Metabolic Disorders- Liver, Pancreas... Flashcards
8 functions of liver
Glucose metabolism Ammonia conversion Protein metabolism Fat metabolism Vitamin and iron storage Bile formation Bilirubin excretion Drug metabolism
Age related changes of hepatobiliary system
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
3 of the most common liver blood tests and description
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
Cause of jaundice
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.
What is portal hypertension?
Usual cause?
Consequences?
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
What is ascities?
Causes?
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)
What is the recommendations for nutritional therapy for ascities?
Negative sodium balance to reduce fluid retention.
Only 10% of patients respond to nutritional therapy alone.
(Usually require diuretics)
Pharmacologic therapy for ascities
Diuretics with sodium restriction is successful in 90% of ascities patients.
Spironaldactone is first line drug. Prevents potassium loss.
What are esophageal varices?
Cause?
Variscosities that develop from elevated pressure in veins that drain portal system.
Treatment of esophageal varices
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
Esophagogastric tamponade
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.
Symptoms of cirrhosis
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
Asterixis
Involuntary flapping of hand
Can’t hold hand in dorsiflex position. It falls down.
Constructional Apraxia
Deterioration of handwriting and inability to draw simple 2 dimensional figure
Symptoms of hepatic encephalopathy
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
Lactulose uses and side effects
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.
What is the function of the gallbladder?
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.
What are some causes of acute pancreatitis?
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.
Symptoms of acute pancreatitis
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
What is chronic pancreatitis
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.
Steatorrhea
Stores become frequent, frothy, and foul smelling because of impaired fat digestion which results in stools with a high fat content.
Diabetic ketoacidosis DKA
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.
Magnetic resonance cholangiopancreatography
MRCP
(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.
Endoscopic retrograde cholangiopancreatography
ERCP
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.
What med helps with gallstones?
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.
What is hyperglycemic hyperosmolar syndrome?
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.
