Liver, Gallbladder, and Pancreas Diseases Flashcards
The liver accounts for approximately _____% of total body weight.
2 to 3%
The liver contains a ______ and a ____ area with which three vessels?
central area
portal Triad: (largest to smallest)
- hepatic portal vein,
- common bile duct
- proper hepatic artery,
What are the physiological functions of the liver?
- MAINTAIN metabolic homeostasis
- SYNTHESIZE serum proteins
- DETOXIFY xenobiotics and waste products
- act as a FUNCTIONAL RESERVE
- REGENERATE to mask hepatic injury
True or False: 60-70% of the liver can be removed and the functional reserve capacity allows it to regenerate within 6 to 8 months.
True
What are the possible liver responses to injury (5 options)?
- Degeneration of hepatocytes/accumulation of toxic products
- Necrosis
- Inflammation (helps or impedes healing)
- Regeneration
- Fibrosis (loss of function over time)
Liver necrosis and inflammation involves many cells (apoptotic cells, eosinophils, etc), but the inflammation process is usually _____ -based.
T-cell
________is a slowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properly
Cirrhosis
A liver affected by cirrhosis will display ______ scar tissue (fibrosis) and an increased number of ________ hepatocytes.
DIFFUSE (not focal, the whole liver will show damage)
regeneration hepatocytes
True or False: Cirrhosis is among the top 10 causes of death in US adults.
True
Cirrhosis is the ______ route of liver-related death.
primary
What are the five main causes of cirrhosis (from most to least common)?
- Alcohol abuse
- Viral Hepatitis (HepC in particular)
- Non-Alcohol Steatohepatitis (NASH=fat buildup)
- Biliary Disease
- Iron Overload
“(A)lcoholics (H)ave (N)asty (B)reath (I)ncluded” with cirrhosis
What type of changes occur in the liver that will ultimately lead to loss of hepatic function?
Fibrosis (bridging septae) with parenchymal nodules
Which type of staining can be used to evaluate cirrhosis histologically?
H&E
Trichrome (blue staining collagen)
What are the symptoms associated with Cirrhosis?
Weight Loss
Liver Failure
Portal Hypertension (ASCITES, splenomegaly, collateral venous channels)
Cirrhosis can result from alcohol abuse due toxic damage or _______ _______. Other causes of cirrhosis include obesity, Diabetes M, and Medication.
nutritional deprivation
Jaundice (aka: icterus) results from the presence of excess _____.
bilirubin
What is the normal amount of bilirubin? What is seen in the case of jaundice?
Normal: 1.1 - 1.2 mg/dL
greater than 2.0mg/dL
Unconjugated bilirubin is _____ and ______. Conjugated bilirubin is ______ and _______.
Un = insoluble and toxic Con = soluble and nontoxic
Other than the overproduction of bilirubin, how can excess accumulation occur?
reduced hepatocyte uptake and obstruction of bile flow
What is the #1 cause of Jaundice?
HEMOLYTIC ANEMIA
What is hepatitis?
hepatocyte injury that is associated with inflammation
True or False: There is a similar pattern of liver injury from hepatitis regardless of the causative agent
True
What are the causative agents of hepatitis?
viruses
autoimmune
drugs
toxic agents
Hepatitis A is a ______ virus that is spread via _______ transmission.
RNA
fecal-oral
Is there a chronic disease or carrier state with Hep A?
No
What is the incubation period for Hep A?
2-6 weeks
Hepatitis B is a ______ virus that is spread via ______ transmission
DNA
parenteral or sexual
What is the incubation period for Hep B?
4-26 weeks
Hep B infections will remain in the blood. How effective are Hep B vaccines?
95% protective antibody response
Is there a chronic disease state with Hep B?
YES, chronic liver disease, cirrhosis, or carrier-state
What percentage of Hep B infections are subclinical and lead to recovery?
60-65%
Hepatitis C is a _____ virus that is spread via ______ transmission.
RNA
parenteral or sexual
What is the incubation period for Hep C?
7-8 weeks (acute phase is asymptomatic)
Is there a chronic disease state of Hep C??
YES! the majority progress
chronic liver disease, cirrhosis, or carrier-state
What are the “hallmark features” of HepC (occurs 85% of the time)?
Persistent infection + chronic hepatitis
Is there an effective Hep C vaccine?
NO! Hep C is too genomically unstable (variable)
Both Hep B and Hep C infections pose a high risk for _______ ________.
Hepatocellular Carcinoma
Is there treatment for Hep C?
Previously: interferon and ribaviron (only moderate response)
Now: PROTEASE and NUCLEOSIDE INHIBITORS
(Harvoni is a combination of the two that is curative in most patients)
How long of a drug course is Harvoni? What are the side effects and down-sides to its use?
8-24 weeks
Side effects: fatigue and headache
Expensive: $100,000-$150,000
How quickly does Acute Viral Hepatitis resolve?
~8 weeks
What are the symptoms of Acute Viral Hepatitis?
Sometimes none (serologic only) Possible Symptoms: -anorexia -fatigue -joint aches -jaundice
What is the histological sign for acute viral hepatits?
PanLobular Disarray
Inflammation
Hepatocyte necrosis
True or False: Acute Viral Hepatitis can transition into a chronic state (Hep B or Hep C)
True
Chronic Hepatitis is defined as abnormal liver function for more than ______.
6 weeks
What are the three main features of Alcohol Liver Disease?
- Hepatic Steatosis (Fatty Change)
- Cirrhosis
- Alcoholic Hepatitis
_____% of chronic liver disease is associated with alcohol overconsumption.
60
_____% of deaths associated with alcohol liver disease are due to cirrhosis.
40-50
Hemochromatosis is a genetic disorder in which the body loads too much _____.
iron
Excess iron will usually accumulate in the _____, _____, and _____.
liver
pancreas
heart
Hemochromatosis is a _________ genetic disorder or can be caused by secondary overload due to ______.
autosomal recessive (HFE gene mutation)
excessive iron intake (supplement use)
Hemochromatosis puts a patient at increased risk for many diseases (DM, cancers, arthritis, heart attack, etc). How is the disease treated?
- Phlebotomy (blood removal)
- Dialysis
- Iron Chelation Therapy (with EDTA-like molecules)
What are the features (pathogenesis) of Hemochromatosis?
Micronodular Cirrhosis
hepatosplenomegaly
Skin Pigmentation
Diabetes
What is Wilson’s Disease?
an autosomal rescessive disease that results in
COPPER accumulation in the liver, brain and eyes
What type of chelation therapy is used for Wilson’s Disease?
D-Penicillamine
In what forms do Hepatic Tumors present?
- cysts
- bile ducts
- hemangiomas
- hepatocyte
True or False: Hepatic Tumors will commonly result due to metastasis.
True, the liver has a rich blood supply and is an important filter for many organs
(common: colon, lung, breast)
What is a Cholangiocarcinoma?
a carcinoma that arises in the bile ducts inside/outside of the liver
- very aggressive
- asymptomatic until late stage detection
Hepatocellular adenoma is a _____ tumor that is associated with the use of _________.
benign
oral contraceptives
How does hepatocellular adenoma present clinically and histologically?
CLINCAL: Acute abdomen (pain, nausea) intra-abdominal bleed
HISTOLOGY:
bland hepatocytes
no bile ducts
Hepatocellular _______ is the third leading cause of cancer deaths in Western countries.
carcinoma
Is hepatocellular carcinoma more common in men or women?
H. Carcinoma is more common in men (3:1)
In 90% of Hepatocellular Carcinoma cases, ______ is the precursor. Hep B and Hep C could also lead to this form of carcinoma.
Cirrhosis
True or False: There is a low chance for vascular invasion with Hepatocellular Carcinoma.
False, strong propensity for invasion
How is Fibrolamellar Carcinoma distinguishable from Hepatocellular Carcinoma?
Fibrolamellar = YOUNGER patients (20-40s), no known risk factors, “Scirrhous tumors” with collagen surrounding them
What is the treatment and prognosis for Hepatocellular vs Fibrolamellar Carcinomas?
HCC: Tx = resection if focal, or liver transplant
Prognosis = grim, new foci may develop
FLC: Tx = surgery
Prognosis = better, 32% 5 yr survival
Which are more common: metastatic or primary tumors?
Metastatic
60-70% of gallbladders will share a common orifice with the ______.
pancreatic duct
What is Cholelithiasis? How common is it?
gallstones
common: 10-20% of adults
True or False: Most gallstones are silent.
True, 80% are silent
What two types of stones are present in the gallbladder?
cholesterol stones: 80%
Pigment stones: 20%
Radiographically, cholesterol stones are mostly _____ and pigmented stones (ex. bilirubin) are ________
radiolucent
radiopaque
What are the risk factors for Cholesterol Gallstones?
Higher prevalence in:
- caucasians
- females
- later age
- estrogen use
What are the risk factors for Pigmented Gallstones?
- hemolysis (hemolytic anemia)
- GI disorders
- biliary infection
Cholecystitis (inflammation of the gall bladder) is more common in _______. There is an acute and chronic form.
women age 40-60
What are the symptoms of acute cholecystitis?
Severe upper right quadrant pain
chemical, bacterial, reflux-ischemia
What are the symptoms of chronic cholecystitis?
symptoms are vague
90% formation of stones
fibrosis + inflammation
What is the five year survival rate for adenocarcinomas of the gallbladder?
5%
How common are carcinomas of the gallbladder?
5th most common among GI malignancies
Gallbladder adenocarcinoma is most common in _______ and _______ with a peak age of ______.
whites
females
70 years
Histologically, gallbladder cancer appears as _______ that replace normal crypts.
burrowing, thread-like growths
The pancreas has both _____ and ______ functions.
exocrine
endocrine
Endocrine Cells (Islets) account for ____ % of the pancreas; whereas, the exocrine cells (acini and ducts) account for the remainder.
1 to 2%
What is the endocrine function of the pancreas?
regulates glucose homeostasis via insulin and glucagon
What is the exocrine function of the pancreas?
food digestion via release of amylase, trypsin, chymotrypsin, and lipase
“Lets T.A.L.C about the enzymes of the pancreas”
80% of Acute Pancreatitis cases involve which three conditions?
- cholelithiasis
- biliary tract disease (many gallbladders share orifice)
- alcoholism
What are the potential causes of acute pancreatitis?
gallstones biliary tract disease alcoholism trauma drugs septisemia/infection hypercalcemic states (metabolic) idiopathic (genetics?)
Acute pancreatitis causes a release of ____ and inflammation proteolysis. There is also fat necrosis and ____ necrosis with hemorrhage.
lipases
vessel
True or False: there is an elevation in enzymes with acute pancreatitis.
True, amylase and lipase
What are possible complications of acute pancreatitis?
organ failure
abscess
8% mortality
Chronic pancreatitis is a progressive destruction with early loss of the ______functioning and later loss of the ______ functioning.
(1st) EXOcrine
(2nd) ENDOcrine
What is the morphological presentation of chronic pancreatitis?
- reduction in acini
- chronic inflammation
- fibrosis
- obstruction of ducts
- spare islets
Behind Lung, Colon, and Breast Cancer, ______ Tumors are the 4th leading cause of cancer death in the USA.
Pancreatic Exocrine Tumors
due to late stage detection
Most pancreatic carcinoma patients will die within _____ of detection.
6 months
______ doubles pancreatic cancer risk.
smoking
Which diseases will also increase risk of pancreatic carcinoma?
diabetes mellitus
chronic pancreatitis
When is the peak age for pancreatic carcinoma?
6th-7th decade (silent growth)
Describe the structure of the pancreatic carcinoma.
ill-defined
gritty
gray-white
hard
Cancers at the head of the pancreas will obstruct the ______ and cause jaundice. Cancers at the body or tail region will be clinically _____.
common bile duct
silent (and large at the time of diagnosis)
