Metabolic Disorders- Liver, Pancreas...

Question 1

8 functions of liver

Answer 1

Glucose metabolism 
Ammonia conversion
Protein metabolism 
Fat metabolism 
Vitamin and iron storage
Bile formation
Bilirubin excretion 
Drug metabolism

Question 2

Age related changes of hepatobiliary system

Answer 2

Decrease in size and weight of liver.
Decreased blood flow
Decreased replacement/ repair of cells after injury
Reduced drug metabolism
Increase risk of gallstones
Decreased gallbladder contractility after a meal

Question 3

3 of the most common liver blood tests and description

Answer 3

ALT: Monitors cirrhosis or hepatitis. Also monitors effect of treatment that may be toxic to liver.

AST:present in tissues with high metabolic activity, so may be increased with damage to tissues of liver, heart, kidney or skeletal muscle.

GGT: elevates in alcohol abuse and marker for biliary cholestasis

Question 4

Cause of jaundice

Answer 4

Increased bilirubin from either:
Presence of liver disease, if flow of bile is impeded.
OR if there is excessive destruction of RBCs.

Serum bilirubin exceeds 2.5.

Question 5

What is portal hypertension?

Usual cause?

Consequences?

Answer 5

Increased pressure throughout portal venous system that results from obstructed blood flow into and through damaged liver.

Usually associated with hepatic cirrhosis.

Main consequences of portal hypertension are:
ascites and
varices

Question 6

What is ascities?

Causes?

Answer 6

As a result of liver damage, large amounts of albumin rich fluid accumulate in peritoneal cavity.

(Ascites may also occur with cancer, kidney disease or heart failure)

Question 7

What is the recommendations for nutritional therapy for ascities?

Answer 7

Negative sodium balance to reduce fluid retention.
Only 10% of patients respond to nutritional therapy alone.
(Usually require diuretics)

Question 8

Pharmacologic therapy for ascities

Answer 8

Diuretics with sodium restriction is successful in 90% of ascities patients.
Spironaldactone is first line drug. Prevents potassium loss.

Question 9

What are esophageal varices?

Cause?

Answer 9

Variscosities that develop from elevated pressure in veins that drain portal system.

Question 10

Treatment of esophageal varices

Answer 10

Nonsurgical measures include:

Pharmacologic therapy: somatostatin, vasopressin, beta-blocker and nitrates
Balloon tamponade, saline lavage, endoscopic sclerotherapy
Transjugular intrahepatic portosystemic shunting (TIPS)
Esophageal banding therapy, variceal band ligation

If necessary, surgery may involve:
Bypass procedures (e.g. portacaval shunts, splenorenal shunt, mesocaval shunt)
Devascularization and transaction

Question 11

Esophagogastric tamponade

Answer 11

Esophagogastric tamponade: A procedure in which a balloon is inflated within the esophagus and stomach to apply pressure on bleeding blood vessels, compress the vessels, and stop the bleeding. Used in the treatment of bleeding veins in the esophagus (esophageal varices) and stomach.

Question 12

Symptoms of cirrhosis

Answer 12

Intermittent fever
vascular spiders
palmar erythema (red palms)
Unexplained epistaxis
ankle edema 
abdominal pain firm 
enlarged liver 
splenomegaly 
G.I. symptoms
Ascites
 jaundice 
weakness and muscle wasting 
weight loss 
continuous mild fever 
clubbing of the fingers

Question 13

Asterixis

Answer 13

Involuntary flapping of hand

Can’t hold hand in dorsiflex position. It falls down.

Question 14

Constructional Apraxia

Answer 14

Deterioration of handwriting and inability to draw simple 2 dimensional figure

Question 15

Symptoms of hepatic encephalopathy

Answer 15

Mental status changes and mood disturbances.
Altered sleep patterns progresses into stupor, difficult to awaken.
Eventually coma and may have seizures.

Asterixis,
Constructional apraxia
rigid extremities
abnormal EEG

Question 16

Lactulose uses and side effects

Answer 16

Lowers serum ammonia levels.
Expels ammonia in feces. Two or three soft stools per day are desirable.

Side effects intestinal bloating and cramps which usually resolved within a week.

Question 17

What is the function of the gallbladder?

Answer 17

Capacity is 30-50 mL of bile.
Connected to the common bile duct of the liver by the cystic duct.
Stores bile.
Bile assists in emulsification of fats.

Question 18

What are some causes of acute pancreatitis?

Answer 18

Acute pancreatitis is Self digestion of the pancreas by its own proteolytic enzymes causes acute pancreatitis.

80% of patients with acute pancreatitis have biliary tract disease- such as gallstones or a history of a long-term alcohol abuse.

Other causes are bacterial or viral infections. Complication of mumps.

Question 19

Symptoms of acute pancreatitis

Answer 19

Severe abdominal pain back pain usually pain occurs in mid epigastrium and may be difficult to localize.
Pain is generally more severe after meals and is unrelieved by antacids. Vomiting that fails to relieve the pain or nausea.
Abdominal guarding.
a rigid or board like abdomen usually indicates peritonitis. hypotension

Question 20

What is chronic pancreatitis

Answer 20

Characterized by recurring attacks of severe upper abdominal and back pain accompanied by via vomiting.
Pressure within the pancreas increases due to increasing fibrous tissue replacing cells with each repeated attack of pancreatitis.

Question 21

Steatorrhea

Answer 21

Stores become frequent, frothy, and foul smelling because of impaired fat digestion which results in stools with a high fat content.

Question 22

Diabetic ketoacidosis DKA

Answer 22

type 1 diabetes and results from a deficiency of insulin.
Acidic ketone bodies are formed and metabolic acidosis occurs.
Three major issues are: hyperglycemia, ketosis, and metabolic acidosis. DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting and fatigue with the eventual stupor and coma if not treated. Breath has fruity odor.

Question 23

Magnetic resonance cholangiopancreatography

MRCP

Answer 23

(MRCP) is a medical imaging technique that uses MRI to visualize the biliary and pancreatic ducts in a non-invasive manner.
This procedure can be used to determine if gallstones are lodged in any of the ducts surrounding the gallbladder.

Question 24

Endoscopic retrograde cholangiopancreatography

ERCP

Answer 24

ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons, although the development of safer and relatively noninvasive such as MRCP and endoscopic ultrasound has meant that ERCP is now rarely performed without therapeutic intent. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject a contrast medium into the ducts in the biliary tree and pancreas so they can be seen on radiographs.

Question 25

What med helps with gallstones?

Answer 25

Ursodiol is used to dissolve gallstones in people who do not want surgery or cannot have surgery to remove gallstones.
Ursodiol is also used to prevent the formation of gallstones in overweight people who are losing weight very quickly.

Question 26

What is hyperglycemic hyperosmolar syndrome?

Answer 26

Hyperosmolar hyperglycemic state (HHS) is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Onset is typically over days to weeks.