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Pathophysiology > Unit 4 - liver, gall bladder, and pancreas > Flashcards

Unit 4 - liver, gall bladder, and pancreas Flashcards

1
Q

hepatomegaly

A

from inflammation and swelling within the hepatic parenchymal tissue
- palpate inferior hepatic margin

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2
Q

Elevated Liver Enzymes-Liver Profile

A 
Aspartate aminotransferase (AST) (Liver parenchyma)
 Alanine aminotransferase (ALT) (Liver parenchyma)
 Lactic Dehydrogenase (LDH) (Liver parenchyma)
 Alkaline phosphatase (APT) Biliary ducts)	
Gamma glutamyl-transferase (GGT) (Biliary ducts)
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3
Q

Portal hypertension and splenomegaly

A

due to occlusion of the venous drainage from the liver via the hepatic veins into the inferior vena cava
- causes passive congestion in the hepatic portal and splenic veins, resulting in fluid back up and swelling in the organs

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4
Q

caval obstruction with pedal edema

A

due to occlusion of the venous drainage from the liver via hepatic veins into inferior vena cava, causing passive congestion in the lower extremities

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5
Q

depression of the clotting mechanism (prothrombin time)

A
  • conversion of vitamin K to prothrombin is impaired
  • prothrombin time normal is 11-15 sec; reduced w liver disease
  • test is INR
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6
Q

Circulating Plasma Protein is Decreased - serum total protein in blood is __

A

7.0gms/dl, which is 7% of body weight

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7
Q

Anasarca

A
  • generalized edema

- Hypoproteinemia & Hypoalbumenemia

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8
Q

Jaundice

A

Elevated Plasma Bilirubin

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9
Q

Ascites

A

due to hepatic portal enlargement
- Hepatic Portal Vein occlusion with passive congestion
Abdominal organs “weep” fluid (plasma)
- Compression of Hepatic Lymphatic Vessels-“weep” fluid (lymph)
- Hypoalbuminemia (decreased plasma proteins)
- Sodium/H2O retention due to decreased renal circulation

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10
Q

other signs of liver disease/summary

A
  • pruritus
  • gynecomastia (breast enlargement)
  • hepatomegaly, splenomegaly
  • red palms and spider nevi
  • hemorrhagic tendency
  • ascites, anasarca
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11
Q

End stage liver

A

Liver has lost all its ability to function

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12
Q

Model for End-Stage Liver Disease-MELD

A 
scoring system for stages of liver failure
40 or more — 71.3% mortality
30–39 — 52.6% mortality
20–29 — 19.6% mortality
10–19 — 6.0% mortality
≤9 — 1.9% mortality
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13
Q

common causes of liver disease

A

infections: bacteria, viruses, fungi
toxic damage
neoplasia
autoimmune - hepatitis

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14
Q

Hepatitis A virus

A 
Oral-fecal route mode of entry
28 day incubation
4-6 week course (self-limiting)
Serological Blood Marker-Anti HAV IgM antibodies
Vaccine-1992
Inactivated HAV
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15
Q

s/s of hep A

A 
Constitutional
 Nausea & Diarrhea
 Jaundice with Pruritus
 Hepatomegaly
 Elevated  liver enzymes (AST, ALT, LDH)
 Aversion to food
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16
Q

Hepatitis B

A 
DNA Virus
Transmission and entry
Inoculation
Oral-fecal route
STD
Dental or Medical Procedures
Childbirth
120 day incubation
Variable course (usually self-limiting)
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17
Q

components and blood markers of Hep B

A

Diagram shows that HBV has an incomplete ring of circular DNA within a core particle (HBcAg).

Surrounded by an intermediate protein coat (HBeAg) and a surface protein coat (HBsAg).

Anti-HBV antibodies
HBV Surface Antigen (HBsAG)
Australian Antigen
Hepatitis Associated Antigen (HAA)

18
Q

s/s Hep B

A 
Constitutional
 Nausea & Diarrhea
 Jaundice with Pruritus
 Hepatomegaly 
 Elevated liver enzymes (AST, ALT, etc.)
 Aversion to food
19
Q

recovery of Hep B

A 
vaccine
90%-complete recovery
-2%-HBV carriers
10%-chronic, progressive hepatitis and hepatic cirrhosis
May develop 1° Hepatocellular Cancer
20
Q

Hepatitis C

A 
RNA Virus
Incubation Period: 50-60 Days
transmission/entry: Initially Blood Transfusion Related
Injecting Drug Use
Dental or Medical Procedures 
Childbirth
Tattoos
STD
21
Q

hep C blood markers and outcomes

A

Serologic Blood Marker: Anti-HCV Antibodies
No current vaccine
1-6% may be HCV Carriers
50% Develop Chronic Hepatitis
20% Develop Cirrhosis and/or Hepatocellular carcinoma

22
Q

Hep C s/s

A 
Constitutional
 Nausea & Diarrhea
 Jaundice with Pruritus
 Hepatomegaly 
 Elevated liver enzymes (AST, ALT)
 Aversion to food
23
Q

Hepatitis D

A

RNA Virus

In combination with hepatitis B virus-highest overall mortality rate of all the acute viral hepatitis infections-at 20%.

24
Q

Hep D blood markers

A

Serologic Blood marker

HDV total antibodies- indicates acute or chronic HDV infection.

25
Q

Hepatitis E

A 
RNA Virus-1955
Oral Fecal Transmission Route 
Incubation period: 3-8 weeks
Has a preventive vaccine
Comparable to HAV-symptoms/severity
Self-limiting, 2% mortality rate
20% mortality rate in pregnancy
Fulminant liver failure-3rd Trimester
26
Q

Cirrhosis

A

Replacement of Normal Liver tissue with non-functional fat and connective (scar) tissue
Most cirrhosis is alcohol related (Laennec’s Cirrhosis)

27
Q

Non-Alcoholic Fatty Liver Disease (NAFLD)

A

> 10% Liver Fat-May develop Cirrhosis
Diabetes mellitus
Elevated Cholesterol and Triglycerides
Obesity

28
Q

Post-necrotic Cirrhosis

A

Toxins, Drugs

- tylenol

29
Q

Biliary Cirrhosis

A

(Post Hepatic Obstructive)

Sclerosing cholangitis-autoimmune

30
Q

Cirrhosis Progression

A

Development of a Fatty Liver
Replacement with nodular scar tissue
End stage liver disease (ESLD)
Hepatocellular failure

31
Q

Hepatocellular Failure

A

End Stage Liver Disease (ESLD)
Mortality 100%-Uniformly Fatal
Liver Transplant

32
Q

Contributing events to Morbidity & Mortality

A

Hemorrhage/Internal Bleeding
Depression of the Clotting Mechanism Easy Bleeding
Prothrombin time, INR

Low levels of Cytokine Thrombopoietin

Failure to detoxify ammonia (NH3) into Urea
NH3 is converted to NH4+ (Ammonium Ion)
Metabolic Acidosis  (pH)
33
Q

ammonia

A

Ammonia combines with water to form the Ammonium ion
Ammonium ionizes (disassociates) to ammonia and free hydrogen
As hydrogen ion concentration rises:
H+ increases-pH falls
Blood/Body Fluid becomes acidic
Thus, Metabolic Acidosis (pH <7.35)

34
Q

Hepatic encephalopathy stages

A 
Stage 1 - Personality changes
Stage 2 - Muscle involvement
Fasciculations, Asterixis
Stage 3 - Violence
Stage 4 - Hepatic Coma
Hepatic fetor-mercaptans           (sulfur compounds) & dimethyl             sulfide from Cysteine
“Breath of the Dead”
35
Q

Glasgow Coma scale

A

Rates consciousness scale 3-15
Rates eye, verbal, motor responses
3=deep unconscious state, unresponsive
15=fully awake

36
Q

Acute pancreatitis

A 
Inflammation of pancreatic tissue and ducts
Swelling and Pain (intense)
Overuse of Alcohol
Gall Stones
Severe pain-often refers to the back
95% resolution in a few days-few weeks

Prolonged cases result in auto-digestion of the pancreas

37
Q

Chronic pancreatitis

A

Chronic, ongoing pancreatic inflammation
May develop from acute pancreatitis or chronic alcohol abuse

In children-Cystic Fibrosis
Gradual replacement of functional tissue with scar tissue

38
Q

Pancreatic Neoplasia

A

Benign Cysts and Tumors

Malignant Tumors (5 year survival < 5%)
Occur most often in African-American 	    males
Risk factors: 
Smoking
Diabetes mellitus 
Aging
African American
Male
39
Q

Cholelithiasis (Gall Stones)

A

Females > Males
Disease of older individuals (>65 years)
Often seen in females 40-50 years of age

40
Q

6 F’s of gall stones

A

“Fair, Fat, Female, Fertile, Flatulent, Forty”

41
Q

etiology of gall stones

A

Precipitation of cholesterol and bile pigments
Stasis of bile
Biliary Tract Bacterial infection

42
Q

s/s gall stones

A

Pain-upper right quadrant
May radiate to the mid upper back & shoulder
Relief-pain food pattern

Pathophysiology (27 decks)

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