Disorders of Exocrine Pancreas and Hepatobiliary

Question 1

Gallbladder

Answer 1

stores bile

Question 2

Exocrine Pancreas

Answer 2

aids in digestion of CHO, fats, proteins

produces enzymes & bicarbonate

Question 3

Liver in Digestion

Answer 3

produces bile, synthesizes plasma proteins, metabolizes & eliminates drugs/toxins and stores vitamins glucose/blood

Question 4

cholelithiasis

Answer 4

gallbladder stone formation
most common gallbladder disorder
can cause choledocholithiasis, cholangitis, cholecystitis and cancer

Question 5

cholelithiasis pathogenesis

Answer 5

typically formed in gallbladder
move to bile ducts
obstruct and cause inflammation
usually formed from cholesterol or pigment

Question 6

cholelithiasis risk factors (five fs)

Answer 6

female
fair
fat
fertile
forty
estrogen replacement therapy
oral contraceptives

Question 7

cholelithiasis s/s early vs acute

Answer 7

e: vague, indigestion, mild gastric distress after fatty meals
a: severe/sudden onset of radiating pain (midepigastric, extends to RUQ/R subscapular region)

Question 8

bile reflux into liver s/s

Answer 8

jaundice
pain
hepatocyte damage

Question 9

bile duct obstruction

Answer 9

pancreatitis
stetorrhea
pruritus

Question 10

cholelithiasis tx

Answer 10

asymptomatic: ursodiol/diet
symptomatic: cholecystectomy

Question 11

cholangitis

Answer 11

inflammation of common bile duct

gallstone impacted into bile/duct inflammation > bacteremia/speticemia/secondary pancreatits

Question 12

cholangitis s/s

Answer 12

RUQ pain
ab tenderness
fever
jaundice
pruritus
dark-colored urine
clay colored stools (^ bilirubin)

Question 13

cholangitis tx

Answer 13

lithotomy 
analgesic
antihistamines
nutrition 
abx
antiemetics

Question 14

cholecystitis

Answer 14

acute/chronic inflammation of gallbladder
stone/digestive juices cause inflammation
> bile builds up
> increased pressure
> chemical damage
> tissue ischemia
> damage to gallbladder walls & mucosa
> perforation & necrosis

Question 15

cholecystitis etiology

Answer 15

cystic duct stone
trauma
infection
sepsis

Question 16

cholecystits s/s

Answer 16

intolerance of fat in diet
epigastric pain (eating)
flatulence
belching
colicky pain
steatorrhea
jaundice
pruritus

Question 17

cholecystits tx

Answer 17

cholecystectomy

abx (metronidazole)

Question 18

Gallbladder cancer

Answer 18

usually on surface lining or epithelium

Question 19

gallbladder cancer etiology

Answer 19

gallbladder damage (stones, toxins, bacteria, parasites)
main RF = gallstones

Question 20

gallbladder cancer s/s Early vs Late

Answer 20

often subtle/coexisting cholethiasis

intense RUQ pain, jaundice, weight loss, palpable gallbladder

Question 21

Gallbladder cancer tx

Answer 21

cholecystectomy
whipple resection (remove surrounding diseased tissues)

Question 22

Pancreas disorders types

Answer 22

head
midsection
tail

Question 23

acute pancreatitis etiology

Answer 23

alcohol abuse
gallstones
viral infections 
trauma
ab surgery
hyperlipidemia
acetaminophen/thiazide diuretics

Question 24

acute pancreatitis alcohol-induced

Answer 24

ethanol metabolized
> toxic metabolites released
> tissue injury/sphincter obstruction

Question 25

acute pancreatitis gallstone-induced

Answer 25

obstruction > trapped digestive enzymes >autodigestion of pancreatic tissue >acute inflammatory response

Question 26

acute pancreatitis s/s

Answer 26

``` ab pain tachycardia hypotension fever jaundice paresthesia cullen sign (bruising around umbilicus) turner sign (bluish flank area) steatorrhea ```

Question 27

acute pancreatitis critical s/s

Answer 27

low urine output hypoxemia restlessness confusion

Question 28

acute pancreatitis tx

Answer 28

based on condition & response pain relief fluid replacement NPO

Question 29

chronic pancreatitis

Answer 29

``` obstruction or strictures of pancreatic duct usually alcohol abuse calculi (stones) tumors or cysts smoking cystic fibrosis primary scelorosing cholangitis toxicity IBD genetics ```

Question 30

chronic pancreatitis s/s

Answer 30

anorexia malabsorption of fats/proteins dull constant ab pain (LUQ or epigastric)

Question 31

chronic pancreatitis tx

Answer 31

eliminate alcohol/smoking low-fat diet oral enzyme replacement insulin

Question 32

pancreatic cysts

Answer 32

previous damage to pancreas | benign (pseudocysts/serious cystadenomas) vs malignant (potentially mucinous)

Question 33

pancreatic cysts s/s

Answer 33

``` usually asymptomatic pain (epigastric radiating to back) nausea vomiting jaundice ab fullness ```

Question 34

pancreatic cysts tx

Answer 34

benign: monitoring malignant: surgery

Question 35

pancreatic cancer

Answer 35

spreads quickly invades lymphatic system lack of well-defined pancreatic capsule

Question 36

pancreatic cancer RF

Answer 36

``` smoking obesity diet diabetes chronic pancreatitis genetic predisposition ```

Question 37

pancreatic cancer s/s

Answer 37

symptoms are slow | late: portal vein hypertension, ascites, hepatomegaly, splenomegaly, esophageal varices

Question 38

pancreatic cancer tx

Answer 38

surgery chemotherapy radiation

Question 39

common liver disorder s/s

Answer 39

vague ab pain indigestion hepatomegaly advanced: jaundice, ascites

Question 40

Liver cancer

Answer 40

5th most common | poor survival rate world wide (2nd most common cause of death for men)

Question 41

liver cancer RF

Answer 41

``` cirrhosis hemochromatosis hep b or c excess alcohol excess coffee obesity oral contraceptive use ```

Question 42

liver cancer patho

Answer 42

immune cells: inflammation > deregulation of liver cell proliferation insulin related: insulin resistance > cytokines > hepatic steatosis & inflammation gene malfunction: malfunction limits ability to manage toxins & carcinogens

Question 43

liver cancer s/s

Answer 43

``` weakness weight loss bloating jaundice disturbances in clotting factors/hormones increase alk-phos, GGT, AST, ALT ```

Question 44

liver cancer tx

Answer 44

surgery radiofrequency ablation cryotherapy percutaneous ablation

Question 45

cirrhosis and causes

Answer 45

``` late stage scarring of liver alcohol (most common) chronic viral hepatitis chronic obstruction of bile ducts genetic disease (wilson disease, hemochromatosis, glycogen storage disease, autoimmune hepatitis) ```

Question 46

acute liver damage

Answer 46

alcoholic hepatitis

Question 47

chronic liver damage

Answer 47

cirrhosis steatosis steatohepatitis fibrosis

Question 48

causes of liver disease

Answer 48

cellular damage inflammation obstruction

Question 49

alcohol and the liver

Answer 49

progressive deterioration of liver cells

Question 50

accumulation of fat in liver

Answer 50

early: steatosis progressive: cirrhosis hepatocytes replaced by scar tissue liver metabolic fx are impaired secondary conditions: portal htn, splenomegaly, systemic effects

Question 51

contributing factors to severity of alcohol induced liver damage

Answer 51

``` patter of drinking (amount/number of years) immunity hmoral disorders genetic biochemical makeup overall nutrition, diet, health ```

Question 52

splenomegaly progression

Answer 52

``` steatosis (usually asymptomatic ^ AST,ALT) > hepatomegaly > RUQ ab discomfort > nausea > esophageal varices ```

Question 53

ascites progression

Answer 53

``` portal hypertension (may lead to gen edema) >dyspnea r/t ascites & portal htn > weakness >anorexia/weight loss >asterixis ```

Question 54

abnormal liver function tests

Answer 54

``` rplonged prothrombin time bruising bleeding jaundice gynecomastia spider angioma caput medusa ```

Question 55

early s/s of alcohol induced cirrhosis

Answer 55

increased serum amnoia restlessness agitation progressive impairment in judgement

Question 56

alcohol induced cirrhosis tx

Answer 56

``` abstinence (most important) improving overall health/nutrition liver transplant (only if pt maintains sobriety) prevention/tx of complications (bleeding/esophageal varices/swollen rectal veins/ascites) ```