module 6 hepatobiliary

Question 1

used to visualize the biliary tree and involves insertion of a needle into the biliary tree by puncture directly through the wall of the abdomen

Answer 1

Percutaneous transhepatic cholangiography (PTC)

Question 2

imaging procedure performed by a gastroenterologist, is a means of visualizing the biliary system and main pancreatic duct, which provides drainage for the pancreatic enzymes into both the digestive tract and the common bile duct.

Answer 2

endoscopic retrograde cholangiopancreatogram (ERCP)

Question 3

Liver damage caused by alcohol consumption resulting in hepatitis and cirrhosis of the liver

Answer 3

ALCOHOL-INDUCED LIVER DISEASE

Question 4

◼ A build up of lipids that are deposited in liver tissue
◼ In the early stages it is often asymptomatic, and diagnosis
equires biopsy of liver tissue
◼ although the disease progresses slowly, it may advance to cirrhosis of the liver if left untreated
◼ management includes implementation of weight loss programs and exercise programs

Answer 4

NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)

Question 5

◼ A chronic liver condition in which the liver parenchyma and architecture is destroyed , fibrous tissue is laid down, and regenerative nodules are formed
◼ In its early stages, it is usually asymptomatic, as it may take months or even years before damage becomes apparent.
◼ Considered an end-stage condition

Answer 5

CIRRHOSIS

Question 6

Two functional impairments

Answer 6

1. impaired liver function
2. portal hypertension

Question 7

• the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) in the abdominal (peritoneal) cavity
• a result of portal hypertension, chronic hepatitis, congestive heart failure, renal failure, cancer (s)
• Patients with ascites generally complain of:
• non-specific abdominal pain
• dyspnea

Answer 7

ASCITES

Question 8

Medical treatment for ascites

Answer 8

• bedrest
• dietary restriction of sodium
• use of diuretics
• treatment of complications
• elimination of the underlying causes

Question 9

Diagnosis/Treatment of Cirrhosis

Answer 9

• sonography
• biopsy

Question 10

◼ Acute inflammation of the liver
◼ Prevents ability to excrete bilirubin
◼ Evidences of the disease are:
- nausea
- vomiting
- discomfort
- tenderness over the liver
- jaundice

Answer 10

VIRAL HEPATITIS

Question 11

• “infectious hepatitis” and it is excreted in the GI tract in fecal material
• spread by contact with an infected individual, normally through ingestion of contaminated food or water
• highly contagious

Answer 11

Hepatitis A (HAV)

Question 12

• formerly called “Serum hepatitis”
• once thought that HBV was spread only by contact with blood, as occurs with blood transfusions and contaminated needles
• however, it is now known that saliva, urine, feces, and semen can spread the virus, which also qualifies it as a sexually transmitted disease
• among adults most commonly spread through sexual contact
• also can spread transplacentally
• incubation is longer with severe effects than those seen in hepatitis A

Answer 12

Hepatitis B (HBV)

Question 13

• Similar to HBV because it also is spread by blood or sexual contact but differs from HBV in that it attacks the RNA of a cell, whereas HBV attacks the DNA
• the cause of most cases of hepatitis following blood transfusion (posttransfusion hepatitis)

Answer 13

Hepatitis C (HCV)

Question 14

◼ Presence of gallstones
◼ Common in females
◼ Great occurrence in diabetic people, obese and in parous women
◼ Characteristics of stones varies:
- single or multiple in appearance
- 80% of all stones comprise a mixture of cholesterol, of bile pigment, and of calcium salts and the remaining 20% are composed of pure cholesterol or calcium- bilirubin mixture

Answer 14

CHOLELITHIASIS

Question 15

• acute inflammation of the gallbladder
• characterized clinically by a sudden onset of pain, fever, nausea, and vomiting
• common in individuals with chronically symptomatic cholelithiasis

Answer 15

cholecystitis

Question 16

◼ Inflammation of the pancreatic tissue
◼ causes include excessive and chronic alcohol consumption, obstruction of the hepatopancreatic ampulla by a gallstone or tumor, and even the injection of contrast media during ERC

Answer 16

pancreatitis

Question 17

◼ Yellow discoloration of the skin and whites of the eyes
◼ Not a disease itself but rather a sign of disease.
◼ The accumulation of excess bile pigments (i.e., bilirubin) in the body tissues “stains” the skin and eyes this yellowish color.

Answer 17

jaundice

Question 18

◼ occurs because of hemolytic disease, in which too many red blood cells (RBCs) are destroyed or because of liver damage from cirrhosis or hepatitis
◼ most common appearance is transient in the first few days after birth, when more bile pigments are released than can be handled

Answer 18

MEDICAL (NONOBSTRUCTIVE) JAUNDICE

Question 19

◼ Occurs when the biliary system is obstructed and prevents bile from entering the duodenum
◼ A common cause of this obstruction is blockage of the common bile duct caused by stones or masses.

Answer 19

SURGICAL (OBSTRUCTIVE) JAUNDICE

Question 20

◼ a benign tumor of the liver
◼ most tumors are asymptomatic, but the incidence of this disease has increased over the past few years
◼ occur most often in women using oral contraceptives
◼ in terms of imaging, both CT and sonography are useful in demonstrating hepatic lesions

Answer 20

HEPATOCELLULAR ADENOMA

Question 21

◼ Most common tumor of the liver
◼ It is benign and composed of newly formed blood vessels and these neoplasms may form in other places within the body

Answer 21

HEMANGIOMA

Question 22

◼ Hepatocarcinoma
◼ A primary neoplasm of the liver
◼ Associated with cirrhosis with poor nutrition and alcoholism
◼ Originate in the liver parenchyma with a large central mass
◼jaundice, abdominal pain, weight loss, an RUQ mass, ascites, or a rapid increase in liver size.
◼Plain abdominal radiographs may demonstrate hepatomegaly.
◼Sonography and CT are often used to reveal the extent of the tumor

Answer 22

HEPATOMA

Question 23

is enlargement of the liver beyond its normal size. Certain conditions such as infection, parasites, tumors, anemias, toxic states, storage diseases, heart failure, congenital heart disease, and metabolic disturbances may all cause an enlarged liver.

Answer 23

HEPATOMEGALY

Question 24

◼ much more common than primary carcinoma because of the liver’s role in filtering blood.
◼ The liver is a common site for metastasis from other primary sites such as the colon, pancreas, stomach, lung, and breast
◼ Primary cancers located in the abdomen often metastasize to the liver
◼ Sonography is most commonly used to screen patients for ___
◼ CT and MRI also allow an accurate diagnosis
◼ liver biopsy, often under sonographic guidance, provides the definitive diagnosis.

Answer 24

METASTATIC LIVER DISEASE

Question 25

◼ occurs infrequently, but most neoplasms within the gallbladder are malignant
◼ more common in women and older, with gallstones present in about 75% of all cases
◼ the symptoms are nonspecific, including RUQ pain, jaundice, and weight loss
◼ Another risk factor associated with the development of gallbladder carcinoma is a “porcelain” gallbladder, which results from chronic cholecystitis
◼ Approximately 22% of patients with porcelain gallbladders develop carcinoma

Answer 25

CARCINOMA OF THE GALLBLADDER

Question 26

a cancer of the bile storage sac. Symptoms include loss of appetite, nausea, vomiting, weight loss, and severe pain near the right Shoulder. Tumors of the gallbladder are often connected with gallstones. They are
3 to 4 times more common in women than in men and rarely occur before the age of 40.
Physical examination shows an enlarged gallbladder in about half the cases. Complete removal of the gallbladder may cure the cancer, but partial removal of the liver also may be required.

Answer 26

Gallbladder carcinoma

Question 27

◼ Usually rapidly fatal
◼ Incidence greater in men than in women and in blacks than in whites.
◼ A clear-cut association with cigarette smoking has been demonstrated, and other risk factors include alcoholism, chronic pancreatitis, diabetes mellitus, and a family history of adenocarcinoma
◼ surgery and chemotherapy are of poor results

Answer 27

CARCINOMA OF THE PANCREAS