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NUTR 442 > Krause ch 29 Liver and Pancreas > Flashcards

Krause ch 29 Liver and Pancreas Flashcards

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1
Q

largest gland of body

A

liver

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2
Q

liver supplied with blood from these two sources:

A

hepatic artery and portal vein

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3
Q

thick viscous fluid secreted from liver, stored in gallbladder, released into duodenum when fatty foods enter duodenum

A

bile

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4
Q

main fxns of liver:

A

1) metabolism CHO, pro, fat 2) storage and activation of vit and min 3) form and excrete bile 4) convert ammonia to urea 5) metabolize steroids 6) detox 7) filter/flood chamber

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5
Q

hepatocytes detox ammonia by converting to ___

A

urea

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6
Q

how does liver work as filter/flood chamber?

A

remove bacteria/debris from blood thru phagocytic Kupffer cells

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7
Q

this is gold standard to assess hepatic inflammation

A

liver biopsy

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8
Q

4 phases of acute viral hepatitis

A

1) incubation 2) preicteric 3) icteric (jaundice) 4) convalescent/recovery

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9
Q

NAFLD most associated with these conditions:

A

obesity, type 2 diabetes, dyslipidemia, metabolic syndrome

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10
Q

NASH is associated with hepatocyte ____ with or without fibrous tissue in the liver

A

injury

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11
Q

treatment for NAFLD include wt loss, insulin-sensitizing drugs, and this vitamin:

A

E

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12
Q

drinking ___ may be protective against NAFLD

A

coffee

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13
Q

toxic byproduct of alcohol metabolism that damages meto membrane and fxn

A

acetaldehyde (and excess hydrogen)

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14
Q

variables that predispose ppl to alcoholic liver disease?

A

genes, gender, exposure to other drugs, infection, immunologic factors, obesity, poor nutrition status

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15
Q

3 stages of alcoholic liver disease:

A

steatosis, hepatitis, cirrhosis

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16
Q

fatty infiltration, also known as ____ is caused by culmination of these metabolic disturbances:

A

hepatic steatosis; 1) ^ mobilization of f.a. from adipose 2) ^ hepatic synth of f.a. 3) v f.a. oxidation 4) ^ TG 5) trapping of TG in liver

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17
Q

alcoholic fatty liver symptoms:

A

poor appetite, right upper quadrant discomfort, hepatomegaly

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18
Q

alcoholic hep generally characterized by:

A

hepatomegaly, ^ serum transaminase and serum bilirubin, v albumin, anemia

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19
Q

complications of cirrhosis

A

GI bleed, hepatic encephalopathy, portal HTN, ascites

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20
Q

what is ascites?

A

accumulation of fluid, serum pro, electrolytes in peritoneal cavity (^ pressure from portal htn and v albumin cause this)

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21
Q

why malnutrition common in alcoholic?

A

displace nutr with alcohol, pancreatic insufficiency and alterations of intestinal mucosa, use of lipid/CHO compromised, insulin resistance, reduced intake and alterations in absorp/store/convert nutr to active forms

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22
Q

conditions affecting bile ducts

A

cholestatic liver disease

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23
Q

chronic cholestatic disease caused by progressive destruction of intrahepatic bile ducts

A

primary biliary cirrhosis (PBC)–it is autoimmune

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24
Q

PBC mostly occurs in ___

A

women

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25
complications from cholestasis:
osteopenia, hypercholesterolemia, fat sol vit deficiencies
26
this condition is characterized by fibrosing inflam of segments of extrahepatic bile ducts (w/ or w/out intrahepatic ducts)
primary sclerosing cholangitis (PSC)
27
3 syndromes of PSC:
cholestasis with biliary cirrhosis, recurrent cholangitis w/ large bile duct strictures, cholangiocarcinoma
28
lots of PSC ppl have ____
IBD
29
this may occur from vit D and Ca malabsorption
hepatic osteodystrophy
30
inherited disease of iron overload
hemochromatosis
31
autosomal recessive disorder associated with impaired biliary copper excretion
wilson's disease
32
wilson's disease characterized by ____ rings
Kayser-Fleisher
33
three types of liver disease based on time of onset and duration:
fulminant, acute, chronic
34
syndrome where severe liver dysfunction accompanied by hepatic encephalopathy
fulminant hepatitis
35
extrahepatic complications of fulminant hepatitis
renal failure, cerebral edema, bleeding, cardio abnormalities, acid-base probs, electrolyte probs, sepsis, pancreatitis
36
most common causes of chronic hepatitis:
hep b, c, autoimmune
37
severe advanced liver disease symptoms:
jaundice, muscle wasting, tea coloured urine, ascites, edema, GI varices, splenomegaly, spider angiomata
38
major complications of cirrhosis:
malnutrition, ascites, hyponatremia, glucose alterations, fat malabsorption, osteopenia
39
ESLD physical manifestations:
portal HTN, ascites, hyponatremia, hepatic encephalopathy
40
portal HTN leads to ___ in GIT which often bleed and result in emergency
varices
41
how to relieve ascites?
large vol paracentesis, diuretics
42
why hyponatremia?
v excretion of water (release of ADH), na loss in paracentesis, excess diuretics
43
syndrome characterized by impaired mentation, neuromusc disturbance, altered consciousness
hepatic encephalopathy
44
why hepatic encephalopathy precipitated?
GI bleed, fluid/electrolyte abnormal, uremia, infection, sedatives, hyper/hypoglycemia, alcohol withdrawal, constipation, dehydration, acidosis
45
mechanism of hepatic encephalopathy?
ammonia accumulation
46
4 stages hepatic encephalopathy
mild confusion, agitation, irritability , sleep disturbance --> lethargy, disorientation, drowsiness, inappropriate behaviour -->somnolent but arousable, incomprehensible speech, confused, aggressive -->coma
47
meds to treat encephalopathy
lactulose, rifaximin
48
nutr related hypothesis for hepatic encephalopathy
altered neurotransmitter theory (aa imbalance)--> aromatics ^ and BCAAs v
49
____ may improve hepatic encephalopathy by reducing ammonia or by preventing production/uptake of lipopolysaccs in gut
probiotics
50
why glucose intolerance in cirrhosis?
IR in peripheral tissues, inslin production ^, hepatic clearance v, portal systemic shunting occurs
51
why fasting hypoglycemia in cirrhosis?
v availability of glucose from glycogen (more common in acute/fulminant than chronic)
52
why fat malabsorbed?
v bile salt secretion, admin of meds, pancreatic enzyme insufficiency
53
treating steatorrhea?
MCTs (don't need micelle formation to be absorbed), low fat diet
54
renal failure associated with severe liver disease without intrinsic kidney abnormalities
hepatorenal syndrome
55
how diagnose hepatorenal syndrome?
urine sodium lvl less than 10 mEq/L and oliguria persists in absence of intravascular vol depletion
56
route of nutrition for liver disease
small frequent meals, oral liquid supplements
57
wernicke encephalopathy related to ___ deficiency and is characterized by:
thiamin; confusion, ataxia, ocular disturbances
58
most popular and studied herbal supplement for liver disease
milk thistle
59
admin of ___ and fibre with tube feeding may reduce postop ___ rate
probiotics; infection
60
main fxn of gallbladder?
concentrate, store, excrete bile
61
primary transporter responsible for bile salte secretion
bile salt export pump
62
the ___ duct joins ___ duct to form common bile duct
cystic; common hepatic
63
during digestions, food reaches ____ which releases _____ hormones that stim gallbladder and pancreas, causing ____ to relax
duodenum; CCK/secretin; sphincter of oddi
64
condition where little or no bile secreted or flow of bile into GI tract obstructed
cholestasis
65
cholestasis can predispose person to acalculous ___
cholecystitis
66
formation of gallstones is referred to as :
cholelithiasis
67
risk factors for cholesterol stone formation:
female, pregnancy, old age, family hx, obesity, DM, IBD, drugs
68
surgical removal of gallbladder called;
cholecystectomy
69
MNT for cholecystitis
high fibre, low fat, plant based
70
why jaundice happen?
obstruction backs up bile, returns to circulation and has affinity for elastic tissues like eye and skin
71
MNT in acute cholecystitis
oral feed d/c, PN may be indicated, low fat diet
72
___ may be responsible for symptoms in postcholecystectomy syndrome
reflux
73
why not strict limitation of fat in chronic cholecystitis
fat in intestine important for some stim and drainage of biliary tract
74
inflamm of bile ducts called ___
cholangitis
75
if have cholangitis, need to be treated with:
fluid resuscitation and antibiotics
76
2 primary hormonal stimuli for pancreatic secretion are :
secretin and CCK
77
3 phases of pancreatic secretions during meal:
cephalic, gastric phase, intestinal phase
78
what is pancreatitis?
inflam of pancreas, characterized by edema, cell exudate, fat necrosis
79
pancreatitis can cause soap formation of ___ and ___
Ca ; f.a.
80
best inhibitor of pancreatic secretion (hormone)
somatostatin
81
objective of therapy for CP pt
prevent further damage, v number of attacks, allevaite pain, v steatorrhea, correct malnutrition
82
surgical procedure often used for pancreatic carcinoma:
pancreaticoduodenectomy (whipple procedure)
83
why pancreaticoduodenectomy?
head of pancreas and duodenum have same arterial blood supply, so both organs must be removed if single blood supply severed (prevent necrosis)

NUTR 442 (34 decks)

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