Liver, Pancreas, Biliary tract

Question 1

discuss viral hepatitis

Answer 1

widespread inflammation of the liver caused by VIRAL infection

Question 2

what cells are destroyed in hepatitis?

Answer 2

hepatocytes (liver cells). so during an acute infection, the hepatocytes are destroyed which leads to liver cell necrosis

Question 3

why do we care so much if the liver is damaged?

Answer 3

liver is responsible for protein metabolism, blood coagulation and bile production (cholestasis - impaired flow of bile)

Question 4

what happens when the infection is resolved?

Answer 4

liver cells regenerate and resume normal function unless liver cell loss is massive and repair is not possible.

chronic infection can lead to scar tissue development

Question 5

what are the 5 types of hepatitis? WATCH VIDEO ON THIS

Answer 5

1) hep A : fecal - oral

2) hep B : exposure to blood products, sexual contact

3) Hep C : blood exposure, sexual contact

4) Hep D : HBV must precede

5) Hep E : fecal-oral outbreaks so drinking contaminated water

Question 6

which are vaccine preventable and which require medication therapy

Answer 6

Hep B - vaccine
Hep C, D - medication therapy

Question 7

what are 8 disorders of the liver?

Answer 7

1) non-alcoholic syndrome : fat in liver causing inflammation and fibrosis

2) non-alcoholic steatopepatitis (NASH) - SEVERE liver scarring aka cirrhosis

3) Alcohol associated liver disease : spectrum of liver injury as a result of alcohol use ranging from simple liver fat aka steatosis to alcohol related excess fat deposits

4) autoimmune hepatitis : body attacks its own liver cells

5) Wilson disease : autosomal recessive disorder of copper transport affecting liver, brain, eyes and kidneys

6) hereditary hemochromatosis : inherited genetic disorder affecting liver, heart, pancreas, and endocrine system

7) primary biliary cholangitis: chronic and slowly progressive disease of small bile ducts of the liver

8) primary sclerosing cholangitis - chronic inflammation, fibrosis and strictures of medium and large bile ducts inside and outside the liver

Question 8

what is cirrhosis?

Answer 8

chronic liver inflammation usually caused by excessive alcohol ingestion. alcohol has direct hepatic effect causing cell necrosis and fatty infiltration.

Question 9

why do you get fibrosis from cirrhosis?

Answer 9

your body tries to regenerate the nodules of the liver to repair itself but it just causes massive fibrosis. this leads to abnormal shape and size of liver and impeded blood flow

Question 10

what are the clinical manifestations of cirrhosis?

Answer 10

jaundice - livers inability to excrete bilirubin or obstruction of biliary tract (known as obstructive jaundice with pruritus from accumultion of bile salts under the skin)

skin lesions
1) spider angiomas - small dilated blood vessels with bright red centers
2) palmar erythema - red area that blanches with pressure on palms

endocrine disturbances - liver metabolizes adrenocortical hormones, estrogen and testosterone. can see hypoaldosteronism (sodium retention and water retention

peripheral neuropathy - dietary deficiency of thiamine, folic acid and cobalamin (Vitamin B12)

Question 11

What are 4 complications of cirrhosis?

Answer 11

1) portal hypertension and esophageal and gastric valves -impaired blood flow through portal and hepatic veins = portal hypertensions. can do varices but they are fragile and do not tolerate high pressure

2) peripheral edema and ascites

3) hepatic encephalopathy

4) hepatorenal syndrome

WATCH YOUTUBE

Question 12

what are diagnostic test for cirrhosis?

Answer 12

CBC, CT/MRI, Liver enzyme test, Liver function (albumin, bilirubin, INR), Liver biopsy

Question 13

what are the inter professional care for advanced cirrhosis?

Answer 13

goal is to slow down progression by treating ethology and manage symptoms/complications

ascites - diuretics, low sodium, paracentesis
varices - prevent bleeding, ballon tamponade, meds
hepatic encephalopathy - antibiotics, lactulose
TIPS procedure - interventional radiological procedure where hypertensive portal vein is connected with normotensive hepatic vein by a stent to redirect portal flow and pressure

Question 14

Discuss acute liver failure

Answer 14

rapid deterioration of liver function resulting in encephalopathy and coagulaopathy

usually caused by medications (acetaminophen) in combination with alcohol

Question 15

what do we see with acute liver failure?

Answer 15

Elevated bilirubin + LFTs, prolonged PT, hypoglycemia

Question 16

discuss acute pancreatitis

Answer 16

inflammation of the pancreas usually caused by spillage of pancreatic enzymes into surrounding tissues which causes auto digestion, bleeding and severe pain

Question 17

what is the range for acute pancreatitis?

Answer 17

Ranges from mild (edematous or interstitial pancreatitis) to severe
(necrotizing pancreatitis)
* Permanent decrease in endocrine/exocrine function after severe disease

Question 18

what is acute pancreatitis linked to?

Answer 18

Gallbladder disease (stones causing blockage), alcohol use, and
hypertriglyceridemia common etiologies

Question 19

what is the key manifestations for acute pancreatitis?

Answer 19

LUQ/mid epigastrium abdominal pain

paralytic ileus

Question 20

what are the 3 complications of acute pancreatitis?

Answer 20

1) pseudocyst - accumulation of fluid pancreatic enzymes, tissue debris and inflammatory exudates next to the pancreas. this causes abdominal pain

2) abscess - pseudocysts gets infected

3) cardiopulmonary complications

Question 21

what are diagnostic studies of acute pancreatitis?

Answer 21

endoscopic ultrasounds, ERCP/MRCP, flat-plate radiograph of the abdomen

serum amylase, calcium, lipase, triglycerides

Question 22

what are inter professional of acute pancreatitis?

Answer 22

relieve pain, control fluid and infection

Question 23

discuss chronic pancreatitis

Answer 23

Continuous, prolonged inflammatory and fibrosing process of the
pancreas

• Interventions same as acute pancreatitis

Question 24

discuss pancreatic cancer

Answer 24

Most often adenocarcinoma originating from epithelium of ductal system

As tumor grows, the common bile duct becomes obstructed, and obstructive jaundice develops

Question 25

discuss the Whipple procedure

Answer 25

Proximal pancreas, duodenum, distal segment of common bile duct, distal
part of stomach are removed together

• Anastomosis of the pancreatic duct, common bile duct and stomach to the
  jejunum

Question 26

discuss cholelithiasis and cholecystitis

Answer 26

Cholelithiasis – stones in gallbladder
1) Develop when the balance that keeps cholesterol, bile salts and calcium in
solution is changes to that these substances precipitate
2) Stones can stay in gallbladder or migrate to cystic duct or common bile duct
causing an obstruction

Cholecystitis – inflammation of the gallbladder
* Usually associated with cholelithiasis and obstruction caused by gallstones or
biliary sludge
* Inflammation, edema, hyperemia
* Gallbladder may become distended with pile or pus
* Wall of gallbladder becomes scarred after an acute attack