L2 LIVER , SLPEEN , PANCREATES EXAMNATION AND DISASES Flashcards
THE MAIN RISK FACTORS OF DEVELOPMENT
OF DISEASES OF THE
HEPATOBILIARY SYSTEM
Alcohol consumption
Medication intake
Surgical intervention
Intravenous injections and / or blood
transfusions
Profession (blood contact)
Sex
Family history of liver disease
Drugs that can cause abnormal
liver function
Analgesics - paracetamol, Aspirin
Cardiovascular drugs -
methyldopa,аmiodarone
Antibacterial drugs - macrolides
(erythromycin), - cephalosporins
(cefoperazone)
Psychotropic drugs - phenothiazines
Other - oral contraceptives
Liver function
Synthetic
- synthesis of albumin, coagulation factors,
fibrinogen, cholesterol, complement, binding
proteins for iron, copper, vitamin A
Detoxification / excretion
- products of protein metabolism, steroids,
prostaglandins, drugs, alcohol, bilirubin, urea,
products of bacteria metabolism
Accumulation - Glycogen, lipids, iron,
copper, vitamins A, B12, D, E, K
Excretory - bile secretion
Main complaints of liver
Pain
Dyspeptic complaints
Fever
Itch (pruritus)
Yellowness of the skin
Discoloration of urine and feces
Peripheral signs of long-term liver
damage
Spider veins
Drumsticks
Palmar erythema
Scratches
Hemorrhagic diathesis –petechial eruption
and hemorrhage into the skin (ecchymosis)
Symptoms of liver disease
jaundice
hepatomegaly
dark urine
light faeces
pruritus
ascites
pain in the right hypochondrium
abdominal distention
EXPLAIN THE Hepatomegaly
—Hepatomegaly : its enlargement of the liver
-Causes of hepatic enlargement
(hepatomegaly) :
Venous congestion in the liver (HF, obstruction of the hepatic veins)
Hepatitis, cirrhosis (alcoholic, medicinal)
Infectious lesion (leptospirosis, malaria, echinococcosis)
Deposition of amyloid, iron, copper, etc.
Tumors (liver carcinoma, mts, hemoblastosis, cysts)
Obstruction of biliary tract
explain the Dark urine (bilirubinuria)
–Dark urine (bilirubinuria) :Appears with an increase in direct
bilirubin in the urine - hepatic and
posthepatic jaundice
explain the Decolorized feces (acholia)
– its Changing the color of feces resulting from the
absence or substantial reduction of stercobilin.
what is the Pruritus
–Pruritus : Caused by irritation of the nerve
endings of the skin and mucous
membranes with bile acids
explain the Ascites
–Ascites - the presence of freedom
of fluid (transudate) in the abdominal cavity
-Clinical manifestations:
increase in abdomen volume
navel bulge, umbilical hernia,
the appearance of stretch marks,
often combined with varicose veins of the anterior abdominal wall -
Caput medusae
explain the Pain in the right hypochondrium
-Pain in the right hypochondrium : May be due to:
-distension of Glisson’s capsule
-liver abscess
-spastic contractions of muscles of the gall
bladder and large bile ducts
Causes of spleen enlargement
(splenomegaly)
1-acute and chronic infectious diseases
(typhus, viral hepatitis, sepsis, malaria,
etc.),
2-in liver cirrhosis,
thrombosis or compression of the splenic
vein,
3-diseases of the hemopoietic system
(hemolytic anemia, thrombocytopenic
purpura, acute and chronic leucosis).
4-deposition of amyloid
What is bilirubin , ?
–Bilirubin: is the product formed by the breakdown of red blood cells in the body. Red blood cells are continuously undergoing hemolysis ( or a breaking down) process, because their average life- span is about 120 days. As the red blood cells disintegrate, the hemoglobin is degraded or broken into globin- which is the protein part, iron (which is conserved for later use), and heme
-The heme initially breaks apart into biliverdin, a green pigment which is rapidly reduced to bilirubin, an orange-yellow pigment. This is called the unconjugated or indirect bilirubin. The bilirubin is then transported to the liver where it reacts with a solubilizing sugar called glucuronic acid. Here in the liver, the unconjugated or indirect bilirubin is converted to a more soluble form of bilirubin which is called the conjugated or direct bilirubin. This Direct bilirubin is excreted into the bile, which goes through the gall bladder into the intestines where the bilirubin is changed into a variety of pigments. The most important ones are stercobilin, which is excreted in the faeces, and urobilinogen, which is excreted as a normal component of the urine.
—Types of bilirubin :
There are two types of bilirubin in the blood…
1-Unconjugated (indirect) bilirubin is insoluble in water. This is the bilirubin before it reaches the liver.(pre hepatic )
2-Conjugated (direct) bilirubin has been converted to soluble bilirubin in the liver. It then goes into the bile to be stored in the gall bladder or sent to the intestines.( post hepatic )
-Note- Routine blood tests for total bilirubin measure both unconjugated and conjugated bilirubin.
–Normal Values of bilirubin:
1-Indirect Bilirubin > 0.00- 0.80 mg/dL
2-Direct Bilirubin > 0.01- 0.30 mg/dL
3-Total Bilirubin > 0.2- 1.2 mg/dL
What is Jaundice and hyperbiliruimia
-Jaundice: is the result of the accumulation of bilirubin in the blood, it is also called hyperbilirubinemia. Jaundice clinically manifests asthe yellowing of the skin and mucosa in the body, as well as itching (pruritus).
–Signs and symptoms of Jaundice :
pale-colored stools
dark-colored urine
skin itching
nauseaandvomiting
rectal bleeding
diarrhea
feverandchills
weakness
weight loss
–Types of Jaundice :
There are three types of jaundice, depending on what’saffecting the movement of bilirubin out of the body.They are:
1-pre-hepaticcauses
2-hepatic (liver) causes
3-post-hepatic causes
——
1-pre-hepaticcauses of Jaundice ( unconjegated bilirubin ) :
-Jaundice caused during the pre-hepatic phase is due to the excessive destruction (hemolysis) of red blood cells from various conditions. This rapid increase in bilirubin levels in the bloodstream overwhelms the liver’s capability to properly metabolize the bilirubin, and consequently the levels of unconjugated bilirubin increase. Conditions which can lead to an increase in the hemolysis of red blood cells include:
Malaria,
Sickle cell disease,
Hereditary spherocytosis,
Thalassemia,
—–
2-hepatic (liver) causes of Jaundice ( congregated and unconjugated bilirubin )
-Jaundice caused during the hepatic phase can arise from abnormalities in the metabolism and/or excretion of bilirubin. This can lead to an increase in both unconjugated and/or conjugated bilirubin levels. Conditions with a hepatic cause of jaundice include:
Acute or chronichepatitis(commonly viral [Hepatitis A, B, C, D, E] or alcohol related),
Cirrhosis(caused by various conditions),
Drugs or other toxins,
Crigler-Najjar syndrome,
—–
3-post-hepatic causes of Jaundice ( Conjugated (direct)
bilirubin )
-Jaundice from a post-hepatic cause arises from a disruption (or an obstruction) in the normal drainage and excretion of the now conjugated bilirubin in the form of bile from the liver into the intestine. This leads to increased levels of conjugated bilirubin in the bloodstream. Conditions that can cause post-hepatic jaundice include
Gallstones
Cancer(pancreatic cancer, gallbladder cancer andbile duct cancer),
Strictures of the bile ducts,
Cholangitis,
Pancreatitis, and Parasites (for example, liver flukes).
