Pancreas and Liver Flashcards
1
Q
Icterus
A
another name for Jaundice
2
Q
what is the Yellowish color of skin and other tissues of jaundice caused from
A
Results from high levels of bilirubin in the blood- product of hemolysis of RBC and breakdown of hemoglobin.
3
Q
Pruritus
A
itching all over
4
Q
signs and symptoms of jaundice
A
- Yellowish coloring of sclera and other tissues; mucous membranes
- Dark urine and light colored stool •
- Pruritus- itching all over - bile salts under the skin
- May cause the stool to change color
5
Q
causes of jaundice
A
- Hepatitis - damage to liver –
- Alcoholic liver disease –
- Blockage of a bile duct by a gallstone or tumor -interfere with bile flow –
- Toxic reaction to a drug –Trigger hemolysis of RBCs, producing more bilirubin than liver can tolerate
6
Q
what are the 3 categories of Jaundice
A
- Pre-hepatic (Hemolytic) Jaundice
- Hepatocellular (Hepatic) Jaundice
- Post-hepatic (Cholestatic) Jaundice
7
Q
Pre-hepatic (Hemolytic) Jaundice
A
- The pathology is occurring prior to the liver. •
- Caused by anything which causes an increased rate of hemolysis –Malaria, Hemolytic anemia, Sickle Cell Anemia, Thalassemia
8
Q
- Hepatocellular (Hepatic) Jaundice
A
- The pathology is located within the liver •
- Cell necrosis reduces the liver’s ability to metabolize and excrete bilirubin leading to a buildup of bilirubin in the blood –Acute or chronic hepatitis, Cirrhosis, alcoholic liver disease
9
Q
Post-hepatic (Cholestatic) Jaundice
A
- The pathology is located after the conjugation of bilirubin in the liver •
- Obstructive jaundice caused by an interruption to the drainage of bile in the biliary system –Gallstones in common bile duct, pancreatic cancer, liver flukes
10
Q
treatment of jaundice
A
•Treatment is directed at the specific cause
11
Q
inflammation of liver may be caused by:
A
•May be caused by:
- Viruses- most common –
- Drugs –
- Alcohol
12
Q
general symptoms inflammation of liver
A
- fatigue –
- Nausea –
- Decreased appetite –
- Mild fever –
- Mild abdominal pain most common in Hep A, B & C
- Eyes yellow, dark urine
13
Q
Hepatitis A how is it spread?
A
•Spread via fecal-oral route or close physical contact
14
Q
what population is a risk of contracting Hep A
A
Those at risk: –
- Those not vaccinated –
- Children –
- Sexual partner of infected individual –
- Underdeveloped countries –
- Travellers
15
Q
incubation period of Hep A
A
Incubation of hepatitis A virus is usually 14-28 days.
16
Q
symptoms of Hep A
A
Symptoms range from mild to severe and may include:
- loss of appetite,
- fever,
- malaise,
- diarrhea,
- nausea,
- dark-colored urine,
- jaundice.
17
Q
what kind of genome of the virus is Hep A
A
RNA
18
Q
____ of people unable to eliminate Hep B and develop chronic infection
A
•5%
19
Q
genome of Hep B virus
A
DNA virus
20
Q
•Transmission Hep B
A
- Mother to child at birth-
- in highly endemic areas –Person to person;
- sexual contact or blood to blood contact - IV drug users,
- can survive outside of body for 7 days
21
Q
signs and symptoms of Hep B
A
•During acute infection phase, mostly asymptomatic. Those who do experience symptoms:
- jaundice,
- dark urine,
- extreme fatigue,
- nausea,
- vomiting and abdominal pain.
22
Q
treatment of Hep B
A
- No specific treatment. Comfort and adequate nutritional balance.
- Those with chronic hepatitis B infection can receive interferon and antivirals with can slow progression of cirrhosis
23
Q
long term effects of Hep B
A
•Those with chronic liver infection can later develop cirrhosis or liver cancer.
24
Q
____ of people who have acute hepatitis eliminate the virus; the remaining become chronically infected
A
•25%
25
genome of Hep C virus
RNA
26
transmission of Hep C
•Transmission:
* primarily via infected blood- sharing needles, blood transfusions;
* infected blood products;
* sexual contact;
* mothers can transmit virus to infant at birth; infants chronically infected.
27
incubation period of Hep C
•Incubation period is from 2-6 months
28
is there a vaccine for Hep C
No
29
treatment for Hep C
•Combination of antiviral therapy with interferon and Ribravirin are mainstay for hepatitis C
30
6 types of Hep C patients
* 80% are asymptomatic following initial infection. Those who do experience symptoms: fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-colored feces, joint pain and jaundice.
* 75-80% newly infected develop chronic infection –
* 60-70% chronics develop liver disease –
* 5-20% develop cirrhosis –
* 1-5% die from cirrhosis or liver cancer
31
•Three types of blood tests for evaluation of patients with hepatitis:
1. Liver enzymes- Liver enzyme levels in the blood indicate liver inflammation.
2. Viral antibodies- antibodies against hepatitis A,B, and C viruses can be detected within weeks of infection
3. Viral proteins and genetic material
32
to check for Hepatitis, what is the most sensitive type of test, and what is trying to be identified?
Liver enzymes: aminotransferases such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) normally contained within liver cells. Liver enzyme levels in the blood indicate liver inflammation.
33
Cirrhosis
•A complication of many liver diseases characterized by abnormal structure and function of the liver
34
causes of cirrhosis
* Chemicals –
* Viruses –
* Toxic metals –
* Autoimmune liver disease
35
what are the 3 important functions in the body?
1. Producing substances required by the body
2. Removing toxic substances that can be harmful
3. Regulates the supply of glucose and lipids that the body uses as fuel
36
•In cirrhosis there is disturbed relationship between:
* Liver and blood flow –
* Liver and bile flow
37
signs and symptoms of cirrhosis
* Jaundice –
* Fatigue –
* Weakness
* Loss of appetite –
* Itching –
* Easy bruising
38
complications due to cirrhosis
* accumulation of fluid due to retention of salt and water in the body. Salt and water first accumulate in tissue beneath skin of ankles and legs- **edema / pitting edema** - indication of Yin type edema - long term and chronic,
* As cirrhosis worsens, more salt and water are retained and fluid may accumulate in abdominal cavity- **ascites**
39
causes of cirrhosis
* alcohol;
* Non-alcoholic fatty liver disease (NAFLD);
* Cryptogenic cirrhosis;
* Chronic viral hepatitis;
* inherited disorders;
* Primary biliary cirrhosis (PBC);
* Primary sclerosing cholangitis (PSC);
* Autoimmune hepatitis;
* Biliary atresia
40
Non-alcoholic fatty liver disease (NAFLD)
accumulation of fat in the liver cells. Associated with insulin resistance seen in diabetes type II.
41
Cryptogenic cirrhosis
cirrhosis due to unidentified causes
42
•Primary biliary cirrhosis (PBC)
due to abnormality in the immune system found predominantly in women
43
Primary sclerosing cholangitis (PSC)
large bile ducts outside liver become inflamed, narrowed and obstructed mostly associated with IBD
44
Biliary atresia
seen in infants born without bile ducts or lacking enzymes for controlling sugars
45
treatment of cirrhosis
1. Preventing further damage to liver
2. Treating complications of cirrhosis
3. Preventing liver cancer or detection early
4. Liver transplantation
46
best way to diagnose cirrhosis
biopsy
47
Colelithiasis
Gallstones
48
where do gallstones develop?
•Gallstones form in the bile within the gallbladder; or anywhere there is bile- intrahepatic, hepatic, common bile ducts.
49
Cholesterol gallstones
primarily composed of cholesterol. The most common type comprising 80% of gallstones.
50
describe what may go wrong in order to form gallstones
If liver secretes too much cholesterol for the amount of bile acids and lecithin it secretes, some cholesterol does not dissolve.
Or, if the liver does not secrete enough bile acids and lecithin, some of that cholesterol also doesn’t dissolve- cholesterol sticks together and forms particles that grow in size.
51
list the two types of gallstones
CHO & Pigment
52
Pigment gallstones
too much bilirubin in the bile combines with other substances like calcium to form pigment which dissolves poorly and sticks together to form particles that grow in size forming black pigment gallstones.
53
If there is reduced contraction of the gallbladder or obstruction to flow of bile through ducts, bacteria may ascend from the duodenum into bile ducts and gallbladder. The bacteria alter the bilirubin which combines with calcium and fat to form \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
brown pigment gallstones.
54
what is the relationship between the amount of CHO in the blood and CHO gallstones
none
55
Diet is responsible for the development of cholesterol gallstones
misconception
56
•The risk factors for developing gallstones include:
* Gender;
* Age;
* Obesity;
* Pregnancy;
* Oral contraceptives and hormone therapy;
* Rapid weight loss;
* Crohn’s disease;
* Increased blood triglycerides
57
why does rapid weight loss correlate to the development of gallstones?
cholesterol release may be increased while bile salts may decrease by fast weight loss. In up to 50% of individuals - why? Imbalance that fast weight loss induces in the body
58
why does Crohn's disease correlate to the development of gallstones?
more likely to develop gallstones because these people lack enough bile acids to dissolve cholesterol in the bile. Ilium is diseased
59
signs and symptoms of gallstones
* some silent; Characteristic symptom is a “gallstone attack” or biliary colic: –
* Intense pain in upper-right side of abdomen –
* Accompanied by nausea and vomiting - 30 min to a few hours –
* May experience referred pain - between shoulder blades, or below the R shoulder
60
what size does the gallstone get to before symptoms begin to appear?
once the stones reach a certain size (\> 8mm).
61
treatment of gallstones
* Cholecystectomy;
* Sphincterectomy;
* Oral dissolution therapy;
* Extracorporeal shock-wave lithotripsy
62
Cholecystectomy
surgical removal of the gallbladder - standard treatment, doesn't affect digestion, may have small problems of loose or watery stools,
63
Sphincterectomy
removal of gallstones - cutting the sphincter of the common bile duct -
64
Oral dissolution therapy to treat gallstones
possible to dissolve some gallstones with medication taken orally: ursodeoxycholic acid/ursodiol- naturally occurring bile acid. Fnx to dissolve bile, reduces the amount of CHO secreted from the bile thereby - CHO gall stones only effective, only small, and take 1-2 years for it to dissolve, only effective on the CHO gallstones,
65
–Extracorporeal shock-wave lithotripsy
shock waves produced outside the body are focused on the gallstone.
66
complications due to gallstones
* Cholecystitis;
* Blockage of common bile duct;
* Blockage of pancreatic duct;
* Gallbladder cancer
67
Cholecystitis
inflammation of the gallbladder. A gallstone can become lodged in the neck of the gallbladder (cystic duct) and cause obstruction. Severe pain and fever.
68
Blockage of common bile duct
the common bile duct is blocked obstructing the flow of bile from the gallbladder or liver to small intestine. Jaundice and infection can result.
69
Blockage of pancreatic duct
gallstone can block the pancreatic duct that runs from pancreas to common bile duct. This can lead to inflammation of the pancreas- pancreatitis, causing intense, constant abdominal pain.
70
Gallbladder cancer
those with gallstone history have increased risk of gallbladder cancer. This is very rare however and the likelihood is very small.
71
•Liver cancer is a deadly cancer killing almost all patients diagnosed within \_\_\_\_\_\_\_\_\_
1 year.
72
causes of Liver cancer
* Men with hepatitis B/C infection –
* Cirrhosis –
* Family history of liver cancer
* Alchohol
* Aflatoxin B1
73
Aflatoxin B1
most potent liver cancer-forming chemical known –Product of mold called Aspergillys flavus which causes mutations in a tumor suppressor p53 gene, in hot and humid environs - micro toxins, peanuts, wheat, corn, rice - mutations - not a concern in Canada because of rigid testing
74
signs and symptoms of Liver cancer
* Initially mild and general •
* Anorexia •
* Vomiting •
* Fatigue •
* Weight loss •
* Enlarged liver •
* Cancer is usually advanced at diagnosis
75
treatment of Liver cancer
* Surgical resection for non-cirrhotic livers, 70% reoccurring cancer. •
* Liver transplantation - LIV surgery not likely because late stage ID •
* Percutaneous ablation only non-surgical treatment that can offer cure - injecting chem's in LIV, radio frequency temp treatment - needle into LIV -\> tumor = heat generated at lision •
* Local chemotherapy
76
Pancreatitis
* Inflammation of the pancreas- active digestive enzymes due to inflammation attack and damage the pancreatic tissue •
* Acute or chronic forms- both occur more often in men
77
Acute pancreatitis
inflammation that occurs suddenly. Most common cause is the presence of gallstones. Chronic, heavy alcohol use is also a common cause. 5-10 years of heavy alcohol use
78
signs and symptoms of acute pancreatitis
* Gradual or sudden pain in upper abdomen - sometimes extends through the back –
* Nausea –
* Vomiting –
* Fever
* Rapid pulse
* Dehydration
* Low BP
79
treatment of acute pancreatitis
Treatment involves hospital stay with IV fluids, antibiotics and analgesics.
80
Chronic pancreatitis
inflammation of the pancreas that does not heal or improve. The most common cause is years of heavy alcohol use. Commonly b/t 30-40, can be caused by 1 acute attack. Underlying issues cystic fibrosis.
81
signs and symptoms of chronic pancreatitis
•Individuals may experience upper abdominal pain, nausea, vomiting, weight loss, diarrhea, oily stools.
82
treatment of chronic pancreatitis
•Treatment requires hospital stay, analgesics, intravenous hydration and nutritional support.
83
what are the two types of pancreatic cancer?
1. Endocrine pancreatic cancers;
2. Exocrine pancreatic cancers
84
Endocrine pancreatic cancers
produces insulin and other hormones. Also called islet cell CA. –Rare and grow slowly –Release hormone into bloodstream
85
Exocrine pancreatic cancers
produces the digestive enzymes. –Develop from the cells that line the system of pancreatic ducts –Commonly referred to as pancreatic adenocarcinomas
86
risk factors to getting pancreatic cancer
* Family hx,
* age,
* smoking –
* Obesity, diet high in red meat,
* DM –
* Chronic infections- hepatits B, or H. pylori
