Liver, Biliary, and Pancreas Flashcards
What organ is responsible for converting glucose to glycogen?
Liver
What organ is responsible for lipid and protein metabolism?
Liver
What organ is responsible for the synthesis of prothrombin? (and other clotting factors)
Liver
What organ is responsible for production and storage of vitamin A and D?
Liver
What organ is responsible for storing vitamin B12 and iron?
Liver
What organ is responsible for metabolizing drugs and alcohol?
Liver
What organ is responsible for producing bile and bile salts?
Liver
What organ is responsible for excreting bilirubin?
Liver
What is bilirubin made from?
Break down of hemoglobin
Unconjugated bilirubin travels to the liver to become what?
Conjugated
After bilirubin is conjugated what happens?
It is excreted into the intestine where it aids in digestion
Do liver dysfunction and a prolonged INR go hand and hand?
Yes
What is the largest internal organ and is also essential?
Liver
Where does the liver get its rich blood supply from?
Hepatic artery and femoral vein
What types of jaundice are there?
- Hemolytic
- Hepatocellular
- Obstructive
Which type of jaundice has a breakdown of RBCs which causes an increase in bilirubin in the blood?
Hemolytic
-Transfusion reactions
-Sickle Cell Crisis (SCC)
-Hemolytic anemia
… are all situations in which what kind of jaundice may be seen?
Hemolytic
The altered ability of the liver to take up bilirubin from blood, conjugate or excrete is the cause of what type of jaundice?
Hepatocellular
-Hepatitis
-Cirrhosis
-Hepatic carcinoma
… are all situations in which what kind of jaundice may be seen?
Hepatocellular
The obstructed flow of bile through liver or biliary duct system, is the cause of what type of juandice?
Obstructive
-Intrahepatic
-Extrahepatic
(Ex: gallstones, swelling, etc)
… are instances in which what type of jaundice may be seen?
Obstructive
What is it called when there is yellowing of the skin, sclera (eyes), dark urine (bilirubin was never conjugated), chalky-grey stool, and itching (accumulation of bile salts beneath the skin) ?
Juandice
What is used to treat itching caused by jaundice?
- Benadryl (antihistamine)
- Hydroxyzine/Vistaril
- Steroid creams
What liver function tests are there?
- Serum bilirubin (will be elevated with liver problems)
- Alkaline phosphatase (ALP)
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT)
- Liver biopsy
When will ALP be elevated?
with biliary obstruction
When will ALT be elevated?
with liver damage or inflammation
Because there is risk of bleeding with a liver biopsy, what techniques helps to stop the bleeding?
Lie flat or on R side to splint site
In what disease is there widespread inflammation of liver tissue causing hepatic cell degeneration and necrosis?
Hepatitis
Can hepatitis have several types and acute or chronic?
Yes
What form of Hep is transmitted through the fecal-oral route generally through contaminated food?
Hep A
How long are you infectious with Hep A?
2 weeks before s/s and 1-2 weeks after
Are immunoglobulins produced in response to a Hep A infection?
Yes
IgM anti-HAV indicates what type of Hep A infection?
Acute
IgG anti-HAV indicates what type of Hep A infection?
Chronic
What forms of immunoglobulins are associated with Hep A?
IgM and IgG
is there a Hep A vaccine?
Yes
Is the Hep A vaccine effective if given up to 2 weeks after exposure?
yes
What are the symptoms of Hep A?
- Flu-like
- Juandice
What is important to teach in the prevention of Hep A?
Good hand washing
Is Hep B a blood Bourne pathogen?
yes
What type of Hepatitis is transmitted through
percutaneous/mucosal exposure/ sexual contact/ prenatal?
Hep B
How long are you infectious with a Hep B infection?
Before and after s/s, for about 4-6 months
Can Hep B be transmitted through all body fluids?
Yes
What type of Hepatitis is spread through percutaneous/ mucosal exposure/ high-risk sexual contact (anal)/ and perinatal?
Hep C
How long are you infectious with a Hep C infection?
1-2 weeks before s/s and continuous during clinical course, indefinite with carriers
How is Hep C treated?
Combination antivirals
The use of combination antivirals for the treatment of Hep C depends on what?
Genotype
Can Hep C be curative?
Yes
Can Hep C treatment be expensive?
Yes
What are s/s of Hep C?
- may be asymptomatic
- body aches
- flu-like
- anorexia
Is it possible to be a lifetime carrier of Hep B?
Yes
Is there a Hep B vaccine?
Yes (95% effective)
How is Hep B treated?
Post exposure prophylaxis
- Hep B vaccine
- HBIG (immune globulin)
-H and P
-Liver function studies
-Hepatitis testing
-genotype testing
… are diagnostics done to diagnose what?
Hepatitis infections
-Well-balanced diet
-Vitamins
-Rest (essential in promoting hepatocyte regeneration)
-Avoid alcohol
-Drug therapy (antivirals)
… are forms of acute and chronic care for what?
Hepatitis infections
If someones albumin is low what is common to see?
- Edema
- Ascites
What disease has irreversible fibrosis and degeneration of the liver?
Cirrhosis
What types of causes are there for cirrhosis?
- Alcohol
- Post-necrotic
- Biliary
- Cardiac
Can long tern right-sided heart failure cause cardiac cirrhosis?
Yes
Can chronic biliary obstruction and infection cause biliary cirrhosis?
yes
Can Hepatitis B, C, and industrial chemical exposure cause post-necrotic cirrhosis?
Yes
Why does long-term right sided heart failure cause cirrhosis?
Liver becomes congested with extra fluid which damages the liver cells
Can some liver cells regenerate?
Yes
What liver cells can not regenerate?
Fibrotic
Does cirrhosis have multi system manifestations?
Yes
-Portal hypertension
-Esophageal varices
-Peripheral edema
-Ascites
-Hepatic encephalopathy
-Hepatorenal Syndrome
… are all potential complications of what?
Cirrhosis
-increased BP in portal vein
-Collateral circulation or shunting
-Increase hydrostatic pressure
… are characteristics of what?
Portal hypertension
What is esophageal varices due to?
Portal HTN
Is esophageal varices life-threatening?
Yes
Can esophageal varies bleed by a slow ooze or a massive hemorrhage?
Yes
-Enlarged blood vessels on the nose
-Red palms due to increase in circulating estrogen which liver normal metabolizes
… are visible manifestations of what?
Cirrhosis
What is caused due to a decrease in colloidal osmotic pressure/ impaired synthesis of albumin?
Peripheral edema
Where is edema typically seen in peripheral edema?
Anke and pre sacral (edema up to groin sometimes)
What is the accumulation of fluid in the peritoneal or and cavity?
Ascites
What is caused due to portal hypertension and the increased flow of hepatic lymph?
Ascites
When is a decrease in serum colloidal oncotic pressure, hyperaldosteronism, and impaired water excretion seen?
In ascites
Impaired ammonia metabolism is the cause of what?
Hepatic encephalopathy
Are there neurological status changes seen with hepatic encephalopathy?
yes
Can hepatic encephalopathy cause someone to be lethargic or even a deep coma?
Yes
Ammonia which accumulates in hepatic encephalopathy is toxic to the brain, how are ammonia levels commonly reduced?
With use of lactulose
-Disorientation
-asterixis * (flapping tremor)
-hyperventialtion
-hypothermia
-grimacing and grasping reflex
-fetor hepaticas (sweet breath odor)
… are signs of what cause by hepatic encephalopathy?
an impending coma
what does the liver usually convert ammonia to?
Urea
What does abdtunded mean?
slow to respond
-Rest
-B-complex vitamins
-Avoid alcohol, ASA, acetaminophen, and NSAIDs
… are ways conservative therapy is used to treat what?
Cirrhosis
How is ascites managed?
- Low sodium diet
- Diuretic
- Paracentesis (if indicated)
What drugs are used to manage varices?
- Non selective beta blockers (to lower BP and HR)
- Octreotide (lower portal HTN pressure)
- Vasopressin (can decrease active bleeding/vasoconstricts)
Band ligation or sclerotherapy, ballon tamponade or shunting is used to manage what?
Varices
How is hepatic encephalopathy managed?
Antibiotics (Rifaximin) and lactulose
Can patients with ascites be dehydrated if they have ascites?
Yes fluid in abdomen is taking fluid needed elsewhere away
Is spironolactone (a potassium sparing diuretic) used to help with ascites?
Yes
Should you monitor daily weights, Intake and output, and abdominal girth for someone with cirrhosis?
Yes
What is the Blakemore-Sengstaken Tube used for?
To stop or slow bleeding in esophagus or stomach from varices
Inflammation of the pancreas which can be acute or chronic is called what?
Pancreatitis
Can acute pancreatitis be life-threatening and range from mild edema to severe hemorrhage from pancreatic vessels?
Yes
Where do people with pancreatitis have pain?
LUQ
-Sever abdominal pain in back or flank that is increased with eating
-N/v, Fever, Leukocytosis, hypocalcemia
- Juandice
-Crackles
-Decreased or absent bowel sounds
-Increased serum amylase and lipase**
-Abdominal wall with areas or cyanosis or greenish or yellow discoloration
-Ecchymosis
… Are manifestations of what disease?
Acute pancreatitis
Where is ecchymosis seen in people with acute pancreatitis?
- Cullen’s (periumbilical)
- Grey Turner’s (Flank)
-Pleural effusion
-Atelectasis
-Pneumonia
… can be pulmonary complications from what?
Acute pancreatitis
Tetany/hypocalcemia can be a complication from acute pancreatitis, what signs should you assess for?
- Chvostek’s
- Trousseau’s
Can gullstones cause pancreatitis?
yes
What do you give a patient with acute pancreatitis who is is symptomatic to tetany?
Calcium gluconate
Why should you watch for hyperglycemia in patient s with acute pancreatitis?
If beta cells of pancreas are injured, may see difficulty in insulin production
Is a raised level of serum amylase and lipase seen in pancreatitis?
Yes
Is there a poor prognosis with a pancreatic cancer diagnosis?
Yes
What is removed during a Whipple procedure for pancreatic cancer?
- Head of pancreas
- The first part of the small intestine (duodenum)
- Gallbladder
- Bile duct
If there is a tumor in the tail of the pancreas will you see jaundice right away?
No, you will as it progresses
Is staging important in the treatment plan of pancreatitis?
yes
Are chemo and radiation often used for pancreatic cancer?
Yes
Inflammation of the gallbladder is called what?
Cholecystitis
Stones in the gallbladder is called what?
Cholelithiasis
Bile is overly saturated (usually with cholesterol) and it precipitates out in what disease?
cholelithiasis (gallstones)
-RUQ pain: usually after eating
-N/V
-Juandice
-Intolerance of fatty foods
-Itching
-Steatorrhea
-Clay-colored stools
-Bleeding tendencies
… are manifestations of what?
Cholelithiasis and Cholecystitis
Do cholelithiasis symptoms depend on if the gallstones have moved?
yes
Why are there bleeding tendencies associated with cholelithiasis and cholecystitis?
Decrease absorption of vitamin K from diet
A laparoscopic cholecystectomy is the gold standard for the treatment of what?
Cholecystitis (and cholelithiasis?)
Can a cholecystectomy also be done through and open incision?
Yes
Is a T-tube commonly placed after a open cholecystectomy to drain bile?
Yes
What is a ERCP (short for endoscopic retrograde cholangiopancreatography)?
is a procedure used to diagnose diseases of the gallbladder, biliary system, pancreas, and liver
What is it called when shock waves are use to break up stones in the gallbladder to be passed?
Lithotripsy
Can people who have had a laparoscopic cholecystectomy return to work in 1 week and resume a usual diet (sometimes after a few weeks of a low-fat diet)?
Yes
-Obesity
-People who have had multiple children
-Oral contraceptives
… put people at higher risk for what?
Gallbladder disease
