Liver Biliary Pancreas

Question 0

Describe prehepatic

Answer 0

1-Caused by excessive hemolysis
The hemolysis being due to diseases that cause an abnormal RBCs

1-due to sickle cell anemia, or
2-hemolytic disease of the newborn

hemolysis mechanical factors
1-rbc’s breaking from hitting artificial heart valves
2-enlarged spleen

Question 1

Jaundice

Cause and classifications (3)

Answer 1

Yellowed skin or sclera
Bilirubin build up to amount of hyperbilirubinemia
Classifications: prehepatic (before liver processes the bilirubin)
Hepatic (problem in the liver)
Post hepatic (problem occurs after the processing in the liver)

Question 2

Hepatic disorders/diseases

define hepatic and name three hepatic disorders.

Answer 2

Bilirubin process gone wrong within the liver;not metabolized - not released into the bile.
Hepatitis
tumors
Cirrhosis

Question 3

Posthepatic

Define and name four types of disorders

Answer 3

Posthepatic occurs after the file gets excreted from the liver. Blockages from gallstones and tumors can obstruct the flow of bile; the bile cannot leave the liver normally. 
1-Gallstones 
2-tumors of the biliary ducts 
3-tumors of the ampulla of Vater 
4-tumors of the pancreas

Question 4

Define Hepatitis

name two types of hepatitis

Answer 4

Hepatitis is inflammation of liver tissue not referring to a bacterial problem
two types -viral forms, one is toxic such as alcohol

Question 5

Viral hepatitis name the four different forms

Answer 5

Hepatitis A -hepatitis B - hepatitis C - hepatitis D - hepatitis E - etc. variable symptoms and the closer they are to the beginning of the alphabet the more common they are
Most common or A, B, C

Question 6

What type of virus is hepatitis A ? how is it spread? what is the incubation? How prevalent? what are the symptoms and major complications?

Answer 6

hepatitis A. is an RNA virus. Spread via feces or oral. Short incubation 15 to 50 days. most prevalent children in undeveloped nations. symptoms mild fever vomiting jaundice. Major and rare complications cirrhosis. Disease can be tracked.

Question 7

hepatitis B

what kind of virus is it? how is it spread? What is incubation period? What are the symptoms?

Answer 7

Hepatitis B is a DNA virus.
Spread infected blood body fluids
Incubation 40 to 180 days
symptoms in three phases

first preicteric - weakness, nausea, vomiting, tender liver
Second icteric - variable levels of jaundice (icteric or icteris is jaundice)
Third convalescent - not all patients recover. Can become chronic hepatitis or liver cancer. Cancer can be fatal

Question 8

Hepatitis C.
what kind of a virus? How is it spread?
Who most commonly gets it? what is the incubation? What are the symptoms?

Answer 8

Hepatitis C
is an RNA virus
spread through blood body fluids
most cases drug abusers
incubation similar to hep B
symptoms similar to B but less severe but potential complications.
80% of infected will recover 20% will have chronic hepatitis C and die of liver failure or cancer. Previously spread through transfusions. Long incubation period.

Question 9

Explain which hepatitis is least problematic and which hepatitis is worse. Which hepatitis has an immunization?

Answer 9

Hepatitis C is worse than hepatitis A and not as bad as hepatitis B. Hep C 80% of infected will recover and 20 will have chronic and then die of liver failure or cancer.
hepatitis B has an immunization. Hepatitis a has an immunization offered if you are going to a foreign country. No immunization for hepatitis C.

Question 10

Toxic forms of hepatitis.

Alcoholic liver disease

Answer 10

Early symptoms are fatty liver which is called steatosis. Later in the disease is alcoholic hepatitis with similar symptoms without the viral changes.

Question 11

Hemochromatosis
explain what kind of a disorder this is (meaning genetically)
what does it lead to?

Answer 11

Hereditary autosomal recessive disorder. The defect of iron absorption. Liver stores iron; the defect is in the storing which results in excessive amounts of iron. Iron damages liver cells if prolonged and scarring will develop which will lead to cirrhosis. Liver turns unnatural brown. Excessive accumulation of iron can be in the liver and in other organs.

Question 12

Wilson’s disease what type of disease is this (genetic)?

Explain what it is and what it leads to.

Answer 12

Hereditary autosomal recessive disorder.
Defect in copper metabolism.
Lesions in the liver, brain and eye. Toxic to these organs.
In the eyes brownish discoloration of the iris called Kaiser Fleischer rings.

Question 13

Alpha-1 antitrypsin deficiency
what type of disease is this
and what does it lead to?

Answer 13

A hereditary autosomal recessive disorder
Cholestasis which means the buildup of bile
most of these diseases are not diagnosed in children but it can lead to chronic hepatitis in young children.

Question 14

Biliary system
immune disorders
name two diseases

Answer 14

Primary biliary cirrhosis
primary sclerosing cholangitis

Both diseases destroy biliary system in the cause obstruction. Antibodies attack the bile ducts then there is no way for the bile to get out of the liver.

Question 15

Cirrhosis describe the process

Answer 15

Chronic liver disease also known as the end stage of any liver disease. All of the diseases discussed can advance and end in cirrhosis. Cirrhosis is irreversible. It is the loss of function caused by extensive scarring.

Question 16

Name six causes of cirrhosis

Answer 16

1- alcohol
2- viral hepatitis
3- hereditary metabolic diseases such as hemachromatosis, Wilson’s disease, alpha-1 anti-trypsin deficiency
4-auto immune diseases such as primary biliary cirrhosis and primary sclerosing cholangitis
5-drugs
6-biliary obstruction such as cystic fibrosis or gallstones

Question 17

Pathogenesis of cirrhosis
list three

Pathology of cirrhosis
List two modes of examination

Answer 17

1-necrosis of liver cells
2-repair by fibrosis
3-regeneration

Gross examination - firm liver tissue with a nodular appearance
Microscopically - extensive scarring

Question 18

Clinical features of cirrhosis

list multiple complications to the disease

Answer 18

Coma - hepatic encephalopathy
Jaundice
Telangiectasias - facial and capture medusae  v.              (vessels engorged and broken peers on face and belly)
Ascites
Esophageal varices
Purpura/edema of the lower extremities
Splenomegaly
Gynecomastia
Absent or reduced pubic hair or small testes

Question 19

Infections of the liver

Answer 19

Ascending: is the most prevalent in the United States
bacterial inflammation of the bile duct
bacteria is from the small bowel
bacterial ascends up to the liver

Question 20

Gallbladder disease

Name two

Answer 20

Cholelithiasis and cholecystitis
gallstones from cholesterol (yellow green stones) or composed of bilirubinate (pigmentary) (Black from excessive bilirubin)
Cholecystitis often preceded by cholelithiasis because of the obstruction of the ducts bladder is inflamed

Question 21

Neoplasms of the biliary system

name four types of cancers

Answer 21

Metastatic tumors are the most common liver tumors found in US
Hepatocellular carcinoma very malignant, and where hepatitis is prevalent
Bile duct cancer a.k.a. Colangiocarcinoma very malignant poor five-year survival
Carcinoma of the gallbladder caused by irritation of lining

Question 22

Pancreatitis

Answer 22

Not usually infectious (Usually caused by obstruction)
sterile inflammation caused by tissue destruction of the pancreas itself
occurs in three forms
acute edematous
acute
chronic

Question 23

Acute Edematous pancreatitis

describe

Answer 23

Mild form
symptoms do not usually require treatment
is usually evidenced in autopsy

Question 24

Acute pancreatitis

describe

Answer 24

Tissue damage from: Obstruction of Main pancreatic duct
mechanical disruption
chemical injury
overstimulation of acinar cells leads to hemorrhagic reaction within the tissue and edema and necrosis
Complications are peritonitis and pseudocyst formation
pseudocyst is a hole in the tissue

Question 25

Chronic pancreatitis

Answer 25

Inflammation slower and more progressive, leads to scarring, greater than 70% associated alcoholism/abuse.
Complications are pain, exocrine insufficiency due to malabsorption problems, endocrine insufficiency leads to diabetes mellitus.

Question 26

Pancreatic neoplasms - adenocarcinoma

Name for important points

Answer 26

1-Most important tumor of the pancreas
2-fourth leading cause of cancer related deaths in males and fifth in females in US
3-risk factors not understood only smoking
4-clinically - weight loss, appetite loss, nausea, tumors invade locally and metastasize widely, less than 5% five-year survival prognosis.

Question 27

Tumors of the endocrine cells -Islet cell tumors- uncommon
name the cells of islet of langorhans
Describe

Answer 27

Alpha cells
beta cells - insulinoma causes Hyperinsulinemia
Delta cells
Benign tumors

Question 28

Diabetes mellitus
name where the disease originates
name two types

Answer 28

Type one diabetes 
younger onset 
sudden onset 
antibodies to islet cells can be demonstrated 
loss of beta cells
Type two diabetes 
older onset 
gradual 
association with obesity 
normal number of beta cells

Question 29

Describe diabetes clinically

name six points

Answer 29

1-Hyperglycemia
2-the 3P’s –polydipsia –polyurea –polyphagia
excessive thirst - urination - hunger
vascular changes -increased artheriosclerosis
susceptibility to infections -hyperglycemia encourages bacterial growth

Question 30

Diabetes complications name five

Answer 30

Heart disease, 
stroke, 
gangrene 
kidney complications - renal failure 
Eye complications can lead to blindness