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Third Exam for Patho > Notes from Liver and Pancreas > Flashcards

Notes from Liver and Pancreas Flashcards

1
Q

GI tract is our esophagus,stomach,small intestine,large intestine…the tubing…which is a closed system and these things contribute by providing additional enzymes and other things that help break down food but they are not but the food doesn’t necessarily go through these things directly

A
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2
Q

our liver is a major large organ

A
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3
Q

__________ has exocrine functions which are more localized and then it has an endocrine function which is more sending these messengers

A

Pancreas

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4
Q

This is why the liver is damaged by drugs…one of its major function is being a __________ organ and so anything we take orally, food,drugs,toxins,alcohols…you name it…if it comes in orally its gets absorbed through the stomach and small intestine

A

detoxifying

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5
Q

What happens is that it goes into those veins and as its going the smaller veins become larger and larger and what they do is they are becoming larger eventually to what we call the portal vein and this vein will lead up to the inferior vena cava

A
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6
Q

Major function of the liver is that it is detoxifying…trying to get rid of substances that are coming into the body so if you have a large dose of drug…The whole thing hits the liver and then it goes to the heart and then it spreads throughout the body so that whole dose of drug high level hits the liver..if we are going to find any organ that’s getting a larger amount than we expect it to or that we wanted it to it’s the liver because of the way its absorbed it all goes directly to the liver before it gets distributed systemically and this is called first pass metabolism and its something we deal with for drugs but it also it can cause damage to the liver if it’s a problem…detoxification is one of the major functions of the liver and that’s why it’s the organ that is probably most likely to be damaged by drugs

A
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7
Q

If the liver is not working what might our problems be? __________, lack of ___________, and lack of blood-clotting factors

A

hypoglycemia, lack of plasma proteins

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8
Q

Liver metabolizes carbohydrates,fats, and proteins so its involved in digestion and its responsible for the degradation and elimination of drugs and hormones…the liver is not functioning properly what happens? We have high levels of drugs…higher than we expect leading to toxicities

A
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9
Q

________ is the body’s way of moving lipophilic like fat based substances in the body…Oil and water don’t mix…fat doesn’t dissolve well or move well within our blood which is primarily water based so we need a way to bring soluble fat to the surface and we also need to find ways to eliminate fat soluble so bile is one of the major ways in which we do this

A

Bile

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10
Q

bile is involved in the creation of ______,helps us move and get rid of ____________, and also make bile acids out of bile

A

bilirubin, get rid of cholesterol

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11
Q

Cholestasis means we don’t have enough bile

A
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12
Q

Example of things that are eliminated by bile but accumulate in the blood if we had cholestasis the answer would be __________

A

bile acids

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13
Q

Excess bilirubin leads to _________

A

jaundice

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14
Q

Here’s bilirubin…we have our red blood cells and we break them down and then we get free bilirubin…the liver is involved in what we are calling conjugating bilirubin…the liver will modify bilirubin to make it more easily eliminated…it conjugates it…then it heads to the general circulation and its eliminated in the feces or in the urine…there’s a part that happens before the liver and there’s a part that happens within the liver and there’s a part that happens after the liver

A
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15
Q

Jaundice is excessive destruction of red blood cells, impaired conjugation of bilirubin something not happening along the liver, decreased conjugation, obstruction of bile flow where we don’t have enough or impaired uptake of bilirubin by the liver

A
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16
Q

Prehepatic means ___________

A

before the liver

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17
Q

______________ means in the liver…either not able to remove it or can’t conjugate it or something is happening within the liver and the liver is the problem…maybe you have liver failure and you can’t conjugate your bilirubin

A

Intrahepatic

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18
Q

______________ is bile flow is obstructed or maybe there is a gallstone that’s blocking the flow of bile between the liver and the intestine and you can’t get it out and now your jaundice because of this blockage the reason that matters is because we are going to treat that jaundice differently. If you have a gallstone that’s going to be different than you having excessive hemolysis we need to treat those differently so that’s why its important to know that’s there are different types

A

Postherpetic

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19
Q

The liver can be damaged from drugs and toxins…because of drug build up

A
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20
Q

Why do drugs tend to build up or get to the liver…the __________

A

the venous return

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21
Q

You have an infection of the liver its not functioning properly and its being attacked by immune system and there’s a number of and that pretty much every organ we have talked about and its infected and its inflamed…its not going to function the way it should and there ‘s a number of metabolism issues if we are breaking down of cholesterol and breaking down proteins,lipids,etc

A
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22
Q

Cancer can make things not work properly either

A
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23
Q

____________is the body tries to make anything that comes into more polar and these reactions phase I makes something slightly more polar

A

Detoxification

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24
Q

__________makes it dramatically more polar…the more polar something is the more water soluble it is and the quicker it is taken out of the body and the quicker its brought to the kidneys and gets eliminated

A

Phase II

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25
Q

The liver plays a major role in that and as people have dysfunction with their liver…drugs are going to stay around longer because they are unable to be cleared as effectively or as quickly as we hoped and would expect

A
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26
Q

Factors Contributing to Drug-Induced Liver Disease
-__________ predisposition(There are mutations in your enzymes that will break down drugs where some of those metabolizing enzymes may not work as properly as they should CYP2D6,CYP3A4)
-________ (Older,doesn’t work as well,very young,doesn’t work as well…for children and elderly
-Underlying _________________(If your liver is not working…your liver is not working)
-Diet and alcohol consumption
-Use of multiple interacting drugs (One drug may interfere with the liver’s ability to degrade another drug and we end up having more of it)

A

Genetic predispostion, Age, chronic liver disease

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27
Q

Drug- Induced Liver Diseases
Potential mechanisms include:
-Direct hepatoxic injury (The drug damages the liver)
-____________ reaction (unexpected or unknown
-_____________ reactions ( we have cholestasis…we don’t have the bile flowing like it should so we are not eliminating things…we are not moving things or there is a problem and then chronic hepatitis

A

idiosyncractic, cholestatic

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28
Q

__________________-Chronic inflammation of the liver

A

chronic hepatitis

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29
Q

________ overdose was the primary cause of drug overdose in hospitalizations or in any ER

A

Tylenol

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30
Q

Acetaminophen goes through the liver and its metabolized rapidly and most of the time it goes down halfway

A
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31
Q

What does it mean for something to be saturated?

A

It is all used up

32
Q

If you use all the substrates and enzymes in that pathway then the only left is this third pathway…the ______and _____________pathway…going down this pathway there is still an off ramp but in general you end of causing direct liver damage so Tylenol if you take it has a narrow therapeutic window where its fine to take

A

CYP2E1 and CYP3A4

33
Q

(You don’t need to know the pathway but LIVER WILL GET DAMAGED DIRECTLY BY ACETAMINOPHEN…we metabolize the drug and we metabolize it into a very reactive species which will damage the cells itself

A
34
Q

The number one drug overdose in ER is Tylenol

A
35
Q

How is an acetaminophen overdose overcome?

A

Acetylcysteine

36
Q

Drug Induced Liver Disease
Idiosyncratic reactions
What’s that mean? ___________

A

unexpected

37
Q

One of the major signs of cholestatic reactions is _____________

A

itchiness

38
Q

Chronic hepatitis: something that is inflaming the liver in some way

A
39
Q

Hepatitis generally comes from infectious diseases or viruses

A
40
Q

You can have hepatitis due to autoimmune disorders and you can have due to reactions from certain drugs

A
41
Q

What does hepatotropic mean? likes the _______

A

liver

42
Q

Hepatotropic viruses means they like the liver

A
43
Q

The known hepatotropic viruses are Hepatitis A virus, Hepatitis B virus, and Hepatitis C virus. (Only know these for exams)

A
44
Q

Hepatitis A is a benign self-limiting disease

A
45
Q

What does it mean if something is a benign, self-limiting disease? Your generally not too worried about hepatitis A…it doesn’t mean its not bad but its not horrible…its usually self-limiting and it can cause death from liver failure if it progresses and that generally would be progressive and its abrupt with its onset of symptoms…fever,dark urine…Children under 6 are often asymptomatic which means children under 6 will have it and won’t wash their hands and they will come home and give it to you and each other so how do we stop this…hand washing!

A
46
Q

_________ is a DNA virus and cause acute hepatitis which can turn into chronic hepatitis and can progress to cirrhosis

A

Hepatitis B

47
Q

Why have rates of Hepatitis B declined?

A

Vaccination

48
Q

Hepatitis C is the most common cause of chronic hepatitis,cirrhosis, and cancer

A
49
Q

Hepatitis C we do have treatments for and it is a very expensive and problematic disease

A
50
Q

____________is primarily the same as A except it causes high fatalities in pregnant women and women who are pregnant and get Hepatitis E about 20% of them will end up dying…primarily occurring in developing countries

A

Hepatitis E

50
Q

If you don’t have Hepatitis B then you don’t need to worry about Hepatitis D

If you do have hepatitis B its likely to make infection worse

A
51
Q

The problem with hepatitis is if it turns into chronic

A
52
Q

Chronic viral hepatitis is caused by hepatitis B, Hepatitis C, and if Hepatitis D gets involved with Hepatitis B its also caused there but Hepatitis C is the problem

A
53
Q

Hepatitis C leads to chronic hepatitis and major causes of cirrhosis

A
54
Q

What is fibrosis? Thickened, ____ tissue

A

scar tissue

55
Q

We are replacing working hepatocytes with scar tissue…what does that mean? and it means that your functioning cell is now scarred which is no longer functioning…the more scarring we have on the liver the less likely it is to work

A
56
Q

Major causes of cirrhosis are alcoholism and _____________

A

chronic viral hepatitis

57
Q

Manifestations of Cirrhosis

_________ is fluid buildup…losing muscle mass and have a lot of water weight, enlargement of liver

A

ascites

58
Q

Late Manifestations of Cirrhosis
Portal hypertension: increased blood pressure within the liver
Portal hypertension leads to increased pressure in the capillaries which leads to ascites which is a fluid, shunting of blood,leads to hemorrhoids and enlargement of the liver…enlargement of spleen leads to bleeding,anemia, leukopenia ,thrombocytopenia, and a decrease in all 3 major blood cells

A
59
Q

In Liver failure we can’t store glucose that leads to ________________events

A

hypoglycemic

60
Q

Why would liver failure lead to a hypoglycemic event? If your getting hypoglycemia you haven’t eaten in 8 hours what does your body do…hey liver give me some glucose.. and liver says no I can’t do that..which leads to hypoglycemia

A
61
Q

Why would decreased coagulation factors lead to bleeding? You can’t coagulate and if you don’t have the factors you can’t do it

A
62
Q

In liver failure, it increases estrogens and liver failure can lead to decreases in testosterone and increases in estrogens so it leads to gynecomastia and testicular atrophy

A
63
Q

If your messing with estrogen your messing with menstrual cycle

A
64
Q

Main function of the gallbladder is to store and concentrate _______

A

bile

65
Q

The main issues with the gallbladder are gallstones and we have too much bile that is participating and if its obstructed whatever the case may be we can have a gallstone and this can lead to cholelithiasis and if we are leading to cholelithiasis we are having difficulty getting rid of bile acids,bilirubin and cholesterol and this is also painful

A
66
Q

Having a gallstone are painful!

A
67
Q

If you have a gallstone and your unable to have bile move like it should sometimes stationary bile can lead to an infection and inflammation and if that occurs its going to be associated with having the gallstone and then inflammation is one of the things that leads to pain associated with it

A
68
Q

A ___________ is an enzyme bound to protein and an enzyme that must be activated before it can work

A

proenzyme

69
Q

A proenzyme is an enzyme that needs to be activated which is good because we don’t want things digesting things until we actually want it digested and this usually gets activated within the stomach or wherever we actually want something to be broken down…we don’t want enzymes flying around and start breaking down things in the body that can be problematic

A
70
Q

________________ enzymes are secreted as inactive and are activated in the intestine to break down these large proteins, carbohydrates, and fats so that we can digest them into smaller pieces and then absorbed them and use them as nutrients

A

Pancreatic

71
Q

Common causes of Acute pancreatitis
Inflammation in the pancreas…this is one of the major side effects we may see so we have gallstones that can cause that…high levels of alcohol can cause that, viral infections, high levels of lipids, hyperparathyroidism and the major ones you are normally going to see are infections,gallstones,alcohol

A
72
Q

Chronic Pancreatitis is acute pancreatitis and damage to the pancreas is reversible but if its chronic its NOT reversible

A
73
Q

Pancreatic cancer is not a common cancer but if you get it…its DEADLY…the mortality rate for pancreatic cancer is higher than it is for other cancers…when pancreatic cancer is detected late and when its detected its quite advanced and its aggressive…cause is unknown

A
74
Q

What does diabetes have to do with the pancreas? Pancreas releases your insulin and glucagon so if you have diabetes there are changes in alterations that are occurring within the pancreas which can make it more susceptible to pancreatic cancer

A
75
Q

A lot of things associated with diabetes are associated with pancreatic cancer.

A

Third Exam for Patho (16 decks)

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