the hepatic, pancreatic, & biliary systems Flashcards
the liver is the sole source for?
produces how much bile each day?
Albumin
600 ml (500-1500 ml) each day
Pancreas exocrine and endocrine function?
Exocrine- exocrine secretion of digestive enzymes and pancreatic juices, neutralizes the acidic substances passed from the stomach to the duodenum
Endocrine- secretion of glucagon and insulin by islet of Langerhans cells for the regulation of carbohydrate metabolism
Function of the gallbladder?
It contracts to??
a reservoir for bile- alkalinizing the intestinal contents and digestion of fat
to expel the bile into the duodenum in response to the arrival of food
Primary signs and symptoms of liver disease?
GI symptoms, edema, dark urine, light colored feces, right upper ab pain
Bristol Stool chart?
Type 1- hard lumps
Type 2- sausage shaped but lumpy
Type 3- sausage but with cracks
Type 4- sausage smooth and soft
Type 5-soft blobs with clear cut edges passed easily
Type 6- fluffy pieces with ragged edges
Type 7- watery
Dark urine and light stools are in association with?
When the serum bilirubin level increases from ____ to ____?
Jaundice
0.1 to 1.0 to a value of 2 or 3.0
What is spider angiomas?
Palmar erythema?
Spider- vascular manifestations increased estrogen levels
Erythema- warm redness of the skin over the palms (liver palms)
What is asterixis?
How can you test for asterixis?
the inability to maintain wrist extension with forward flexion of the upper extremities
asking the client to extend the wrist and hand with the rest of the arm supported by a firm surface
PT implications for liver disease?
Active intense exercise should be avoided, risk for pressure ulcers, increased risk of coagulopathy
What is jaundice?
4 common causes of jaundice?
Skin becomes yellow color, urine turns a darker color, and stool is light in color
Overproduction of bilirubin, decreased uptake in bilirubin metabolism, hepatocyte dysfunction, impaired bile flow
What is cirrhosis?
the final common pathways of progressive inflammation of the liver, causing liver damage and necrosis
Clinical presentation and Lab findings associated with Cirrhosis?
jaundice, palmar erythema, lower leg edema, spleen becomes larger
Lab findings: increase ALT, Decrease bsp, decrease albumin, increase PT
What is portal hypertension?
Most cases are related to?
An elevated portal pressure gradient occurs when the pressure of the blood entering the liver (portal vein) is higher than the pressure in the inferior vena cava
Cirrhosis
What is hepatic encephalopathy?
Due to?
a complex neuropsychiatric syndrome with symptoms ranging from subtle disturbances to coma and death
Hepatic dysfunction, portosystemic shunting of blood, portal hypertension
What is ascites?
Most often caused by?
What is spontaneous bacterial peritonitis?
Abnormal accumulation of fluid within the peritoneal cavity
Liver cirrhosis (85% of cases)
Infection of ascitic fluid in the setting of portal hypertension
What is hepatitis?
What are the 6 identifiable viruses?
Where is F?
Inflammation of the liver caused by a virus
ABCDE and G
F is fulminant hepatitis which is severe and sometimes fatal)
Chronic hepatitis how many months and can lead to?
Most people are??
Over 6 months and can lead to cirrhosis and end stage liver disease
Asymptomatic and when symptoms occur they are non specific and mild
What is acute liver failure (fulimant hepatic failure)?
What is the most common cause?
Rapidly progressing form of liver injury without prior disease
Acetaminophen hepatotoxicity (50% of all cases)
Viral hepatitis incubation periods HAV HBV HCV
HAV: 15 to 50 days, HBV: 2 to 5 months, HCV: 2 weeks to 6 months
Route for HAV? Causes?
Is it highly contagious?
When is it the greatest danger of transmission?
Results in what?
Fecal oral route, contaminated water or food, poor handwashing or personal hygiene
Yes
During incubation period
Acute infection only and not chronic hepatitis
Route for HBV?
Is it highly infectious?
How is it transmitted?
How can risk be lowered?
Sexually transmitted disease
Yes
Percutaneously or through mucosal contact
HBV vaccine
Route for HCV?
When does the period of inactivity begin?
One may become?
Injection drug use
before the onset of symptoms
A lifetime carrier
HDV and HEV are?
HDV manifests as?
HEV transmitted by?
uncommon in the US
a superinfection of HBV, needs Hep B for replication
Transmitted by contaminated water via the fecal oral route and resembled HAV
Pathogenesis of Alcoholic liver disease?
metabolism of alcohol results in ?
chronic alcohol use results in?
fatty liver disease occurs with the accumulation of fat in hepatocytes
oxidative stress to the hepatocytes
bacterial overgrowth and disturbances of the junctions between the intestinal cells
Clinical manifestations of alcoholic liver disease?
it is often____ and detected only____?
Asymptomatic and detected by lab eval
What is non alcoholic fatty liver disease?
Related to what two things?
What are the two categories?
Defined as a fatty liver disease without significant inflammation or fibrosis
Diabetes and insulin resistance
Nonalcoholic fatty liver or hepatic steatosis, non alcoholic steatohepatitis
Clinical manifestations of acute pancreatitis?
Mild?
Moderately severe?
Severe?
Mild- absence of organ failure or local or systemic complications
Mod. Severe- transient organ failure and may have local or systemic complications
Severe RUQ abdominal pain
Severe- cytokines and free radicals mediate a systemic response, leading to persistent multi organ failure
Chronic Pancreatitis:
Risk Factors?
Pathogenesis?
Involves the activation of what?
Chronic alcohol consumption, smoking, and genetic predisposition
Result from inflammation that begins as acute pancreatitis and becomes persistent, activation of stellate cells which leads to fibrosis
Chronic Pancreatitis- Clinical manifestations?
Pancreas is able to compensate until?
Endocrine function is also lost?
- ab pain, epigastric in location to back
- worse with meals but can be relived by bringing knees to chest or bending forward
- 90 percent of pancreatic function is lost
- both beta and alpha cells
Pancreatitis- PT implications?
Acute pancreatitis?
Chronic pancreatitis?
Back pain, decreased spinal extension
may be accompanied by GI symptoms such as diarrhea, pain after a meal etc
Back pain in the upper thoracic area or pain at the thoracolumbar junction
Pancreatic cancer is the ____ of cancer mortality?
It has the lowest what?
Most arise from _____ cells?
95 percent are____
75 percent are____
3rd leading cause
Lowest 5 year survival rate after diagnosis
Exocrine cells
Adenocarcinoma
proximal or head of the pancreas
Pancreatic cancer Risk factors:
Causes?
Increased risk?
Specific cause is unknown, do not have genetic or familial cause
Related to advancing age with most people in their 70s and 80s at diagnosis
History of T2D or impaired glucose intolerance
Pancreatic cancer clinical manifestations?
What contributes to the delay in diagnosis?
Ab pain, weight loss, and jaundice?
Obstruction to the?
The development of what is common?
nonspecific and vague in onset
ab pain- 80-85%
weight loss- 60%
jaundice- 47%
Portal vein or pancreatic duct
Diabetes or glucose intolerance
Pancreatic cancer metastasis?
Tumors of the body and tail of pancreas are?
First to regional lymph nodes then to liver, lungs etc
twice as likely to metastasize to the peritoneum compared with tumors in the head of the pancreas
Biliary Tract Terminology:
Cholecyst-
Cholecystecotomy-
Cholecystitis-
Cholecystography-
Cholecystostomy-
Cholelith-
Cholelithiasis-
pertaining to gallbladder
removal of gallbladder
Inflammation of gallbladder
Radiographic study of gallbladder
incision and drainage of gallbladder
gallstones
prescence of gallstones
Cholelithiasis - what is it?
75% consists primarily due to____
25% composed of ____
Most gallstones are ____
Symptoms occur when____. The most common being the____.
stones form in the bile
cholesterol
bilirubin salts caled pigment stones
asymptomatic
stones block bile flow into the ducts; the cystic duct
Cholelithiasis risk factos?
Female over male
Litho-genic
Cholelithiasis pathogenesis?
caused by changes in the composition of bile, solids become supersaturated in the gallbladder causing stones
Cholelithiasis clinical manifestations?
In older adults?
Complications?
Abdominal pain in the RUQ
often radiating to the right shoulder and upper back—> nausea and vomiting
Mental confusion may be the only manifestation
Cholecystitis most common
Cholangitis (inflammation of bile duct)
Acute cholangitis- what is it?
Symptoms? Charcot triad?
Reynolds pentad?
What may be the only sign in elderly?
obstruction of bile from stones from common bile duct
Charcot triad: pain fever jaundice
Charcot triad plus hypotension and mental confusion
Hypotension
What is acute cholecystitis and occurs most commonly when?
What does it cause?
Steady where and radiates where?
inflammation of the gallbladder and occurs most often as a result of impaction of gallstones in the cystic duct causing obstruction to bile flow
Prolonged abdominal pain lasting greater than 6 hours; steady in RUQ with tenderness, muscle guarding, or rebound pain, and radiates to upper back and into right scapula or right shoulder
