Hepatitis, Pancreatic, Cancer Diseases (Adults Pt 3)

Question 1

Define Portal Hypertension

Answer 1

Abnormally high blood pressure in the portal venous system primarily caused by resistance to portal blood flow

Question 2

“Prehepatic” Portal Hypertension

Answer 2

Occurs before it reaches the liver (Ex: Portal vein thrombosis)

Question 3

“Hepatic” causes of portal hypertension

Answer 3

Occurs inside the liver Ex: Cirrhosis (most common cause)

Question 4

“Posthepatic” Causes of Portal Hypertension

Answer 4

Occurs btw the liver and the heart (Ex: Inferior vena cava obstruction, RH failure from constrictive pericarditis)

Question 5

Portal Hypertension Pathophysiology

Answer 5

1. Increased vascular resistance
2. Hepatic & myofibroblasts are activated
3. Nitric oxide vasodilator; more blood flow in portal veins
4. Increased portal hypertension

Question 6

Portal Hypertension Clinical Manifestations

Answer 6

Vomiting blood “hematemesis”

Question 7

Define Ascites & most common cause

Answer 7

Accumulation of fluid in the peritoneal cavity; Most common cause “Cirrhosis”

Question 8

Ascites “Overflow theory”

Answer 8

Renal sodium retention is stimulated by portal hypertension; hypervolemia; overflows and weeps into the peritoneal cavity

Question 9

Ascites “Under fill theory”

Answer 9

Hepatic sinusoidal hydrostatic pressure increases & plasma oncotic pressure decreases. Causes weeping of the lymph fluid from the surface of the liver.

Question 10

Ascites “Peripheral Arterial Vasodilation theory or Forward Theory”

Answer 10

1. Is the synthesis of the overflow & underfill theories
   most acceptable theory
2. Portal hypertension &; Splanchnic vasodilation occurs
3. Causes fluid transudation &; lymph formation, producing ascites.

Question 11

Define Hepatic Encephalopathy

Answer 11

Complex neurological syndrome characterized by impaired behavioral, cognitive, & motor function. Occurs when impaired cerebral function caused by blood borne toxins (ammonia) are not metabolized in the liver.

Question 12

Clinical Manifestations of Hepatic Encephalopathy

Answer 12

LOC decreases, personality changes, irritability, confusion, flapping tremor (asterxis), stupor (decreased level of consciousness; arousal to pain), coma, death

Question 13

Jaundice (also called “icterus”)

Answer 13

Yellow or greenish pigmentation of the skin caused by hyperbilirubin

Question 14

Jaundice Clinical Manifestations

Answer 14

Dark urine, clay colored stools, yellow discoloration, skin xanthomas, anorexia, malaise fatigue.

Question 15

Define Hepatorenal Syndrome & Major Cinical manifestation

Answer 15

functional renal failure caused by advanced renal disease, particularly cirrhosis with portal hypertension.

GI hemorrhage/Liver failure=hypovolemia=renal failure.

Clinical manifestation: Oliguria

Question 16

Acute Liver Failure

Answer 16

Severe impairment or necrosis of liver cells without preexisting liver disease or cirrhosis

Question 17

Pathophysiology Acute Liver Failure

Answer 17

1. Hepatocytes become edematous (swollen with fluid)
2. Patchy areas of necrosis and inflammatory cell infiltrates disrupt the parenchyma
3. Hepatic necrosis is irreversible

Question 18

Acute Liver Failure: Rene Syndrome vs Wilson’s Disease

Answer 18

Reye Syndrome: ALF in a child with a viral infection (chickenpox) & aspirin use

Wilson: Hereditary copper accumulation

Question 19

Acute Liver failure Clinical Manifestations

Answer 19

Anorexia, jaundice, abdominal pain

Question 20

Autoimmune hepatitis

Answer 20

• rare, chronic, & progressive autoimmune inflammatory liver disease .
• T cell mediated
• absence of viral hepatitis
• Clinical manifestation: Amenorrhea

Question 21

Hepatitis A

Answer 21

• Liver disease caused by Hep A

- Transmitted by fecal oral route

Question 22

Hep B

Answer 22

• Infectious disease caused by hepatitis B virus (HBV) that affects the liver; can be acute/chronic.
• Parenterally & sexually transmitted
• H.Bacteria

Question 23

Hep C

Answer 23

• Infectious disease caused by the hep C virus (HCV) that primarily affects the liver
• resp. For posttransfusion hepatitis
• HIV/ drug use
• no vaccine is available

Question 24

Hep D

Answer 24

Dependent on hepatitis B for replication

Question 25

Hep E

Answer 25

Fecal oral transmission; contaminated water or uncooked meat

Question 26

Phases of Hepatitis

Answer 26

Prodromal (preicteric): 2 weeks after exposure; ends when jaundice appears Icteric phase (jaundice): begins 1 -2 weeks after prodormal phase Recovery phase: begins with resolution of jaundice; chronic hep may begin at this phase

Question 27

Cirrhosis

Answer 27

Irreversible inflammation fibrotic disease that disrupts liver function and even liver structure; HCV most commonly associated with cirrhosis!

Question 28

Cirrhosis causes disorganization of _____ structure, ______, and _____ regeneration.

Answer 28

Lobular, fibrosis, and nodular regeneration

Question 29

Bile obstruction causes _____.

Answer 29

Jaundice

Question 30

Alcoholic Liver Disease

Answer 30

Oxidation of alcohol, causing damage to hepatocytes

Question 31

Steatosis (alcoholic fatty liver)

Answer 31

Mildest form of cirrhosis; reversible if drinking is stopped

Question 32

Alcoholic hepatitis (steatohepatitis)

Answer 32

Inflammation; degeneration & necrosis of the hepatocytes occur

Question 33

Alcoholic cirrhosis (fibrosis)

Answer 33

Toxic effects of alcohol metabolism on the liver, immunologic alterations, oxidative stress from lipid peroxidation, & malnutrition occur.

Question 34

Alcoholic liver disease also impairs hepatocytes ability to ____ fatty acids, synthesize _____, and proteins, degrade hormones, and clear portal blood of ______ & toxins.

Answer 34

Oxidize, enzymes, ammonia

Question 35

Liver Inflammation Pathophysiology

Answer 35

1. Pain,fever 2. nausea, vomiting, anorexia 3. Fatigue 4. Decreased hormone metabolism 5. Menstrual dysfunction, loss of body function 6. Increased ADH & aldosterone; Edema 7. Liver failure 8. Hepatic Encephalopathy 9. Hepatic Coma 10. Death

Question 36

Liver Necrosis Patho

Answer 36

1. Decreased bilirubin 2. Jaundice, increased bilirubin 3. Decreased bile 4. Light colored stools 5. Decreased vitamin K absorption (bleeding) 6. Dark urine (decreased plasma proteins) 7. Ascites and edema 8. Liver failure 9. Hepatic encephalopathy 10. Coma 11. Death

Question 37

Liver Fibrosis and Scarring Patho

Answer 37

1. Portal Hypertension 2. Ascites, edema, splenomegaly 3. Varices 4. Hepatopulmonary Syndrome 5. Biochemical Alterations 6. Elevated Bilirubin 7. prolonged PTT 8. liver failure 9. Hepatic encephalopathy 10. Hepatic coma 11. Death

Question 38

Vascular Obstruction causes portal hypertension , shunting, and _____.

Answer 38

Varices

Question 39

Cirrhosis can result from hepatitis or exposure to toxins such as ________ (a product of alcohol metabolism).

Answer 39

Acetaldehyde

Question 40

Vascular Obstruction causes progressive _______ liver damage, usually over a period of years.

Answer 40

Irreversible

Question 41

Alcoholic liver disease is progressive and includes: ______,______, and _____.

Answer 41

Steatosis (fatty liver disease), steatohepatitis (fatty liver disease), and alcoholic cirrhosis.

Question 42

Cholelithiasis

Answer 42

Gallstone formation

Question 43

Cholelithiasis ______ formation in bile that is supersaturated with cholesterol.

Answer 43

Stones

Question 44

Cholesthiasis pathophysiology

Answer 44

Results in bile aggregation of cholesterol crystals (cholesterol stones) or precipitates of unconjugated bilirubin (pigmented stones).

Question 45

CholeCYSTITIS

Answer 45

Inflammation of the gallbladder and is usually associated with obstruction of the cystic duct by gallstones.

Question 46

Acute pancreatitis Pathophysiology

Answer 46

1-Biliary obstruction and alcoholism 2-injury permits leakage of digestive enzymes into pancreatic tissue 3-Enzymes become activated followed by autodigestion, inflammation, and destruction of tissues. 4-Release of pancreatic enzymes into the bloodstream or abdominal cavity cause damage to other organs.

Question 47

Acute pancreatitis clinical manifestation

Answer 47

Pain radiating to back

Question 48

Chronic Pancreatitis

Answer 48

impairment of the pancreas usually related to alcoholism or recurrent acute pancreatitis. Causes recurrent abdominal pain, and digestive disorders!

Question 49

Cancer of the esophagus is rare and occurs in people older than ____.

Answer 49

60

Question 50

Esophageal carcinoma is associated with the following deficiencies:

Answer 50

Alcohol/tobacco use, reflux esophagitis, radiation exposure, and nutritional deficiencies

Question 51

What is the third most common cause of cancer death in the U.S?

Answer 51

Colon Cancer

Question 52

Familial adenomatous polyposis coli is an inherited form of colon cancer. T or F

Answer 52

True

Question 53

Colon & rectum cancer tumors of the RIGHT (_________ colon) are usually large and bulky (_______). Tumors of the LEFT (______, _______) colon develop as small __________ masses.

Answer 53

Right: Ascending; polypoid Left: Descending, sigmoid; buttonlike

Question 54

Rectal carcinoma is located up to ______cm from the opening of the anus. The tumor spreads transmurally to the vagina in women or to the prostate in men.

Answer 54

15

Question 55

Metastastic Invasion is more common than primary cancer of the ______.

Answer 55

Liver

Question 56

Chronic liver cancers (cirrhosis, HBV, HCV) are associated with primary _____ cancers.

Answer 56

Liver

Question 57

Hepatocellular carcinomas arise from the ______.

Answer 57

Hepatocytes

Question 58

Cholangiocellular carcinomas arise from the ____ _____.

Answer 58

Bile ducts

Question 59

Cancer of the gallbladder is rare and occurs in women older than ____.

Answer 59

50

Question 60

Cancer of the pancreas ranks ____ as a cause of cancer deaths.

Answer 60

Pancreas

Question 61

Cancer of the pancreas

Answer 61

Most common called dúctil adenocarcinomas