Chapter 30: Disorders of Hepatobiliary and Exocrine Pancreas Function Flashcards
(109 cards)
1
Q
Describe what Jaundice is
A
It is excessive or elevated levels of bilirubin in the blood
2
Q
Why is bilirubin often first seen in the eyes?
A
because it is drawn to elastic fibers which are abundant in the eyes
3
Q
List and briefly describe the three types of jaundice.
A
1) PRE-HEPATIC: excessive destruction of RBCs
2) INTRA-HEPATIC: impaired uptake or conjugation of bilirubin by liver cells
3) POST-HEPATIC: obstruction of outflow of bile
4
Q
What are some things that can cause pre-hepatic jaundice?
A
hemolytic blood transfusion
Hereditary and acquired hemolytic disorders
Autoimmune hemolytic anemia
5
Q
What type of jaundice is physiological jaundice of a newborn?
A
Pre-hepatic jaundice
6
Q
What are the (2) manifestations of pre-hepatic jaundice?
A
mild jaundice
elevated unconjugated bilirubin
7
Q
What are the 2 general causes of intra-hepatic jaundice. List some things that can cause these.
A
lack of enzymes
damage
hepatitis, cirrhosis, liver Ca, meds
8
Q
List the 4 manifestations of intra-hepatic jaundice
A
1) mild jaundice
2) elevated bilirubin
3) dark urine
4) elevated serum alkaline phosphate (d/t dmg to cells lining bile duct)
9
Q
list 4 causes of post-hepatic jaundice
A
1) structural disorders
2) congenital atresia
3) cholelithiasis
4) tumors
10
Q
List the 7 manifestations of post-hepatic jaundice
A
1) elevated conjugated bilirubin
2) inc alkaline phosphatase
3) inc AST
4) clay coloured stool
5) dark urine
6) pruritis
7) jaundice
11
Q
Define cholestasis
A
impaired bile formation and flow
12
Q
Define cholangitis
A
inflammation of the common bile duct
13
Q
Define cholecystitis
A
inflammation of gall bladder
14
Q
Define cholelithiasis
A
gallstones
15
Q
Define choledocholithiasis
A
presence of at least one gallstone in the common bile duct
16
Q
What is hepatitis?
A
acute or chronic inflammation of the liver cells
17
Q
What are the 5 types of hepatitis?
A
ACUTE VIRAL: a, b, c, d, e
Chronic viral
Autoimmune
Acute fulminant
Chronic
18
Q
What are the three phases of hepatitis?
A
1) prodromal
2) icterus
3) convalescent
19
Q
Describe the manifestations for the prodromal stage of hepatitis (stage 1)
A
Malaise, fatigue, anorexia, myalgia, arthralgia, chills, fever
GI: diarrhea/constipation, N and V, mild right abd pain
20
Q
Describe the 4 manifestations of the icterus stage of hepatitis (stage 2)
A
Jaundice (less so with HCV)
dark urine
severe pruritis
liver tenderness
21
Q
What occurs in the convalescent stage of hepatitis?
A
complete recovery if type A or B
22
Q
What can be said about the symptoms of HAV (hep A) (duration)
A
benign and self-limiting
23
Q
Where does HAV survive and what type of countries is it an endemic in?
A
in sea, fresh, and waste water and soil
endemic in countries with poor hygiene/sanitation
24
Q
What is the mode of transmission for HCA. Describe when it is excreted and its incubation time.
A
Fecal to oral
excreted 2-3 weeks before symptom onset
incubation of 2-30 days
25
List the (7) manifestations of HCA
```
fever
malaise
nausea
anorexia
abd discomfort
dark urine
Jaundice (70 percent of time)
```
26
What age is HCA asymptomatic for?
<6 yrs old
27
Can HCA cause chronic hepatitis?
no
28
What can HCA progress to?
Fulminant hepatitis
29
What is the treatment for HCA and HCB?
vaccination
30
What ratio of people are infected with HBV?
1/3
31
List 3 activities that can lead to transmission of HBV
perinatal transmission
IV drug use
Unprotected sex
32
How is HBV transmitted?
blood
perinatal
oral/sex contact
33
What can infection with HBV progress to?
can result in carrier state
can progress to acute, chronic, or fulminant
34
When was HCV discovered?
1989
35
How is HCV transmitted? (2)
Blood (transfusion, IV, needle stick, tattoo, piercing)
High risk sexual behaviour
36
What group is at decreased risk for HCV?
young female
37
What is the incubation period of HCV?
2-26 wks
38
Describe the manifestations for HCV
can be asymptomatic to mild nonspecific resulting in difficulty detecting
Jaundice and Dark urine for some
39
What does HCV usually develop into?
Chronic hepatitis
40
Describe what Acute Fulminant Hepatitis is.
Progression from acute hepatitis to encephalopathy in 2-3 weeks with no sign of chronic hepatitis
41
List the causes of fulminant hepatitis (5)
Acetaminophen toxicity (45 percent)
other idiosyncratic drug reactions
poisonous mushrooms
fatty liver disease in pregnancy
HAV more than other types
42
List the 5 manifestations of fulminant hepatitis (think of impaired liver function)
GI symptoms
Hemorrhage (can't produce factors)
Jaundice
Inc serum ammonia
- leads to CNS symptoms and hepatic encephalopathy
Cerebral edema (possibly due to dec plasma protein production)
43
How is fulminant hepatitis treated?
symptomatic management and transplant
44
What is hepatic encephalopathy caused by?
by the accumulation of neurotoxins (like ammonia) d/t the liver not being able to remove them
45
List the manifestations of hepatic encephalopathy (6)
1) signs of liver failure
2) asterisis (flapping tremor of hand)
3) personality changes
4) speech difficulty
5) dec mental alertness
6) coma and seizure
46
How long does hepatitis need to go on for before it is diagnosed as chronic
> 6 months
47
What is the most common cause of chronic hepatitis?
HCV
48
List the 4 manifestations of chronic hepatitis
Fatigue
Anorexia
Jaundice
elevated ATF
49
What are the 2 complications of chronic hepatitis?
Cirrhosis
Ca
50
What is the leading cause of acute liver failure in NA?
Drug induced liver disease
accidental acetaminophen OD
51
What are the three conditions associated with alcohol induced liver disease?
Fatty liver disease
Alcoholic hepatitis
Alcoholic cirrhosis
52
Describe what Fatty liver disease is (sub category of alcohol induced liver disease)
Accumulation of fat in hepatocytes
53
List the 2 manifestations of fatty liver disease (sub category of alcohol induced liver disease). Are these manifestations reversible?
Steatosis (fatty liver)
hepatomegaly
reversible if alcohol consumption is stopped
54
Describe what alcoholic hepatitis is.
Inflammation and necrosis of liver cells d/t alcohol
55
What are the 6 manifestations of alcoholic hepatitis (think of normal hepatitis manifestations)
```
Jaundice
pain
fever
anorexia
ascites
encephalopathy
```
56
What is alcoholic cirrhosis?
scar tissue build up due to chronic alcohol abuse
nodules compress blood flow
57
What are some causes of Cirrhosis?
alcohol
viral hepatitis
biliary disease
non-alcoholic fatty liver disease
58
Describe the manifestations of Cirrhosis (8)
Asymptomatic until late
1) wt loss
2) wkness
3) anorexia
4) diarrhea
5) sometimes constipation
6) hepatomegaly
7) jaundice
8) pain
59
What two manifestations of cirrhosis are the late manifestations?
Pain and jaundice
60
List some complications of Cirrhosis (10)
Portal HTN
splenomegaly
bleeding
thrombocytopenia
insulin resistance
hemorrhoids
caput medusa
testosterone/estrogen imbalances
spider angiomas/palmer erythema
encephalopathy
61
What is caput medusa?
swelling of the vessels in the umbilical area
62
What are the (3) RF for non-alcoholic fatty liver disease?
OBESITY: DM type 2, hyperlipidemia, insulin resistance
rapid wt loss
TPN
63
Describe and list the 5 manifestations of non-alcoholic fatty liver disease
Usually asymptomatic
RUQ pain
INC AST, ALT, INR
Dec albumin
64
What can non-alcoholic fatty liver disease progress to?
cirrhosis and end stage liver disease
65
What is portal hypertension?
inc BP in the portal vein
66
the causes of portal hypertension are grouped into categories by location. List these causes.
PRE-HEPATIC:
- obstructive thrombosis
- portal vein narrowing
- splenomegaly
INTRA-HEPATIC:
- cirrhosis
POST-HEPATIC:
- R sided heart failure
- hepatic outflow obstruction
67
What are the three complications of portal hypertension?
ASCITES
SPLENOMEGALY / HYPERSPLENISM
INC VENOUS PRESSURE IN abd, rectum, esophagus
68
At what stage of portal hypertension does ascites occur?
late stage
69
How much and what type of fluid accumulates in ascites?
500 mL of serous fluid
70
List 3 causes of ascites
Portal HTN
Sodium/water retention by kidneys
Impaired albumin syntheses by liver
71
What can ascites progress to?
peritonitis
72
Explain what occurs in splenomegaly (or hypersplenism)
RBC life span is reduced resulting in:
anemia
thrombocytopenia
leukopenia
73
What does increased venous pressure in the abdomen, rectum and esophagus lead to?
Esophageal varices (enlarged veins in lower esophagus
Caput medusa
Hemorrhoids
74
What percentage of liver function must be lost to be diagnosed with liver failure?
80-90 percent
75
The manifestations of liver failure are grouped into 5 categories. List them and describe the symptoms
GI: fetor hepaticus (musty sweat breath)
HEMATOLOGICAL: anemia, thrombocytopenia, coagulation defects, leukopenia
INTEGUMENT: purpura, bruising, vascular spiders, telangiectasis, spider angiomas and nevi, palmar erythema, clubbing, jaundice
ENDOCRINE: increased androgens/estrogens, dec aldosterone
HEPATORENAL SYNDROME: Progressive azotemia, oliguria
Hepatic encephalopathy
76
Is the liver a popular site of secondary metastasis?
yes
77
What are the two types of Liver Ca
HEPATOCELLULAR CARCINOMA: involves most liver cells
CHOLANGIOCARCINOMA: bile duct cells
78
What is the key sign of liver Ca in adults?
elevated AFP (alpha fetoprotein)
79
What is the approach to treatment for liver Ca?
Palliative
80
What are the RF or causes for Hepatocellular Carcinoma (4)
Chronic viral hepatitis
ETOH
NFLD (non-alcoholic liver disease)
Environmental exposure
81
List some of the (9) manifestations for hepatocellular carcinoma
```
Weakness
Anorexia
Wt loss
Fatigue
Bloating
Dull abd ache
Ascites
Jaundice
Hepatomegally
```
82
What are the two risk factors for cholangiocarcinoma
Long-standing inflammation
Injury to bile duct epithelium
83
List the 5 manifestations for cholangiocarcinoma
```
pain
wt loss
anorexia
abd swelling
jaundice
```
84
What are the (5) risk factors for cholangelithiasis?
Female
Multiparity (multiple child births)
Oral contraceptives
Obesity
Genetics
85
List 3 etiological causes of cholangelithiasis
ABNORMAL COMPOSITION OF BILE: starvation, rapid wt loss, pregnancy
CHOLESTASIS: not moving, settles out
CHOLANGECYSTITIS: inflammation of gall bladder
86
Are the manifestations asymptomatic for cholelithiasis?
yes, unless obstruction occurs
87
What is the complication that can occur from Cholelithiasis?
BILIARY COLIC: gallstone lodging in the common bile duct or travelling through ducts causing spasms
88
Describe and list the symptoms of biliary colic (2)
Abrupt and persistent symptoms
RUQ/epigastric pain
- may be referred to R midscapula
Bilirubinemia (excess bilirubin in blood)
89
What are the two types of Acute Cholecystitis? Briefly describe each and give the percentage prevalence for each.
Acute Calculous Cholecystitis (85 percent)
- impacted stones in cystic duct
- lipases released, bile salts dmg epithelium
```
Acalculous Cholecystitis (15 percent)
- d/t ischemia, edema, bile stasis, obstruction
```
90
What can Alcalculous Cholecystitis (type of acute cholecystitis) progress to?
Gangrene and perforation
91
List 5 causes of Acalculous Cholecystitis (type of acute cholecystitis).
```
Sepsis
Trauma
Burns
DM
MSOF (multiple system organ failure)
```
92
List the 4 manifestations of Acute Cholecystitis
RQ or Epigastric pain (acute onset and persistant)
Mild fever
Anorexia
N and V
93
For what type of acute cholecystitis can symptoms be relieved?
Calculous Cholecystitis
94
Describe acute pancreatitis
It is reversible inflammation d/t early activation of pancreatic enzymes
trypsin first which activates others
95
What is the age group that acute pancreatitis tends to occur during
> 40 yrs old
96
What are the causes of pancreatitis (there are 2 main ones and others)
GALLSTONES
ALCOHOL ABUSE
```
hyperlipidemia
hypercalcemia
viral infections
trauma
medications (thiazide, diuretics)
```
97
There are 6 categories of symptoms for pancreatitis. List them and some of the manifestations under them.
```
GI:
LQ/epigastric/periumbilical
distension and abd tenderness
N and V
*hypoactive BS*
steatorrhea
```
CNS: fever, thirst, agitation, confusion
CVS: tachycardia, hypotension, massive fluid loss
RESPORITORY: tachypnea, hypoxia, dyspnea
RENAL: oliguria
```
INTEGUMMENT:
Cullen's sign
Turner's sign
Jaundice
cool/clammy skin
```
98
List 4 serum concentrations that can be tested to diagnose pancreatitis
Inc Pancreatic enzymes (trypisin, amylase, lipase, elastase)
High BG: poor carb metabolism
Hypocalcemia: fat necrosis releases fat which binds to calcium
Elevated Bilirubin: d/t hepatobiliary obstruction
99
List 4 complications of pancreatitis
SEPSIS
ARDS
ACUTE TUBERCULAR NECROSIS
MSOF
100
What is Chronic Pancreatitis
Progressive PERMANENT destruction of exocrine pancreas
101
Is chronic pancreatitis reversible?
No
102
Describe the manifestations of Chronic Pancreatitis
Same as acute, but less severe
103
What is the 4th leading cause of cancer death?
Pancreatic Ca
104
What is the 5 yr survival rate for pancreatic Ca?
4-5 percent
105
List 5 RF for pancreatic Ca
```
age
smoking
DM
Chronic Pancreatitis
genetics
```
106
List the 4 manifestations of pancreatic Ca
Dull epigastric pain (radiates back, worse in supine and when eating, relief when sitting forward)
Jaundice
Pruritis
Wt loss
107
What is the complication of pancreatic Ca
THROMBOPHLEBITIS: swelling of a vessel d/t clotting
108
What is the surgical treatment for pancreatic Ca called? Describe this surgical treatment
WHIPPLE PROCEDURE:
- RESECTION of proximal pancreas, duodenum, distal stomach, distal bile duct
- ANASTOMOSIS of pancreatic and common bile duct and stomach to duodenum
109
What condition results from the whipple procedure?
insulin dependent diabetes
