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

Final: Ch 30 Hepatobiliary & Exocrine Pancreas Disorders Flashcards

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1
Q

liver gross anatomy

A

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

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2
Q

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

A

the common bile duct –> empties into duodenum

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3
Q

what is the functional unit of the liver

A

liver lobule

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4
Q

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

A

vein, vein

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5
Q

plates of hepatocytes are separated by ________

A

sinusoids

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6
Q

hepatocytes produce ____, which flows to the _____ duct

A

bile, bile

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7
Q

Kupfer cells are what

A

macrophages

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8
Q

metabolic functions of the liver: carbohydrates

A

glycogen storage

gluconeogenesis

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9
Q

metabolic functions of the liver: lipids

A

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

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

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10
Q

most cells metabolize ____ for energy via acetyl-coA

A

fats

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11
Q

cholesterol is stored or exported as _________

A

lipoprotein

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12
Q

metabolic functions of the liver: proteins

A

synthesis - albumin, fibrinogen

use aa for gluconeogenesis

deamination –> ammonia –> urea –> renal excretion

synethesis of nonessential aa

transamination

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13
Q

ammonia is also produced in the ____ by ________

A

gut, bacteria

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14
Q

bile production and flow

A

produced in liver –> duodenum –> emulsify fat

some bile is reabsorbed into portal circulation

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15
Q

how is bilirubin formed

A

hemoglobin –> heme –> biliverdin –> free bilirubin

free bilirubin to liver bound to plasma proteins –> bile

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16
Q

jaundice

A

caused by elevated serum bilirubin

easily seen in eyes (scleral icterus)

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17
Q

prehepatic jaundice

A

RBC destruction (post-transfusion)

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18
Q

intrahepatic jaundice

A

low bilirubin uptake or conjugation by liver

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19
Q

posthepatic jaundice

A

obstructed bile flow (stones)

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20
Q

cholestasis

A

low bile production and flow

high bilirubin and cholesterol in the blood

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21
Q

intrahepatic cholestasis

A

from liver disease or shock

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22
Q

extrahepatic cholestasis

A

duct obstruction

gallstones, pancreatitis, tumor

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23
Q

symptoms of cholestasis

A

pruritus

hyperlipidemia

poor absorption of fat soluble vitamins

high serum alkaline phosphatase

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24
Q

liver function tests

A

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

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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

Pathophysiology (24 decks)

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