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Internal Medicine > Week 11- Hepatic, Pancreatic, and Biliary Systems 1 > Flashcards

Week 11- Hepatic, Pancreatic, and Biliary Systems 1 Flashcards

1
Q

Versatile functions of the liver

A

-Digestive
-Endocrine
-Excretory
-Hematologic
-Immune

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2
Q

Examples of versatile functions for the liver

A

-Conversion and excretion of bilirubin
-Produce of clotting factors and storage of vitamins
-Metabolize drugs, chemicals and toxins
-Filters all of the blood from the gastrointestinal (GI) system

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3
Q

The liver is the sole source of _________

A

Albumin

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4
Q

The liver produces ______ ml of bile each day

A

600 (500-1500 ml)

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5
Q

True or false: The pancreas is only an exocrine gland

A

False

(exocrine AND endocrine gland

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6
Q

Pancreas as an exocrine gland

A

-Primary function in digestion is exocrine secretion of digestive enzymes and pancreatic juices

-Neutralize the acidic substances passed from the stomach to the duodenum

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7
Q

Pancreas as an endocrine gland

A

-Secretion of glucagon and insulin by islet of Langerhans cells for the regulation of carbohydrate metabolism

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8
Q

Reservoir for bile

A

Gallbladder

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9
Q

Function of gallbladder

A

Stores and concentrates the bile during fasting periods and then contracts to expel the bile into the duodenum in response to the arrival of food

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10
Q

Bile helps in… and plays a role in…

A

-Alkalinizing the intestinal contents
-Emulsification, absorption, and digestion of fat

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11
Q

Primary signs and symptoms of liver diseases

A

-Gastrointestinal (GI) symptoms
-Edema/ascites
-Dark urine
-Light-colored or clay-colored feces
-Right upper abdominal pain

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12
Q

True or false: Hepatic failure can be acute or chronic

A

True

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13
Q

This occurs during hepatic failure

A

-The mass of liver cells is sufficiently diminished
-The function is impaired as a result of cirrhosis, liver cancer, or infection and/or inflammation

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14
Q

Clinical syndrome for hepatic failure

A

-Hepatic encephalopathy (HE)
-Renal failure (hepatorenal syndrome [HRS])
-Endocrine changes
-Jaundice

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15
Q

SLIDE 10

A
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16
Q

Dark urine and light stools occurs in association with…

A

Jaundice

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17
Q

Serum bilirubin level increases from normal (0.1 to 1.0mg/dL) to a value of 2.0 or 3.0 mg/dL

A

Dark urine and light stools associated with jaundice

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18
Q

Why is the stool normally brown?

A

Bile converted from bilirubin causes brown coloration of the stool

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19
Q

What do light-colored (almost white) stools and urine the color of tea or cola indicate?

A

Inability of the liver or biliary system to excrete bilirubin properly

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20
Q

Skin changes associated with the hepatic system include…

A

-Jaundice
-Pallor
-Orange/green skin

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21
Q

Spider angiomas may be vascular manifestations of increased _________ levels

A

Estrogen

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22
Q

___________ is warm redness of the skin over the palms, also called liver palms

A

Palmar erythema

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23
Q

Neurologic symptoms of hepatic problems

A

-Confusion, sleep disturbances, muscle tremors, hyper-reactive reflexes, and asterixis
-Impair PNS function
-Hepaticencephalopathy (HE) or Portosystemic encephalopathy (PSE)

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24
Q

The inability to maintain wrist extension with forward flexion of the upper extremities

A

Asterixis

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25
Q

True or false: It is important to observe for quick, irregular extensions and flexions of the wrist when a patient has asterixis

A

True

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26
Q

True or false: Regarding asterixis, tremor is not absent of rest, increased by intentional movement, and maximal on unsustained posture; usually unilateral

A

False

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27
Q

Asterixis can be observed in…

A

-Uremia
-Respiratory failure
-Severe heart failure

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28
Q

Test for asterixis

A

Asking the client to extend the wrist and hand with the rest of the arm supported on a firm surface or with the arms held out in front of the body

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29
Q

MSK symptoms

A

-Thoracic pain between scapulae, right shoulder, right upper trapezius, right interscapular, or right subscapular areas
-Hepatic osteodystrophy

30
Q

Abnormal development of bone, can occur in all forms of cholestasis (bile flow suppression) and hepatocellular disease

A

Hepatic osteodystrophy

31
Q

Hepatic osteodystrophy is associated with…

A

Osteomalacia and osteoporosis

32
Q

Pain may develop in the ____________ and ___________ as a nonspecific complication of chronic liver disease

A

-Wrist
-Ankles

33
Q

True or false: Client presenting with undiagnosed or untreated jaundice must be referred to the physician

A

True

34
Q

True or false: A patient can participate in active, intense exercise when the liver is compromised

A

False

35
Q

How to educate individuals at risk for pressure ulcers

A

-Implement prevention strategies such as skin care, optimal nutrition, and hydration
-Teach the client and family pressure-reducing or -relieving positions and turning strategies

36
Q

Increased risk of ___________ also occurs with liver disease

A

Coagulopathy

37
Q

True or false: Easy bruising and bleeding under the skin or into the joints in response to the slightest trauma can occur with liver disease

A

True

38
Q

True or false: Liver decreases in size (volume), weight (mass), and blood flow with advancing age

A

True

39
Q

Affects of liver decreasing in size (volume), weight (mass), and blood flow with advancing age

A

-Require more time to process substances, medications, and alcohol
-Become less tolerant to damage and less able to repair and regenerate

40
Q

Cellular changes in the hepatic system…

A

Contribute to the liver’s difficulty in responding to stress, inflammation, and injury

41
Q

Modification of drug dosage may be required—__________ production decreases with age

A

Albumin

42
Q

True or false: Drugs that are typically bound to albumin and rendered pharmacologically unavailable become more readily available

A

True

43
Q

Medications that are _________ have an increased area of distribution in older people secondary to an increase in the proportion of fat mass and decrease of lean mass

A

Lipophilic

44
Q

True or false: The liver does not contain a large number of immunologically active cells

A

False

(it does)

45
Q

The liver is a major site of production of _________ that are associated with ______________ reactions

A

-Proteins
-Acute inflammatory

46
Q

True or false: Age-related changes in sinusoids result in substantial alterations in many immunologic functions

A

True

47
Q

Severe complications that occur when the liver has been damaged or is no longer functioning

A

-Jaundice (Icterus)
-Cirrhosis
-Portal Hypertension
-Hepatic Encephalopathy
-Ascites
-Hepatorenal Syndrome

48
Q

Yellow discoloration of the skin, sclerae, and mucous membranes

A

> 2.0 mg/dL

49
Q

Skin becomes a yellow color; urine turns a darker color, and stool is light in color

A

> 3.0 mg/dL

50
Q

Four common causes of jaundice

A

-Diseases associated with overproduction of bilirubin
-Decreased uptake or conjugation in bilirubin metabolism
-Hepatocyte dysfunction
-Impaired bile flow

51
Q

The final common pathway of chronic, progressive inflammation of the liver; usually not reversible

A

Cirrhosis

52
Q

Cirrhosis when inflammation (from disease or toxin) causes…

A

Liver tissue damage and/or necrosis

53
Q

Cirrhosis characterizes a progressive loss of normal tissue that is replaced with…

A

Fibrosis and nodular regeneration

54
Q

True or false: Cirrhosis can be compensated or uncompensated

A

True

55
Q

SLIDE 25-26

A
56
Q

An elevated portal pressure gradient occurs when the pressure of the blood entering the liver (portal vein) is higher than the pressure of the blood in the inferior vena cava

A

Portal hypertension

57
Q

Most cases of portal hypertension are related to _________

A

Cirrhosis

58
Q

These combine to form mechanical barriers to blood flow and increase resistance

A

-Fibrosis
-Nodularity
-Abnormal liver architecture

59
Q

Blood can back up in the… causing dilation and expansion

A

-Stomach
-Esophagus
-Umbilicus
-Rectum

60
Q

A complex neuropsychiatric syndrome with symptoms ranging from subtle neuropsychiatric and motor disturbances to coma and death

A

Hepatic encephalopathy (HE)

61
Q

HE occurs due to…

A

-Hepatic dysfunction
-Portosystemic shunting of blood
-Portal hypertension

62
Q

Serious and common causes of HE include…

A

-GI bleeding
-Infection
-Hypovolemia
-Electrolyte abnormalities

63
Q

True or false: Pathologic mechanisms of HE are well understood

A

False

(not well understood)

64
Q

Pathologic mechanisms of HE may be related to…

A

-Ammonia
-Glutamate
-Neurotransmitters

65
Q

True or false: Reversal of HE is typically successful when a source is identified, corrected, and treated appropriately

A

True

66
Q

SLIDE 29

A
67
Q

Abnormal accumulation of fluid within the peritoneal cavity

A

Ascites

68
Q

Ascites is most often caused by…

A

-Decompensated liver cirrhosis (85% of cases)
-Heart failure
-Abdominal malignancies
-Nephrotic syndrome
-Infection
-Malnutrition

69
Q

Dyspnea with increased respiratory rate occurs in Ascites when the fluid displaces the ____________

A

Diaphragm

70
Q

Infection of ascitic fluid in the setting of portal hypertension

A

Spontaneous Bacterial Peritonitis (SBP)

Internal Medicine (25 decks)

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