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Pathophysiology > The Hepatic, Biliary, and Pancreatic Systems > Flashcards

The Hepatic, Biliary, and Pancreatic Systems Flashcards

1
Q

What is the major functions of the liver?

A

production of bile
absorbs nutrients
storage
conversion of bilirubin and amonia

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2
Q

What percentage of CO does the liver receive?

A

25%

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3
Q

What vein provides 2/3rds of the blood supply? What artery provides the rest?

A

portal vein; hepatic artery

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4
Q

Where does the portal vein drain blood from?

A

The GI tract
spleen
pancreas
gallbladder

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5
Q

What is the functional unit of the liver?

A

The liver lobule

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6
Q

The principal site of exchange between the blood and perisinusoidal space is the:

A

hepatic sinusoid

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7
Q

What are the minor signs and symptoms of liver disease?

A
  • N and V
  • Diarrhea
  • constipation
  • edema/ascites
  • increase in bilirubin (dark urine)
  • light or clay colored stool
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8
Q

What are the major signs and symptoms of liver disease?

A

R Upper Quadrant abdominal pain
neurologic involvement (confusion)
hepatic osteodystrophy
osteoporosis
jaundice

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9
Q

Is jaundice a medical emergency? Is it a disease?

A

yes! no, not a disease.

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10
Q

How do you treat jaundice?

A
  1. have to deal with underlying disease
  2. return to normal color suggests the resolution
  3. activity can be resumed
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11
Q

What does neurologic involvement of liver disease look like?

A

confusion
sleep disturbances
muscle tremors
hyper reactive reflexes

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12
Q

liver disease limits the catabolism of __________, which will result in a decrease of __________.

A

ammonia
urea

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13
Q

If ammonia cannot break down in the liver, will this cause an increase in ammonia in the blood stream or a decrease?

A

increase

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14
Q

Physiologically, what leads to the range of neuropsychiatric and neurological symptoms associated with liver disease?

A

increase in ammonia levels

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15
Q

What is a flapping tremor and how is it associated with liver disease?

A

flapping tremor is a clonus-like movement of the hands in response to wrist hyperextension. occurs due to the accumulation of ammonia in the blood.

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16
Q

why is hepatic osteodystrophy an issue?

A

leads to abnormal development of bone in the individuals with chronic liver disease

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17
Q

what will hepatic osteodystrophy eventually lead to?

A

osteopenia and osteoporosis.

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18
Q

does healing of the liver occur slowly or quickly?

A

quickly

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19
Q

what is cirrhosis?

A

a late stage of scarring of the liver caused by many forms of liver disease.

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20
Q

What is the pathophysiology of liver cirrhosis?

A

progressive patterned loss of healthy tissue which is replaced with fibrotic tissue.

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21
Q

What should we as a PT know about a pt with cirrhosis?

A

it can lead to:
- osteoporosis
- impaired posture
- impaired muscle performance/weakness
- loss of balance
- deconditioning
- blood loss

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22
Q

what is recommended for a pt with cirrhosis in order to reduce metabolic demand on the heart?

A

rest

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23
Q

for an individual with cirrhosis, a pt should make sure to plan for:

A

rest breaks and avoid unnecessary fatigue.

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24
Q

the portal vein carries blood to the:

A

capillary beds in the liver

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25
Q

Portal hypertension is defined as an increase in hepatic sinusoidal BP by greater than

A

6 mm

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26
Q

increased portal pressure causes a __________ flow of blood back into the stomach, spleen, small intestine, rectum and esophagus.

A

retrograde

27
Q

Retrograde flow of the portal vein will result in:

A

varices or varicose veins

27
Q

Retrograde flow of the portal vein will result in:

A

varices or varicose veins

28
Q

Varicose veins may leak blood and can result in hepatic bleeding that leads to:

A

hypovolemia
shock
death

29
Q

What are consequences of portal hypertension?

A

ascites
splenomegaly
hemorrhoids
varices
rupture and bleeding

30
Q

What is the condition called where the epigastric veins are seen radiating from the umbilicus across the abdomen?

A

caput medusae

31
Q

Hepatic encephalopathy is thought to be caused by:

A

elevated blood ammonia and altered neurotransmitter status in the brain

32
Q

ammonia is created by:

A

bacteria in the colon from the metabolism of protein and urea

33
Q

ammonia is absorbed into the portal blood system and transported to the: _______________. Then the ammonia is converted into _______.

A

liver; urea

34
Q

When the liver is diseased, what happens to ammonia?

A

it cannot be metabolized so blood ammonia levels go up leading to impaired cognitive and motor function

35
Q

Decorticate posture -

A

elbow flexion, wrist flexion
extension of legs and plantar flexion

36
Q

decerebrate posture -

A

elbow extension, pronation and wrist flexion
extension and plantar flexion

37
Q

Decorticate posture -

A

elbow flexion, wrist flexion
extension of legs and plantar flexion

38
Q

what are implications for the PT regarding hepatic encephalopathy?

A

patient safety
impaired motor and sensory integrity
impaired mobility
impaired arousal
increased risk of pressure ulcers

39
Q

What is ascites?

A

abnormal accumulation of fluid in the abdomen.

40
Q

Ascites is associated mostly with:

A

cirrhosis and portal hypertension

41
Q

Why is it important to recognize ascites as a physical therapist?

A

along with it comes impaired cardiac and respiratory function
lymphedema
integumentary disorders
malnutrition
muscle degradation

42
Q

Hepatitis is an __________________ condition of the liver.

A

inflammatory

43
Q

Viral hepatitis can cause ___________ or _____________ inflammation of the liver.

A

acute or chronic

44
Q

Most people who have hepatitis are:

A

asymptomatic

45
Q

How do you diagnose viral hepatitis?

A

symptoms
physical exam
blood test

46
Q

What are the symptoms of viral hepatitis?

A

N and V
poor appetite and weight loss
weakness
jaundice (dark urine)
pale or clay colored stool
fatigue

47
Q

what hepatitis is known as infecitous hepatitis?

A

hep a

48
Q

which hepatitis can be described as “benign, self-limiting, most people can recover from it, highly contagious and preventable with a vaccine?

A

Hepatitis A

49
Q

What hepatitis was known as serum hepatitis?

A

HEP B

50
Q

How is Hep B spread?

A

Blood transfusions, needle sticks, sharing of needles, dialysis, sexual contact, exchange of body fluids.

51
Q

HEP B is considered an:

A

STD

52
Q

Healthcare workers who come into contact with blood are at risk of which Hep?

A

Hep B

53
Q

What percentage of adults infected with Hep B develop chronic liver disease?

A

2 - 6%

54
Q

There is a vaccine for all hepatitis except:

A

HEP C

55
Q

______________ is the leading cause of chronic liver disease.

A

Hepatitis C

56
Q

How is Hep C transmitted?

A

contact with blood of an infected person.

57
Q

What percentage of individuals with Hep C develop cirrhosis?

A

5 - 20%

58
Q

What is a major problem with detecting Hepatitis C?

A

IT is often asymptomatic.

59
Q

What are other viral causes of hepatitis?

A
  1. autoimmune hepatitis
  2. cytomegalovirus CMV
  3. Epstein - Barr (mono)
  4. Yellow fever
60
Q

What drug or toxin can cause liver disease?

A

acetaminophen
tetracycline
alcohol

61
Q

How many Americans are alcoholics? What percentage of these individuals will develop cirrhosis?

A

10 million
10 - 15 %

62
Q

How many Americans are alcoholics? What percentage of these individuals will develop cirrhosis?

A

10 million
10 - 15 %

63
Q

what will excessive fat content lead to?

A

inflammation, which will cause the degeneration of hepatocytes

Pathophysiology (11 decks)

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