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NUTR 442 > Krause ch 29 Liver and Pancreas > Flashcards

Krause ch 29 Liver and Pancreas Flashcards

1
Q

largest gland of body

A

liver

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2
Q

liver supplied with blood from these two sources:

A

hepatic artery and portal vein

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3
Q

thick viscous fluid secreted from liver, stored in gallbladder, released into duodenum when fatty foods enter duodenum

A

bile

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4
Q

main fxns of liver:

A

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

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5
Q

hepatocytes detox ammonia by converting to ___

A

urea

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6
Q

how does liver work as filter/flood chamber?

A

remove bacteria/debris from blood thru phagocytic Kupffer cells

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7
Q

this is gold standard to assess hepatic inflammation

A

liver biopsy

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8
Q

4 phases of acute viral hepatitis

A

1) incubation 2) preicteric 3) icteric (jaundice) 4) convalescent/recovery

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9
Q

NAFLD most associated with these conditions:

A

obesity, type 2 diabetes, dyslipidemia, metabolic syndrome

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10
Q

NASH is associated with hepatocyte ____ with or without fibrous tissue in the liver

A

injury

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11
Q

treatment for NAFLD include wt loss, insulin-sensitizing drugs, and this vitamin:

A

E

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12
Q

drinking ___ may be protective against NAFLD

A

coffee

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13
Q

toxic byproduct of alcohol metabolism that damages meto membrane and fxn

A

acetaldehyde (and excess hydrogen)

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14
Q

variables that predispose ppl to alcoholic liver disease?

A

genes, gender, exposure to other drugs, infection, immunologic factors, obesity, poor nutrition status

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15
Q

3 stages of alcoholic liver disease:

A

steatosis, hepatitis, cirrhosis

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16
Q

fatty infiltration, also known as ____ is caused by culmination of these metabolic disturbances:

A

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

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17
Q

alcoholic fatty liver symptoms:

A

poor appetite, right upper quadrant discomfort, hepatomegaly

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18
Q

alcoholic hep generally characterized by:

A

hepatomegaly, ^ serum transaminase and serum bilirubin, v albumin, anemia

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19
Q

complications of cirrhosis

A

GI bleed, hepatic encephalopathy, portal HTN, ascites

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20
Q

what is ascites?

A

accumulation of fluid, serum pro, electrolytes in peritoneal cavity (^ pressure from portal htn and v albumin cause this)

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21
Q

why malnutrition common in alcoholic?

A

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

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22
Q

conditions affecting bile ducts

A

cholestatic liver disease

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23
Q

chronic cholestatic disease caused by progressive destruction of intrahepatic bile ducts

A

primary biliary cirrhosis (PBC)–it is autoimmune

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24
Q

PBC mostly occurs in ___

A

women

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25
Q

complications from cholestasis:

A

osteopenia, hypercholesterolemia, fat sol vit deficiencies

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26
Q

this condition is characterized by fibrosing inflam of segments of extrahepatic bile ducts (w/ or w/out intrahepatic ducts)

A

primary sclerosing cholangitis (PSC)

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27
Q

3 syndromes of PSC:

A

cholestasis with biliary cirrhosis, recurrent cholangitis w/ large bile duct strictures, cholangiocarcinoma

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28
Q

lots of PSC ppl have ____

A

IBD

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29
Q

this may occur from vit D and Ca malabsorption

A

hepatic osteodystrophy

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30
Q

inherited disease of iron overload

A

hemochromatosis

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31
Q

autosomal recessive disorder associated with impaired biliary copper excretion

A

wilson’s disease

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32
Q

wilson’s disease characterized by ____ rings

A

Kayser-Fleisher

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33
Q

three types of liver disease based on time of onset and duration:

A

fulminant, acute, chronic

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34
Q

syndrome where severe liver dysfunction accompanied by hepatic encephalopathy

A

fulminant hepatitis

35
Q

extrahepatic complications of fulminant hepatitis

A

renal failure, cerebral edema, bleeding, cardio abnormalities, acid-base probs, electrolyte probs, sepsis, pancreatitis

36
Q

most common causes of chronic hepatitis:

A

hep b, c, autoimmune

37
Q

severe advanced liver disease symptoms:

A

jaundice, muscle wasting, tea coloured urine, ascites, edema, GI varices, splenomegaly, spider angiomata

38
Q

major complications of cirrhosis:

A

malnutrition, ascites, hyponatremia, glucose alterations, fat malabsorption, osteopenia

39
Q

ESLD physical manifestations:

A

portal HTN, ascites, hyponatremia, hepatic encephalopathy

40
Q

portal HTN leads to ___ in GIT which often bleed and result in emergency

A

varices

41
Q

how to relieve ascites?

A

large vol paracentesis, diuretics

42
Q

why hyponatremia?

A

v excretion of water (release of ADH), na loss in paracentesis, excess diuretics

43
Q

syndrome characterized by impaired mentation, neuromusc disturbance, altered consciousness

A

hepatic encephalopathy

44
Q

why hepatic encephalopathy precipitated?

A

GI bleed, fluid/electrolyte abnormal, uremia, infection, sedatives, hyper/hypoglycemia, alcohol withdrawal, constipation, dehydration, acidosis

45
Q

mechanism of hepatic encephalopathy?

A

ammonia accumulation

46
Q

4 stages hepatic encephalopathy

A

mild confusion, agitation, irritability , sleep disturbance –> lethargy, disorientation, drowsiness, inappropriate behaviour –>somnolent but arousable, incomprehensible speech, confused, aggressive –>coma

47
Q

meds to treat encephalopathy

A

lactulose, rifaximin

48
Q

nutr related hypothesis for hepatic encephalopathy

A

altered neurotransmitter theory (aa imbalance)–> aromatics ^ and BCAAs v

49
Q

____ may improve hepatic encephalopathy by reducing ammonia or by preventing production/uptake of lipopolysaccs in gut

A

probiotics

50
Q

why glucose intolerance in cirrhosis?

A

IR in peripheral tissues, inslin production ^, hepatic clearance v, portal systemic shunting occurs

51
Q

why fasting hypoglycemia in cirrhosis?

A

v availability of glucose from glycogen (more common in acute/fulminant than chronic)

52
Q

why fat malabsorbed?

A

v bile salt secretion, admin of meds, pancreatic enzyme insufficiency

53
Q

treating steatorrhea?

A

MCTs (don’t need micelle formation to be absorbed), low fat diet

54
Q

renal failure associated with severe liver disease without intrinsic kidney abnormalities

A

hepatorenal syndrome

55
Q

how diagnose hepatorenal syndrome?

A

urine sodium lvl less than 10 mEq/L and oliguria persists in absence of intravascular vol depletion

56
Q

route of nutrition for liver disease

A

small frequent meals, oral liquid supplements

57
Q

wernicke encephalopathy related to ___ deficiency and is characterized by:

A

thiamin; confusion, ataxia, ocular disturbances

58
Q

most popular and studied herbal supplement for liver disease

A

milk thistle

59
Q

admin of ___ and fibre with tube feeding may reduce postop ___ rate

A

probiotics; infection

60
Q

main fxn of gallbladder?

A

concentrate, store, excrete bile

61
Q

primary transporter responsible for bile salte secretion

A

bile salt export pump

62
Q

the ___ duct joins ___ duct to form common bile duct

A

cystic; common hepatic

63
Q

during digestions, food reaches ____ which releases _____ hormones that stim gallbladder and pancreas, causing ____ to relax

A

duodenum; CCK/secretin; sphincter of oddi

64
Q

condition where little or no bile secreted or flow of bile into GI tract obstructed

A

cholestasis

65
Q

cholestasis can predispose person to acalculous ___

A

cholecystitis

66
Q

formation of gallstones is referred to as :

A

cholelithiasis

67
Q

risk factors for cholesterol stone formation:

A

female, pregnancy, old age, family hx, obesity, DM, IBD, drugs

68
Q

surgical removal of gallbladder called;

A

cholecystectomy

69
Q

MNT for cholecystitis

A

high fibre, low fat, plant based

70
Q

why jaundice happen?

A

obstruction backs up bile, returns to circulation and has affinity for elastic tissues like eye and skin

71
Q

MNT in acute cholecystitis

A

oral feed d/c, PN may be indicated, low fat diet

72
Q

___ may be responsible for symptoms in postcholecystectomy syndrome

A

reflux

73
Q

why not strict limitation of fat in chronic cholecystitis

A

fat in intestine important for some stim and drainage of biliary tract

74
Q

inflamm of bile ducts called ___

A

cholangitis

75
Q

if have cholangitis, need to be treated with:

A

fluid resuscitation and antibiotics

76
Q

2 primary hormonal stimuli for pancreatic secretion are :

A

secretin and CCK

77
Q

3 phases of pancreatic secretions during meal:

A

cephalic, gastric phase, intestinal phase

78
Q

what is pancreatitis?

A

inflam of pancreas, characterized by edema, cell exudate, fat necrosis

79
Q

pancreatitis can cause soap formation of ___ and ___

A

Ca ; f.a.

80
Q

best inhibitor of pancreatic secretion (hormone)

A

somatostatin

81
Q

objective of therapy for CP pt

A

prevent further damage, v number of attacks, allevaite pain, v steatorrhea, correct malnutrition

82
Q

surgical procedure often used for pancreatic carcinoma:

A

pancreaticoduodenectomy (whipple procedure)

83
Q

why pancreaticoduodenectomy?

A

head of pancreas and duodenum have same arterial blood supply, so both organs must be removed if single blood supply severed (prevent necrosis)

NUTR 442 (34 decks)

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