Liver, Biliary, Exocrine and Pancreas Function

Question 1

What is cirrhosis?

Answer 1

Irreversible scarring of liver tissue, typically due to chronic damage (e.g., alcohol, hepatitis).

Question 2

Define steatosis.

Answer 2

Fatty liver
abnormal fat accumulation in hepatocytes.

Question 3

What is ascites?

Answer 3

Fluid accumulation in the peritoneal cavity, often from portal hypertension or low albumin.

Question 4

What is the function of bile?

Answer 4

A digestive fluid made by the liver that emulsifies fats.

Question 5

What is cholestasis?

Answer 5

Bile flow stoppage.

Question 6

Difference between free and conjugated bilirubin?

Answer 6

Free (unconjugated) is fat-soluble and not yet processed

conjugated is water-soluble and excreted in bile.

Question 7

What are key signs of liver failure?

Answer 7

Jaundice, ascites, encephalopathy, bleeding, fatigue.

Question 8

what are the 6 functions of the liver

Answer 8

production of bile salts
elimination of bilirubin
metabolism of steroid hormones
fat metabolsim
protein metabolism
vitamin and mineral storage

Question 9

what is a normal bilirubin value
and when does jaundice present?

Answer 9

normal: <1.5 mg/dL
jaundice: 2 or 2.5 +

Question 10

what is jaundice?

Answer 10

yellowish discoloration of the skin and deep tissues

Question 11

what is the etiology of jaundice?

Answer 11

imbalance between synthesis of bilirubin and the clearance/excretion

Question 12

Main types of jaundice and causes?

Answer 12

Pre-hepatic: ↑ RBC breakdown (e.g., hemolysis)

Intra-hepatic: impaired uptake by liverHepatic dysfunction (e.g., hepatitis)

Post-hepatic: Bile duct obstruction (e.g., gallstones)

Answer 13

Alcoholism

Chronic hepatitis B or C

toxic rxns to drugs

Biliary disease (e.g., primary biliary cholangitis)

Nonalcoholic fatty liver disease (NAFLD/NASH)

Hemochromatosis (iron overload)

Wilson’s disease (copper overload)

Autoimmune hepatitis

Answer 14

Chronic liver injury

→ Inflammation → hepatocyte death
→ Fibrosis (scarring)
→ Nodular regeneration
→ Disrupted liver architecture and function

→ Portal hypertension develops due to blocked blood flow
→ obstructed bile channels
→ loss of liver cells

Question 15

bile channels carry bile and other dogestive juices to …

Answer 15

GB
small int

Question 16

What happens to liver function in cirrhosis?

Answer 16

↓ Detoxification (ammonia buildup) → encephalopathy

↓ Protein synthesis → hypoalbuminemia → ascites/edema

↓ Clotting factor production → bleeding

↓ Bile production/excretion → jaundice, pruritus

Question 17

What are general symptoms of cirrhosis?

4

Answer 17

Fatigue, weakness, weight loss, anorexia

Question 18

What are skin findings in cirrhosis?

Answer 18

Jaundice
spider angiomas
palmar erythema
pruritus

Question 19

What GI/hepatic symptoms are associated with cirrhosis?

Answer 19

Ascites
hepatomegaly (early)
RUQ pain
nausea, vomiting

Question 20

What hematologic findings occur in cirrhosis?

Answer 20

Easy bruising and bleeding (↓ clotting factors)

Anemia, thrombocytopenia (from splenomegaly)

Question 21

What are endocrine manifestations of cirrhosis?

Answer 21

Gynecomastia

Testicular atrophy

Amenorrhea

Infertility

Question 22

What are neurological manifestations of cirrhosis?

Answer 22

Hepatic encephalopathy (confusion, asterixis)
fetor hepaticus

Question 23

What is cholelithiasis?

Answer 23

The formation of gallstones in the gallbladder.

Question 24

What is the most common type of cholecystitis?

Answer 24

Calculous cholecystitis – inflammation of the gallbladder caused by gallstones obstructing the cystic duct.

Question 25

What are the major risk factors for cholelithiasis?

Answer 25

Female sex (estrogen) Obesity (high fat/cholesterol diet) Anemia Crohn's disease Pregnancy Age (older adults) Diabetes Rapid weight loss Native American or Hispanic ethnicity

Question 26

Describe the pathophysiology of cholelithiasis.

Answer 26

Imbalance in bile components: cholesterol or bilirubin > bile salts → Cholesterol or pigment (bilirubin) precipitates form stones → May obstruct bile flow → inflammation if the cystic duct is blocked

Question 27

manifestations of cholelithiasis

Answer 27

cholecysitis biliary colic pancreatitis cholangitis fever NV murphy's sign digestive issues URQ pain (epigastric, referred pain!)

Question 28

What is portal hypertension?

Answer 28

Increased pressure in the portal vein, typically >12 mmHg (normal is 5–10 mmHg).

Question 29

What causes portal hypertension?

Answer 29

Pre-hepatic: Portal vein thrombosis Intra-hepatic: Cirrhosis (most common) Post-hepatic: Right-sided heart failure, Budd-Chiari syndrome

Question 30

How does cirrhosis lead to portal hypertension?

Answer 30

Scar tissue and nodular regeneration disrupt liver architecture, compressing sinusoids and increasing resistance to blood flow.

Question 31

What are the consequences of portal hypertension?

Answer 31

Ascites Esophageal varices Splenomegaly Hemorrhoids Caput medusae (dilated abdominal veins)

Question 32

What is ascites and how is it related to portal hypertension?

Answer 32

Fluid accumulation in the peritoneal cavity due to: ↑ Hydrostatic pressure (from portal HTN) ↓ Oncotic pressure (from low albumin) Sodium and water retention Leaky lymphatics

Question 33

What are esophageal varices?

Answer 33

Dilated veins in the lower esophagus formed due to portal hypertension; risk of rupture and GI bleeding.

Question 34

Signs and symptoms of ruptured esophageal varices?

Answer 34

Hematemesis (vomiting blood) Melena (black, tarry stools) Hypovolemic shock Anemia Often painless bleeding

Question 35

What is splenomegaly and how does it relate to portal hypertension?

Answer 35

Enlarged spleen due to blood backing up into the splenic vein from portal congestion.

Question 36

What are signs of splenomegaly?

Answer 36

LUQ fullness or pain Thrombocytopenia (low platelets) Fatigue, pallor Increased infection risk

Question 37

What is acute cholecystitis?

Answer 37

Sudden inflammation of the gallbladder, typically due to obstruction of the cystic duct by gallstones.

Question 38

What is chronic cholecystitis?

Answer 38

Long-standing inflammation of the gallbladder, usually due to repeated episodes of acute cholecystitis or chronic gallstone irritation

Question 39

What is the most common cause of acute cholecystitis?

Answer 39

Gallstones (calculous cholecystitis) blocking the cystic duct.

Question 40

What are other causes of acute cholecystitis besides gallstones?

Answer 40

high cholesterol high bilirubin secondary to obstruction of GB outlet

Question 41

What is the pathophysiology of acute cholecystitis?

Answer 41

Gallstone blocks cystic duct → bile stasis → Bacterial overgrowth (E. coli, Enterococcus) → Inflammation, distention, and pain If untreated → gangrene, perforation, peritonitis

Question 42

What are the signs and symptoms of acute cholecystitis?

Answer 42

Severe RUQ pain (esp. after fatty meals) Murphy’s sign Fever, chills Nausea, vomiting Abdominal bloating Jaundice (if bile duct is blocked)

Answer 43

**Recurrent gallstones** **Chronic low-grade infection/inflammation** Biliary dyskinesia (motility issues) Long-standing duct obstruction

Question 44

What are symptoms of chronic cholecystitis?

Answer 44

Intermittent RUQ pain (less severe than acute) Bloating, nausea, belching Indigestion (dyspepsia) Possible jaundice (intermittent obstruction) Murphy’s sign may be present but less pronounced intolerance for fatty foods GB enlarged

Question 45

patho of chronic cholecysitis

Answer 45

varying degrees of chronic inflammation gallstones acute exacerbations of GB inflammation, commin duct stone, pancreatitis, cancer

Question 46

What is acute pancreatitis?

Answer 46

A sudden inflammation of the pancreas due to premature activation of digestive enzymes that begin digesting the pancreas itself.

Question 47

What is chronic pancreatitis?

Answer 47

Long-standing inflammation of the pancreas causing irreversible damage, fibrosis, and loss of both exocrine and endocrine function.

Question 48

What are common causes of acute pancreatitis?

Answer 48

**Gallstones (most common)** **Alcohol use** Hyperlipidemia Trauma Certain medications (e.g., corticosteroids, diuretics) Infections (e.g., mumps) Post-surgical (e.g., ERCP) Idiopathic

Question 49

What are causes of chronic pancreatitis?

Answer 49

**Chronic alcohol use (most common)** Genetic mutations (e.g., PRSS1 gene) Repeated gallstone attacks Hypercalcemia Hyperlipidemia Cystic fibrosis Long-standing duct obstruction (cancer)

Question 50

What is the pathophysiology of acute pancreatitis?

Answer 50

Pancreatic enzymes (trypsin, amylase, lipase) activate inside the pancreas → Autodigestion of tissue → Inflammation, necrosis, and possible hemorrhage → Can lead to peritonitis, SIRS, multi-organ failure

Question 51

What is the pathophysiology of chronic pancreatitis?

Answer 51

Repeated inflammation → progressive fibrosis → Loss of pancreatic acinar cells → ↓ enzyme & hormone production (insulin) → Malabsorption, diabetes, and chronic pain

Question 52

What are clinical manifestations of acute pancreatitis?

Answer 52

Severe epigastric pain (LUQ) (radiates to back) N/V + Fever Tachycardia, hypotension (shock signs) Abdominal tenderness Jaundice (if bile duct obstructed) Grey Turner’s sign (flank bruising) Cullen’s sign (umbilical bruising) ↑ Amylase and lipase

Question 53

What are clinical manifestations of chronic pancreatitis?

Answer 53

Chronic upper abdominal pain (intermittent) pain after eating Steatorrhea (fatty, foul-smelling stools) constipation and flatulence Weight loss (malabsorption) + anorexia Nausea, vomiting Diabetes Jaundice (with bile duct obstruction) Pancreatic calcifications on imaging Malnutrition