Final: Ch 30 Hepatobiliary & Exocrine Pancreas Disorders Flashcards Preview

Pathophysiology > Final: Ch 30 Hepatobiliary & Exocrine Pancreas Disorders > Flashcards

Flashcards in Final: Ch 30 Hepatobiliary & Exocrine Pancreas Disorders Deck (86):
1

liver gross anatomy

inferior to diaphragm under ribs - can't be palpated unless enlarged

arterial blood via hepatic artery, venous blood via portal vein

drained by hepatic vein

2

the hepatic duct and cystic duct (gallbladder) meet to form which duct

the common bile duct --> empties into duodenum

3

what is the functional unit of the liver

liver lobule

4

liver lobules are organized around a central ___, which drains to the hepatic ____

vein, vein

5

plates of hepatocytes are separated by ________

sinusoids

6

hepatocytes produce ____, which flows to the _____ duct

bile, bile

7

Kupfer cells are what

macrophages

8

metabolic functions of the liver: carbohydrates

glycogen storage

gluconeogenesis

9

metabolic functions of the liver: lipids

acetyl-CoA --> ketones (used for energy by other tissues)

acetyl-CoA --> HMG-CoA --> bile salts/cholesterol

10

most cells metabolize ____ for energy via acetyl-coA

fats

11

cholesterol is stored or exported as _________

lipoprotein

12

metabolic functions of the liver: proteins

synthesis - albumin, fibrinogen

use aa for gluconeogenesis

deamination --> ammonia --> urea --> renal excretion

synethesis of nonessential aa

transamination

13

ammonia is also produced in the ____ by ________

gut, bacteria

14

bile production and flow

produced in liver --> duodenum --> emulsify fat

some bile is reabsorbed into portal circulation

15

how is bilirubin formed

hemoglobin --> heme --> biliverdin --> free bilirubin

free bilirubin to liver bound to plasma proteins --> bile

16

jaundice

caused by elevated serum bilirubin

easily seen in eyes (scleral icterus)

17

prehepatic jaundice

RBC destruction (post-transfusion)

18

intrahepatic jaundice

low bilirubin uptake or conjugation by liver

19

posthepatic jaundice

obstructed bile flow (stones)

20

cholestasis

low bile production and flow

high bilirubin and cholesterol in the blood

21

intrahepatic cholestasis

from liver disease or shock

22

extrahepatic cholestasis

duct obstruction

gallstones, pancreatitis, tumor

23

symptoms of cholestasis

pruritus

hyperlipidemia

poor absorption of fat soluble vitamins

high serum alkaline phosphatase

24

liver function tests

direct and indirect bilirubins

elevated enzymes suggest hepatocyte damage

ALT (alanine aminotransferase)

AST (aspartate aminotransferase)

total protein, clotting factors, albumin (low in disease)

imaging/biopsy

25

viral hepatitis overview

liver injury causes necrosis

chronic carrier state also possible with HCV (or HBV)

3 stages

26

3 stages of viral hepatitis

prodromal

icterus

convalescence

27

prodromal stage

general malaise & GI symptoms

fever & chills

28

icterus stage

jaundice

pruritis

liver tenderness

worsening of prodromal symptoms

29

convalescence stage

jaundice and other symptoms disappear

30

hepatitis A

benign and self-limiting

ssRNA virus replicates in liver, excreted in bile

doesn't cause chronic infection

vaccine available

31

hep A symptoms, transmission, Ab

N/V, malaise, abd pain, jaundice, dark urine

fecal-oral (contaminated water/milk, shellfish)

Ab give immunity and mark infection

32

hepatitis B

dsDNA virus that can produce acute or chronic hepatitis, cirrhosis, or acute hepatic necrosis

transmitted through blood or bodily fluids

33

hep B Dx, vaccine?

viral antigens and Ab measured in blood

vaccine available

34

hepatitis C

ssRNA virus - world's leading cause of chronic hepatitis, cirrhosis, and liver cancer

spread through drug use/sexual contact/ blood

long incubation period

35

hep C symptoms, Dx

initial symptoms non-specific or asymptomatic

causes jaundice and cirrhosis but not usually acute failure

virus and Ab tests available

36

hepatitis D

commonly superimposed on HepB infection

makes HepB infection worse

37

hepatitis E

non-enveloped ssRNA virus

transmitted fecal-oral, contaminated water

20 million infections

38

hep E is ____-______ but may develop into _______ hepatitis

self-limiting (resolves in 4-6 wks), fulminant hepatitis (acute liver failure)

39

hep E is most prominant where

east and south asia

china has vaccine but it's not available globally

40

$1000 pill for Hep C cure

Sovaldi

84k for full treatment

41

chronic viral hepatitis

infection persists for 3-6 mnths or more

ALT & virus levels elevated

causes chronic liver disease, cirrhosis, and cancer

from hep B, C, or D

42

Rx for chronic viral hepatitis

inferferons and anti-viral drugs

liver transplant

43

primary biliary cirrhosis

chronic liver disease - autoimmune destruction in small bile ducts --> liver failure

insidious onset and slow progression

44

Rx for primary biliary cirrhosis

symptomatic only until failure then liver transplant

45

secondary biliary cirrhosis

from prolonged duct obstruction with gallstones

46

hepatic drug metabolism phase 1

chemical modifications by liver enzymes (cytochrome P450)

induced (EtOH) or suppressed (cimetidine H2r blocker)

47

hepatic drug metabolism phase 2

conversion of lipid-soluble substances to water soluble form

48

drug-induced liver disease

tylenol is hepatotoxic

some drugs are cholestatic - antipsychotics and antibiotics

49

alcohol induced liver disease

alcohol absorbed from GI tract including stomach

2 phases of metabolism in hepatocytes

microsomal ethanol-oxidizing system (MEOS) uses cytochrome P450

50

alcohol dehydrogenase

uses NAD to make NADH

51

NAD depletion/NADH excess in alcohol induced liver disease

lowers gluconeogenesis --> hypoglycemia and less beta-oxidation --> fatty liver

52

are the metabolic end products of alcohol breakdown toxic?

yes, acetaldehyde

53

mechanism of damage in alcohol induced liver disease

unknown but there are fatty changes

hepatitis and cirrhosis result

cirrhosis compresses/disrupts hepatic vein branches --> portal HTN

54

nonalcoholic fatty liver disease

seen w/ insulin resistance and higher liver uptake of FA

Rx: weight loss and avoid alcohol

55

cirrhosis

end stage of chronic liver disease

diffuses fibrosis and destruction of vascular and biliary channels

leads to portal HTN, biliary stasis, and liver failure

56

causes of cirrhosis

alcohol abuse

viral hepatitis

mineral deposits (hemochormatosis Fe, Wilson disease Cu)

non-EtOH liver disease including biliary obstruction

57

symptoms of cirrhosis

weight loss

ascites

hepatomegaly

abd pain

jaundice

58

portal HTN

high resistance to blood flow from liver --> high portal pressure

59

pre-hepatic causes of portal HTN

portal vein thrombosis or compression (cancer)

60

intra-hepatic causes of portal HTN

cirrhosis

61

post-hepatic causes of portal HTN

Rt HF

Budd-Chiari syndrome (occlusion of hepatic vein or IVC)

62

complications of portal HTN

ascites - high pressure low COP

splenomegaly - less blood

portosystemic shunts - venous collaterals

63

high pressure of portal HTN can cause

esophageal varices

dilated veins around umbilicus

reverse flow - toxic to systemic circulation

64

Rx of portal HTN

balloon tamponade

reduce GI blood flow w/ endoscopic sclerosis

vessel ligation

drugs

surgical shunt of portal vein blood to systemic circulation

65

liver failure

most severe complication of liver disease

decreased clotting factors

lower metabolism (higher function of steroid hormones)

hepatorenal syndrome (renal failure 2ndary to hepatic failure)

66

cause of liver failure

encephalopathy - blood bypasses liver and neurotoxins like ammonia buildup

67

Rx for liver failure

stop alcohol

prevent infection

limit protein, give carbs

liver transplant

68

2 types of liver cancer

primary - hepatocellular carcinoma

metastatic - most common: from colon, breast, of lung

69

risk factors, symptoms for primary liver cancer

viral hepatitis

weakness, anorexia, fatigue --> ascites + jaundice

70

Rx of primary liver cancer

subtotal hepatectomy

chemo/radiation are palliative

71

cholelithiasis

gallstones: 4/5 made of cholesterol, other bile salts/bilirubin

abrupt onset but transient pain

72

predisposing factors for cholelithiasis

excess cholesterol in bile - obesity/birth control pill

stasis of bile - liver disease/obstruction

inflammation of gallbladder - high water/bile salt absorption

73

cholecystitis

inflammation secondary to obstruction from stones

caused by sepsis, trauma, infection

acute or chronic

74

symptoms of cholecystitis

persistent pain

fever

n/v

75

Dx/Rx of cholecystitis

ultrasound, CT

surgery

76

choledocholithiasis

stones in CBD

can cause sepsis, shock, and pancreatitis

77

acute pancreatitis

reversible inflammation caused by activation of pancreatic enzymes outside the cut

trypsinogen -> trypsin --> others activated

pancreas digests itself

78

causes of acute pancreatitis

CBD obstruction w/ gallstones --> bile reflux to pancreas

alcohol abuse increases pancreatic secretions

79

symptoms of acute pancreatitis

pain

fever

shock

80

acute pancreatitis can cause

ATN

ARDS

multiple organ failure

death

81

Dx of acute pancreatitis

high serum amylase and lipase

CT

82

Rx of acute pancreatitis

NG suctino

pain relief (demerol lowers duct spasms)

NPO

IV fluids

83

chronic pancreatitis

caused by alcohol abuse and not reversible

2ndary to chronic duct obstruction

84

Rx of chronic pancreatitis

no alcohol

treat gallstones

give pancreatic enzymes

85

pancreatic cancer

mostly adenocarcinomas

symptoms from mass and mets

jaundice and pain

86

Dx/Rx of pancreatic cancer

Dx: high bilirubin and alk. phos, CT, ultrasound

Rx: palliative