Disorders of Hepatobiliary and Exocrine Pancreas Function

Question 1

Liver is a highly ____________ organ

Answer 1

vascular (contains about 500-1000ml of blood)

Question 2

What is the blood in the liver supplied by?

Answer 2

the hepatic artery and hepatic (portal) vein (which does not contain valves)

Question 3

What does the liver serve as filter for?

Answer 3

-nutrients and toxins absorbed in the intestines
-blood cell debris from the spleen
-insulin and glucagon from the pancreas

Question 4

Where do hepatic veins empty into?

Answer 4

the inferior vena cava then superior vena cava for transport into the right atrium

Question 5

What do the hepatic veins supply blood with?

Answer 5

a lower O2 sat than arterial blood, but it does provide 75% of oxygen needs of the liver

Question 6

What are the liver functions?

Answer 6

-metabolism of nutrients and vitamins
-synthesis of proteins and enzymes
-detoxification of drugs, hormones, and alcohol
-production/ excretion of bile and bilirubin

Question 7

Liver-Metabolism Functions

Answer 7

-essential role in carbs metabolism and glucose homeostasis
-manufactures proteins for its own use and secretes proteins released into circulation for cellular needs

Question 8

What do carbs do in liver metabolism?

Answer 8

-stores large amounts of glucose as glycogen through glycogenesis
-concerts glycogen back to glucose with hypoglycemia
-performs gluconeogenesis

Question 9

What do proteins do in liver metabolism?

Answer 9

-albumin contributes to plasma colloid osmotic pressure and binds and transports some hormones, fatty acids, bilirubin and anions
-produces fibrinogen and clotting factors to promote clotting

Question 10

Pathophysiology of Liver Dysfunction

Answer 10

-bleeding r/t inadequate clotting factor production

-infection risk r/t decreased immune globulins

-accumulation of toxins and drugs

-inadequate conjugation/excretion of bile leads to hyperbilirubinemia and jaundice

-biliary tract obstruction with possible gallstone formation

-hormone accumulation led to feminization in males

-increased ammonia because the liver is unable to convert ammonia to urea for excretion in stool and urine and it is toxic

Question 11

What is the liver an important site for?

Answer 11

manufacture and break down of proteins

Question 12

Ammonia produced by protein metabolism in the GI tract is absorbed by what?

Answer 12

the portal circulation and transported to the liver to be converted to urea for excretion in urine and stool

Question 13

When is ammonia increased in the intestine?

Answer 13

with high protein foods and GI bleeding

Question 14

Hepatic encephalopathy

Answer 14

central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma

Question 15

Liver- Exocrine Function

Answer 15

bile production (made by hepatocytes into ducts instead of blood)

Question 16

What happens once the common bile duct delivers bile into the duodenum?

Answer 16

digestion and absorption of fats and fat-soluble vitamins

Question 17

What does decrease bile in the duodenum produce?

Answer 17

light clay or tannish colored stools

Question 18

Bilirubin is the end product of

Answer 18

heme degradation

Question 19

Elevated bilirubin in the blood leads to what?

Answer 19

jaundice in the skin and eye

Question 20

Intestinal flora concerts some bilirubin to what?

Answer 20

urobilinogen that is excreted in stool and urine

Question 21

What is jaundice caused by?

Answer 21

-increased breakdown of RBCs
-liver dysfunction
-blockage of bile passage within the biliary system

Question 22

What is Hepatitis?

Answer 22

-inflammation of the liver
-can occur from specific viral infections, drugs, toxins, or an autoimmune disorder

Question 23

The viruses that cause hepatitis differ by what?

Answer 23

-manner of transmission
-incubation period
-mechanism
-extent
-chronicity of liver damage

Question 24

How can viral hepatitis cause liver damage?

Answer 24

by direct injury to cells and by immune responses

Question 25

Liver Cirrhosis

Answer 25

-as the liver is damaged, cells become replaced with fatty tissue -the new tissue does not perform functions of normal liver cells

Question 26

Liver Cirrhosis- Pathophysiology

Answer 26

-abnormal blood vessels and bile ducts lead to hypertension inside liver -hypertension within liver leads to compression and destruction of veins -chronic progressive destruction of liver parenchyma is a hallmark of cirrhosis -liver attempts to regenerate but with abnormal fibrous tissue

Question 27

Portal Hypertension

Answer 27

-portal vein drains abdominal blood to liver -cirrhotic structural changed obstruct blood flow through the liver -pressure increases in portal vein system -venous blood backs up in liver and as far as into the esophageal veins -esophageal varices

Question 28

Esophageal Varices

Answer 28

-can rupture at any time -sudden and severe hemorrhage -high mortality rate

Question 29

Ascites

Answer 29

-accumulation of fluid and electrolytes in abdominal cavity -fluid leaks from liver and petal veins -hypokalemia with ascites -associated with low serum albumin and low protein in circulating volume -decreased circulating volume leads to hypotension

Question 30

What is the function of the gallbladder?

Answer 30

stores and concentrates bile

Question 31

What does bile contain?

Answer 31

water, bile salts, bile pigments, cholesterol, electrolytes

Question 32

What does the gallbladder do as food enters?

Answer 32

it contracts then releases bile that moves into the duodenum

Question 33

What are gallbladder disorders?

Answer 33

-cholelithiasis: gallstones -cholecystitis: gallbladder inflammation -cholangitis: inflammation of common bile duct

Question 34

What can lack of bile salts lead to?

Answer 34

-light tan stools -steatorrhea (malabsorption of fats) -intolerance to fatty food

Question 35

Cholecystitis/ Cholelithiasis- Clinical Manifestations

Answer 35

-RUQ pain -indigestion after fatty foods -light stools -steatorrhea (fatty stools)

Question 36

What is the pancreas?

Answer 36

-positioned transversely in posterior abdomen -has both endocrine and exocrine functions

Question 37

When does pancreas become active?

Answer 37

when food enters the duodenum

Question 38

What does pancreas secrete?

Answer 38

amylase to break down starches and lipase to break down fat

Question 39

Endocrine

Answer 39

secretes substances directly into blood stream

Question 40

Exocrine

Answer 40

secretes substances into ducts instead of the blood

Question 41

What is pancreatitis?

Answer 41

Auto digestion of the Pancreas

Question 42

What are factors of pancreatitis?

Answer 42

-ethyl alcohol -gallstones -abdominal trauma

Question 43

Pancreatitis- Pathophysiology

Answer 43

-food in duodenum stimulates release of digestive enzymes from the pancreas to be delivered to the duodenum for digestion -the pancreatic duct may be obstructed by a wandering gallstone -enzymes back up and leak into pancreas -systemic chemical mediators released by inflammation

Question 44

What is acute pancreatitis?

Answer 44

inflammation of the pancreas

Question 45

Pancreatitis- Clinical Manifestations

Answer 45

-increased serum amylase and lipase -fluid and electrolyte abnormalities: hyperglycemia and hypokalemia -SEVERE abdominal pain

Question 46

What could cause chronic pancreatitis ?

Answer 46

-chronic alcohol abuse -chronic gallstone obstruction

Question 47

What can happen during chronic pancreatitis?

Answer 47

-progressive loss of pancreas tissue -destruction of insulin producing cells leads to diabetes -chronic pain but symptoms less severe than acute form -acute episodes can occur