
E
drinking ___ may be protective against NAFLD
coffee
toxic byproduct of alcohol metabolism that damages meto membrane and fxn
acetaldehyde (and excess hydrogen)
variables that predispose ppl to alcoholic liver disease?
genes, gender, exposure to other drugs, infection, immunologic factors, obesity, poor nutrition status
3 stages of alcoholic liver disease:
steatosis, hepatitis, cirrhosis
fatty infiltration, also known as ____ is caused by culmination of these metabolic disturbances:
hepatic steatosis; 1) ^ mobilization of f.a. from adipose 2) ^ hepatic synth of f.a. 3) v f.a. oxidation 4) ^ TG 5) trapping of TG in liver
alcoholic fatty liver symptoms:
poor appetite, right upper quadrant discomfort, hepatomegaly
alcoholic hep generally characterized by:
hepatomegaly, ^ serum transaminase and serum bilirubin, v albumin, anemia
complications of cirrhosis
GI bleed, hepatic encephalopathy, portal HTN, ascites
what is ascites?
accumulation of fluid, serum pro, electrolytes in peritoneal cavity (^ pressure from portal htn and v albumin cause this)
why malnutrition common in alcoholic?
displace nutr with alcohol, pancreatic insufficiency and alterations of intestinal mucosa, use of lipid/CHO compromised, insulin resistance, reduced intake and alterations in absorp/store/convert nutr to active forms
conditions affecting bile ducts
cholestatic liver disease
chronic cholestatic disease caused by progressive destruction of intrahepatic bile ducts
primary biliary cirrhosis (PBC)–it is autoimmune
PBC mostly occurs in ___
women
complications from cholestasis:
osteopenia, hypercholesterolemia, fat sol vit deficiencies
this condition is characterized by fibrosing inflam of segments of extrahepatic bile ducts (w/ or w/out intrahepatic ducts)
primary sclerosing cholangitis (PSC)
3 syndromes of PSC:
cholestasis with biliary cirrhosis, recurrent cholangitis w/ large bile duct strictures, cholangiocarcinoma
lots of PSC ppl have ____
IBD
this may occur from vit D and Ca malabsorption
hepatic osteodystrophy
inherited disease of iron overload
hemochromatosis
autosomal recessive disorder associated with impaired biliary copper excretion
wilson’s disease
wilson’s disease characterized by ____ rings
Kayser-Fleisher
three types of liver disease based on time of onset and duration:
fulminant, acute, chronic
syndrome where severe liver dysfunction accompanied by hepatic encephalopathy
fulminant hepatitis
extrahepatic complications of fulminant hepatitis
renal failure, cerebral edema, bleeding, cardio abnormalities, acid-base probs, electrolyte probs, sepsis, pancreatitis
most common causes of chronic hepatitis:
hep b, c, autoimmune
severe advanced liver disease symptoms:
jaundice, muscle wasting, tea coloured urine, ascites, edema, GI varices, splenomegaly, spider angiomata
major complications of cirrhosis:
malnutrition, ascites, hyponatremia, glucose alterations, fat malabsorption, osteopenia
ESLD physical manifestations:
portal HTN, ascites, hyponatremia, hepatic encephalopathy
portal HTN leads to ___ in GIT which often bleed and result in emergency
varices
how to relieve ascites?
large vol paracentesis, diuretics
why hyponatremia?
v excretion of water (release of ADH), na loss in paracentesis, excess diuretics
syndrome characterized by impaired mentation, neuromusc disturbance, altered consciousness
hepatic encephalopathy
why hepatic encephalopathy precipitated?
GI bleed, fluid/electrolyte abnormal, uremia, infection, sedatives, hyper/hypoglycemia, alcohol withdrawal, constipation, dehydration, acidosis
mechanism of hepatic encephalopathy?
ammonia accumulation
4 stages hepatic encephalopathy
mild confusion, agitation, irritability , sleep disturbance –> lethargy, disorientation, drowsiness, inappropriate behaviour –>somnolent but arousable, incomprehensible speech, confused, aggressive –>coma
meds to treat encephalopathy
lactulose, rifaximin
nutr related hypothesis for hepatic encephalopathy
altered neurotransmitter theory (aa imbalance)–> aromatics ^ and BCAAs v
____ may improve hepatic encephalopathy by reducing ammonia or by preventing production/uptake of lipopolysaccs in gut
probiotics
why glucose intolerance in cirrhosis?
IR in peripheral tissues, inslin production ^, hepatic clearance v, portal systemic shunting occurs
why fasting hypoglycemia in cirrhosis?
v availability of glucose from glycogen (more common in acute/fulminant than chronic)
why fat malabsorbed?
v bile salt secretion, admin of meds, pancreatic enzyme insufficiency
treating steatorrhea?
MCTs (don’t need micelle formation to be absorbed), low fat diet
renal failure associated with severe liver disease without intrinsic kidney abnormalities
hepatorenal syndrome
how diagnose hepatorenal syndrome?
urine sodium lvl less than 10 mEq/L and oliguria persists in absence of intravascular vol depletion
route of nutrition for liver disease
small frequent meals, oral liquid supplements
wernicke encephalopathy related to ___ deficiency and is characterized by:
thiamin; confusion, ataxia, ocular disturbances
most popular and studied herbal supplement for liver disease
milk thistle
admin of ___ and fibre with tube feeding may reduce postop ___ rate
probiotics; infection
main fxn of gallbladder?
concentrate, store, excrete bile
primary transporter responsible for bile salte secretion
bile salt export pump
the ___ duct joins ___ duct to form common bile duct
cystic; common hepatic
during digestions, food reaches ____ which releases _____ hormones that stim gallbladder and pancreas, causing ____ to relax
duodenum; CCK/secretin; sphincter of oddi
condition where little or no bile secreted or flow of bile into GI tract obstructed
cholestasis
cholestasis can predispose person to acalculous ___
cholecystitis
formation of gallstones is referred to as :
cholelithiasis
risk factors for cholesterol stone formation:
female, pregnancy, old age, family hx, obesity, DM, IBD, drugs
surgical removal of gallbladder called;
cholecystectomy
MNT for cholecystitis
high fibre, low fat, plant based
why jaundice happen?
obstruction backs up bile, returns to circulation and has affinity for elastic tissues like eye and skin
MNT in acute cholecystitis
oral feed d/c, PN may be indicated, low fat diet
___ may be responsible for symptoms in postcholecystectomy syndrome
reflux
why not strict limitation of fat in chronic cholecystitis
fat in intestine important for some stim and drainage of biliary tract
inflamm of bile ducts called ___
cholangitis
if have cholangitis, need to be treated with:
fluid resuscitation and antibiotics
2 primary hormonal stimuli for pancreatic secretion are :
secretin and CCK
3 phases of pancreatic secretions during meal:
cephalic, gastric phase, intestinal phase
what is pancreatitis?
inflam of pancreas, characterized by edema, cell exudate, fat necrosis
pancreatitis can cause soap formation of ___ and ___
Ca ; f.a.
best inhibitor of pancreatic secretion (hormone)
somatostatin
objective of therapy for CP pt
prevent further damage, v number of attacks, allevaite pain, v steatorrhea, correct malnutrition
surgical procedure often used for pancreatic carcinoma:
pancreaticoduodenectomy (whipple procedure)
why pancreaticoduodenectomy?
head of pancreas and duodenum have same arterial blood supply, so both organs must be removed if single blood supply severed (prevent necrosis)
