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Flashcards in Liver and Biliary Tract Deck (45):

Bile ducts exit the liver through the ______.



The common bile duct joins the pancreatic duct AKA ______

Duct of Wirsung; contained exocrine-digestive enzymes and pH control


The hepatic _______ enter the liver carrying nutrients from the small intestine for processing

Portal vein


The blood then passes though the liver, and once processed is “dumped” into the __________ for a “trip” to the right side of the heart

Inferior vena cava


What are the major liver functions?

1. Excretory: Bile = Bilirubin + Bile Acids
2. Metabolic: Fats, Carbohydrates, Proteins
3. Storage: Carbohydrates & Fats
4. Synthetic: Clotting Proteins, Albumin, transport proteins


What is the main indication that the liver is involved with a pathology?



Derived from the macrophage destruction of red blood cells that have completed there life span in the liver, spleen, & red bone marrow



Give bile a foamy trait, and are important for digestion of fats in the small intestine

Bile acids


Bile acids are reabsorbed from the intestines and transported back to the liver via the portal vein for reuse. This “reuse” circulation of bile acids is called

Enterohepatic circulation of bile


Includes abnormal formation, processing , or excretion of bilirubin; yellow discoloration of skin and mucosa; brown or foamy urine with viral hepatitis; itchiness

Jaundice syndromes


Inflammation of the liver caused by viruses, drugs, alcohol, and immune mechanisms; often asymptomatic



Injury of liver cells by exogenous chemicals or endogenous metabolites

Toxic/metabolic hepatic injury


End-stage liver disease which may result from many different liver diseases



Diseases caused by gallstones

Extrahepatic Bile Ducts & Gallbladder Diseases


Occur in the liver and biliary tract, classified as benign, malignant, and primary or secondary (metastasis)



Bilirubin end product of phagocytosis of senescent red blood cells in the _______ of the liver

Kupffer’s cells


Transmitted fecal – oral route, may occur in a sporadic or epidemic form; Symptoms of infection include a short lived mild-fever, vomiting, loss of appetite, and jaundice

Hepatitis A


Transmitted via blood transfusions, exposure to contaminated blood or blood products, saliva, semen, or sexual contact; Most prevalent among health care workers, and those working in or around blood products should be inoculated and screened (leads to cirrhosis!); most common form

Hepatitis B


What are signs and symptoms of Hep B?

1. Symptoms are weakness, nausea, vomiting
2. Some have enlarged & painful liver on palpation
3. Darkening of urine which contains bilirubin
4. Some have measles-like skin rash


2nd Major cause of cirrhosis in the U.S. after alcohol abuse

Hepatitis B


Transmitted by contaminated blood products, needle sticks, intravenous drug use, contaminated blood transfusions; no vaccine available

Hepatitis C


End-stage liver disease; irreversible; incurable except by liver transplant; common causes are alcoholism, Hep B, C, and D, drugs, toxins, bile duct obstruction and inherited abnormalities



What is the pathophysiology of cirrhosis?

1. Death of liver cells
2. Tissue repair with fibrosis and fibrous bands which obstruct blood flow
3. Regenerative tissue nodules separated by gray scar tissue which restricts blood flow


What are the complications in cirrhosis?

1. Ascites (fluid in abdominal cavity)
2. Splenomegaly
3. Thrombocytopenia


What are clinical features of cirrhosis?

1. Liver cell injury and necrosis (increase serum liver enzymes)
2. loss of liver fxn
3. Portal hypertension (causes esophageal varicies)
4. Increase of NH4 (causes hepatic encephalopathy, liver flap, numbness, tingling, etc.)


What is liver flap (coarse hand tremor) caused by?

excess ammonia (not being broken down)


Concretions composed of chemical normally formed in bile and are extremely common

Gallstones, aka Cholelithiasis


What are the 2 types of gallstones? which is more common?

1. Cholesterol (more, 75%)
2. Pigmentary (25%0


What are the signs and symptoms of gallstones?

1. Excruciating spasmodic pain from cystic duct (immediate duct to gallbladder) obstruction
2. Pain presents within hours of a fatty meal under the right scapula (gallbladder attack)
3. Jaundice (if bile flow is blocked)


What are the types of malignant hepatic biliary tumors?

1. Hepatocellular carcinomas (>1 million deaths)
2. Gallbladder cancer (less common, 1% cancer deaths)


What are the signs, symptoms and prognosis of hepatocellular carcinomas?

1. Weight Loss
2. Loss of appetite
3. Nausea
4. Painful enlarged liver-compresses other organs
5. Portal hypertension

Poor Prognosis: 5 year survival rate is 10%


What are causes of referred shoulder pain related to the GI and hepatic systems?

1. Liver disease
2. Ruptured speleen (left shoulder, kehr's sign)
3. Pancreas (left shoulder)
4. Aortic aneurysm
5. Peptic Ulcer
6. Gallbladder disease
7. Hiatal hernia
8. Diaphragmatic hernia
9. Ectopic Pregnancy
10. Mono (left shoulder/left upper trap)


What features occurring with shoulder pain should be approached as a sign of systemic visceral illness - even with objective findings at the shoulder joint (pain on movement, etc.)?

1. Exasperated by recumbency
2. Coincident diaphoresis
3. Coincident, nausea, vomiting, dysphagia
4. Other GI complaints (anorexia, early satiety, epigastric pain or discomfort/fullness)
5. Exacerbation by exertion unrelated to shoulder movement
6. Urologic complaints
7. Jaundice
8. Pleuritic component (dry hacking or productive cough, blood tinged sputum, chest pain)


What are potential pathologies that could result in people having referred cervical pain?

1. Esophagitis
2. Esophageal cancer


What are potential pathologies that could result in people having referred thoracic/scapular pain?

1. Severe esophagitis
2. esophageal spasm
3. Peptic ulcer
4. Acute cholecystitis (gallbladder attack)
5. Pancreatic diseas


What are potential pathologies that could result in people having referred lumbar pain?

1. Intestinal obstruction (neoplasm)
2. Irritable bowel syndrome
3. Crohn's disease
4. Pancreatic disease


What are potential pathologies that could result in people having referred sacroiliac/sacral pain?

1. Ulcerative colitis
2. Colon cancer
3. IBS
4. Crohn's disease


Where is the location for referred pain due to esophagitis?

Midback btwn scapulae


Where is the location for referred pain due to peptic ulcer: stomach/ duodenal?

6th through 10th thoracic vertebrae


Where is the location for referred pain due to biliary colic?

Right upperback; midback btwn scapulae; right inter scapular or subscapular areas


Where is the location for referred pain due to pancreatic carcinoma?

Mid thoracic or lumbar spine


What are aggravating factors that increase symptoms of referred pain due to GI/hepatic pathologies?

1. Swallowing: esophagus
2. Eating: GI
3. Movement musculoskeletal


What are relieving factors that decrease symptoms of referred pain due to GI/hepatic pathologies?

1. Lean forward: gallbladder*
2. Lean to involved side: kidney*
3. Leaning forward and sitting upright: pancreas*
4. Decrease movement/ rest: muscle or joints
*if rest or change in position relieves the pain there is usually a cyclic progression of increasing frequency, intensity, or duration of pain until rest or change in position is no longer a relieving factor


What are associated S and S with GI?

1. nausea
2. vomiting
3. anorexia
4. unexplained weight loss
5. diarrhea
6. constipation
7. early satiety


What are associated S and S with bowel?

1. frequency of bowel movements (increased or decreased)
2. melena (blood in feces)