Liver and Biliary Tract Flashcards
Bile ducts exit the liver through the ______.
Hilus
The common bile duct joins the pancreatic duct AKA ______
Duct of Wirsung; contained exocrine-digestive enzymes and pH control
The hepatic _______ enter the liver carrying nutrients from the small intestine for processing
Portal vein
The blood then passes though the liver, and once processed is “dumped” into the __________ for a “trip” to the right side of the heart
Inferior vena cava
What are the major liver functions?
- Excretory: Bile = Bilirubin + Bile Acids
- Metabolic: Fats, Carbohydrates, Proteins
- Storage: Carbohydrates & Fats
- Synthetic: Clotting Proteins, Albumin, transport proteins
What is the main indication that the liver is involved with a pathology?
Jaundice
Derived from the macrophage destruction of red blood cells that have completed there life span in the liver, spleen, & red bone marrow
Bilirubin
Give bile a foamy trait, and are important for digestion of fats in the small intestine
Bile acids
Bile acids are reabsorbed from the intestines and transported back to the liver via the portal vein for reuse. This “reuse” circulation of bile acids is called
Enterohepatic circulation of bile
Includes abnormal formation, processing , or excretion of bilirubin; yellow discoloration of skin and mucosa; brown or foamy urine with viral hepatitis; itchiness
Jaundice syndromes
Inflammation of the liver caused by viruses, drugs, alcohol, and immune mechanisms; often asymptomatic
Hepatitis
Injury of liver cells by exogenous chemicals or endogenous metabolites
Toxic/metabolic hepatic injury
End-stage liver disease which may result from many different liver diseases
Cirrhosis
Diseases caused by gallstones
Extrahepatic Bile Ducts & Gallbladder Diseases
Occur in the liver and biliary tract, classified as benign, malignant, and primary or secondary (metastasis)
Tumors
Bilirubin end product of phagocytosis of senescent red blood cells in the _______ of the liver
Kupffer’s cells
Transmitted fecal – oral route, may occur in a sporadic or epidemic form; Symptoms of infection include a short lived mild-fever, vomiting, loss of appetite, and jaundice
Hepatitis A
Transmitted via blood transfusions, exposure to contaminated blood or blood products, saliva, semen, or sexual contact; Most prevalent among health care workers, and those working in or around blood products should be inoculated and screened (leads to cirrhosis!); most common form
Hepatitis B
What are signs and symptoms of Hep B?
- Symptoms are weakness, nausea, vomiting
- Some have enlarged & painful liver on palpation
- Darkening of urine which contains bilirubin
- Some have measles-like skin rash
2nd Major cause of cirrhosis in the U.S. after alcohol abuse
Hepatitis B
Transmitted by contaminated blood products, needle sticks, intravenous drug use, contaminated blood transfusions; no vaccine available
Hepatitis C
End-stage liver disease; irreversible; incurable except by liver transplant; common causes are alcoholism, Hep B, C, and D, drugs, toxins, bile duct obstruction and inherited abnormalities
Cirrhosis
What is the pathophysiology of cirrhosis?
- Death of liver cells
- Tissue repair with fibrosis and fibrous bands which obstruct blood flow
- Regenerative tissue nodules separated by gray scar tissue which restricts blood flow
What are the complications in cirrhosis?
- Ascites (fluid in abdominal cavity)
- Splenomegaly
- Thrombocytopenia
What are clinical features of cirrhosis?
- Liver cell injury and necrosis (increase serum liver enzymes)
- loss of liver fxn
- Portal hypertension (causes esophageal varicies)
- Increase of NH4 (causes hepatic encephalopathy, liver flap, numbness, tingling, etc.)
What is liver flap (coarse hand tremor) caused by?
excess ammonia (not being broken down)
Concretions composed of chemical normally formed in bile and are extremely common
Gallstones, aka Cholelithiasis
What are the 2 types of gallstones? which is more common?
- Cholesterol (more, 75%)
2. Pigmentary (25%0
What are the signs and symptoms of gallstones?
- Excruciating spasmodic pain from cystic duct (immediate duct to gallbladder) obstruction
- Pain presents within hours of a fatty meal under the right scapula (gallbladder attack)
- Jaundice (if bile flow is blocked)
What are the types of malignant hepatic biliary tumors?
- Hepatocellular carcinomas (>1 million deaths)
2. Gallbladder cancer (less common, 1% cancer deaths)
What are the signs, symptoms and prognosis of hepatocellular carcinomas?
- Weight Loss
- Loss of appetite
- Nausea
- Painful enlarged liver-compresses other organs
- Portal hypertension
Poor Prognosis: 5 year survival rate is 10%
What are causes of referred shoulder pain related to the GI and hepatic systems?
- Liver disease
- Ruptured speleen (left shoulder, kehr’s sign)
- Pancreas (left shoulder)
- Aortic aneurysm
- Peptic Ulcer
- Gallbladder disease
- Hiatal hernia
- Diaphragmatic hernia
- Ectopic Pregnancy
- Mono (left shoulder/left upper trap)
What features occurring with shoulder pain should be approached as a sign of systemic visceral illness - even with objective findings at the shoulder joint (pain on movement, etc.)?
- Exasperated by recumbency
- Coincident diaphoresis
- Coincident, nausea, vomiting, dysphagia
- Other GI complaints (anorexia, early satiety, epigastric pain or discomfort/fullness)
- Exacerbation by exertion unrelated to shoulder movement
- Urologic complaints
- Jaundice
- Pleuritic component (dry hacking or productive cough, blood tinged sputum, chest pain)
What are potential pathologies that could result in people having referred cervical pain?
- Esophagitis
2. Esophageal cancer
What are potential pathologies that could result in people having referred thoracic/scapular pain?
- Severe esophagitis
- esophageal spasm
- Peptic ulcer
- Acute cholecystitis (gallbladder attack)
- Pancreatic diseas
What are potential pathologies that could result in people having referred lumbar pain?
- Intestinal obstruction (neoplasm)
- Irritable bowel syndrome
- Crohn’s disease
- Pancreatic disease
What are potential pathologies that could result in people having referred sacroiliac/sacral pain?
- Ulcerative colitis
- Colon cancer
- IBS
- Crohn’s disease
Where is the location for referred pain due to esophagitis?
Midback btwn scapulae
Where is the location for referred pain due to peptic ulcer: stomach/ duodenal?
6th through 10th thoracic vertebrae
Where is the location for referred pain due to biliary colic?
Right upperback; midback btwn scapulae; right inter scapular or subscapular areas
Where is the location for referred pain due to pancreatic carcinoma?
Mid thoracic or lumbar spine
What are aggravating factors that increase symptoms of referred pain due to GI/hepatic pathologies?
- Swallowing: esophagus
- Eating: GI
- Movement musculoskeletal
What are relieving factors that decrease symptoms of referred pain due to GI/hepatic pathologies?
- Lean forward: gallbladder*
- Lean to involved side: kidney*
- Leaning forward and sitting upright: pancreas*
- Decrease movement/ rest: muscle or joints
* if rest or change in position relieves the pain there is usually a cyclic progression of increasing frequency, intensity, or duration of pain until rest or change in position is no longer a relieving factor
What are associated S and S with GI?
- nausea
- vomiting
- anorexia
- unexplained weight loss
- diarrhea
- constipation
- early satiety
What are associated S and S with bowel?
- frequency of bowel movements (increased or decreased)
2. melena (blood in feces)
