the hepatic, pancreatic, & biliary systems

Question 1

the liver is the sole source for?

produces how much bile each day?

Answer 1

Albumin

600 ml (500-1500 ml) each day

Question 2

Pancreas exocrine and endocrine function?

Answer 2

Exocrine- exocrine secretion of digestive enzymes and pancreatic juices, neutralizes the acidic substances passed from the stomach to the duodenum

Endocrine- secretion of glucagon and insulin by islet of Langerhans cells for the regulation of carbohydrate metabolism

Question 3

Function of the gallbladder?
It contracts to??

Answer 3

a reservoir for bile- alkalinizing the intestinal contents and digestion of fat
to expel the bile into the duodenum in response to the arrival of food

Question 4

Primary signs and symptoms of liver disease?

Answer 4

GI symptoms, edema, dark urine, light colored feces, right upper ab pain

Question 5

Bristol Stool chart?

Answer 5

Type 1- hard lumps
Type 2- sausage shaped but lumpy
Type 3- sausage but with cracks
Type 4- sausage smooth and soft
Type 5-soft blobs with clear cut edges passed easily
Type 6- fluffy pieces with ragged edges
Type 7- watery

Question 6

Dark urine and light stools are in association with?

When the serum bilirubin level increases from ____ to ____?

Answer 6

Jaundice

0.1 to 1.0 to a value of 2 or 3.0

Question 7

What is spider angiomas?
Palmar erythema?

Answer 7

Spider- vascular manifestations increased estrogen levels
Erythema- warm redness of the skin over the palms (liver palms)

Question 8

What is asterixis?

How can you test for asterixis?

Answer 8

the inability to maintain wrist extension with forward flexion of the upper extremities

asking the client to extend the wrist and hand with the rest of the arm supported by a firm surface

Question 9

PT implications for liver disease?

Answer 9

Active intense exercise should be avoided, risk for pressure ulcers, increased risk of coagulopathy

Question 10

What is jaundice?

4 common causes of jaundice?

Answer 10

Skin becomes yellow color, urine turns a darker color, and stool is light in color

Overproduction of bilirubin, decreased uptake in bilirubin metabolism, hepatocyte dysfunction, impaired bile flow

Question 11

What is cirrhosis?

Answer 11

the final common pathways of progressive inflammation of the liver, causing liver damage and necrosis

Question 12

Clinical presentation and Lab findings associated with Cirrhosis?

Answer 12

jaundice, palmar erythema, lower leg edema, spleen becomes larger

Lab findings: increase ALT, Decrease bsp, decrease albumin, increase PT

Question 13

What is portal hypertension?

Most cases are related to?

Answer 13

An elevated portal pressure gradient occurs when the pressure of the blood entering the liver (portal vein) is higher than the pressure in the inferior vena cava

Cirrhosis

Question 14

What is hepatic encephalopathy?

Due to?

Answer 14

a complex neuropsychiatric syndrome with symptoms ranging from subtle disturbances to coma and death

Hepatic dysfunction, portosystemic shunting of blood, portal hypertension

Question 15

What is ascites?

Most often caused by?

What is spontaneous bacterial peritonitis?

Answer 15

Abnormal accumulation of fluid within the peritoneal cavity

Liver cirrhosis (85% of cases)

Infection of ascitic fluid in the setting of portal hypertension

Question 16

What is hepatitis?

What are the 6 identifiable viruses?
Where is F?

Answer 16

Inflammation of the liver caused by a virus

ABCDE and G
F is fulminant hepatitis which is severe and sometimes fatal)

Question 17

Chronic hepatitis how many months and can lead to?

Most people are??

Answer 17

Over 6 months and can lead to cirrhosis and end stage liver disease

Asymptomatic and when symptoms occur they are non specific and mild

Question 18

What is acute liver failure (fulimant hepatic failure)?

What is the most common cause?

Answer 18

Rapidly progressing form of liver injury without prior disease

Acetaminophen hepatotoxicity (50% of all cases)

Question 19

Viral hepatitis incubation periods HAV HBV HCV

Answer 19

HAV: 15 to 50 days, HBV: 2 to 5 months, HCV: 2 weeks to 6 months

Question 20

Route for HAV? Causes?
Is it highly contagious?
When is it the greatest danger of transmission?
Results in what?

Answer 20

Fecal oral route, contaminated water or food, poor handwashing or personal hygiene

Yes

During incubation period

Acute infection only and not chronic hepatitis

Question 21

Route for HBV?
Is it highly infectious?
How is it transmitted?
How can risk be lowered?

Answer 21

Sexually transmitted disease

Yes

Percutaneously or through mucosal contact

HBV vaccine

Question 22

Route for HCV?
When does the period of inactivity begin?
One may become?

Answer 22

Injection drug use

before the onset of symptoms

A lifetime carrier

Question 23

HDV and HEV are?
HDV manifests as?
HEV transmitted by?

Answer 23

uncommon in the US

a superinfection of HBV, needs Hep B for replication

Transmitted by contaminated water via the fecal oral route and resembled HAV

Question 24

Pathogenesis of Alcoholic liver disease?
metabolism of alcohol results in ?
chronic alcohol use results in?

Answer 24

fatty liver disease occurs with the accumulation of fat in hepatocytes

oxidative stress to the hepatocytes

bacterial overgrowth and disturbances of the junctions between the intestinal cells

Question 25

Clinical manifestations of alcoholic liver disease? it is often____ and detected only____?

Answer 25

Asymptomatic and detected by lab eval

Question 26

What is non alcoholic fatty liver disease? Related to what two things? What are the two categories?

Answer 26

Defined as a fatty liver disease without significant inflammation or fibrosis Diabetes and insulin resistance Nonalcoholic fatty liver or hepatic steatosis, non alcoholic steatohepatitis

Question 27

Clinical manifestations of acute pancreatitis? Mild? Moderately severe? Severe?

Answer 27

Mild- absence of organ failure or local or systemic complications Mod. Severe- transient organ failure and may have local or systemic complications Severe RUQ abdominal pain Severe- cytokines and free radicals mediate a systemic response, leading to persistent multi organ failure

Question 28

Chronic Pancreatitis: Risk Factors? Pathogenesis? Involves the activation of what?

Answer 28

Chronic alcohol consumption, smoking, and genetic predisposition Result from inflammation that begins as acute pancreatitis and becomes persistent, activation of stellate cells which leads to fibrosis

Question 29

Chronic Pancreatitis- Clinical manifestations? Pancreas is able to compensate until? Endocrine function is also lost?

Answer 29

- ab pain, epigastric in location to back - worse with meals but can be relived by bringing knees to chest or bending forward - 90 percent of pancreatic function is lost - both beta and alpha cells

Question 30

Pancreatitis- PT implications? Acute pancreatitis? Chronic pancreatitis?

Answer 30

Back pain, decreased spinal extension may be accompanied by GI symptoms such as diarrhea, pain after a meal etc Back pain in the upper thoracic area or pain at the thoracolumbar junction

Question 31

Pancreatic cancer is the ____ of cancer mortality? It has the lowest what? Most arise from _____ cells? 95 percent are____ 75 percent are____

Answer 31

3rd leading cause Lowest 5 year survival rate after diagnosis Exocrine cells Adenocarcinoma proximal or head of the pancreas

Question 32

Pancreatic cancer Risk factors: Causes? Increased risk?

Answer 32

Specific cause is unknown, do not have genetic or familial cause Related to advancing age with most people in their 70s and 80s at diagnosis History of T2D or impaired glucose intolerance

Question 33

Pancreatic cancer clinical manifestations? What contributes to the delay in diagnosis? Ab pain, weight loss, and jaundice? Obstruction to the? The development of what is common?

Answer 33

nonspecific and vague in onset ab pain- 80-85% weight loss- 60% jaundice- 47% Portal vein or pancreatic duct Diabetes or glucose intolerance

Question 34

Pancreatic cancer metastasis? Tumors of the body and tail of pancreas are?

Answer 34

First to regional lymph nodes then to liver, lungs etc twice as likely to metastasize to the peritoneum compared with tumors in the head of the pancreas

Question 35

Biliary Tract Terminology: Cholecyst- Cholecystecotomy- Cholecystitis- Cholecystography- Cholecystostomy- Cholelith- Cholelithiasis-

Answer 35

pertaining to gallbladder removal of gallbladder Inflammation of gallbladder Radiographic study of gallbladder incision and drainage of gallbladder gallstones prescence of gallstones

Question 36

Cholelithiasis - what is it? 75% consists primarily due to____ 25% composed of ____ Most gallstones are ____ Symptoms occur when____. The most common being the____.

Answer 36

stones form in the bile cholesterol bilirubin salts caled pigment stones asymptomatic stones block bile flow into the ducts; the cystic duct

Question 37

Cholelithiasis risk factos?

Answer 37

Female over male Litho-genic

Question 38

Cholelithiasis pathogenesis?

Answer 38

caused by changes in the composition of bile, solids become supersaturated in the gallbladder causing stones

Question 39

Cholelithiasis clinical manifestations? In older adults? Complications?

Answer 39

Abdominal pain in the RUQ often radiating to the right shoulder and upper back---> nausea and vomiting Mental confusion may be the only manifestation Cholecystitis most common Cholangitis (inflammation of bile duct)

Question 40

Acute cholangitis- what is it? Symptoms? Charcot triad? Reynolds pentad? What may be the only sign in elderly?

Answer 40

obstruction of bile from stones from common bile duct Charcot triad: pain fever jaundice Charcot triad plus hypotension and mental confusion Hypotension

Question 41

What is acute cholecystitis and occurs most commonly when? What does it cause? Steady where and radiates where?

Answer 41

inflammation of the gallbladder and occurs most often as a result of impaction of gallstones in the cystic duct causing obstruction to bile flow Prolonged abdominal pain lasting greater than 6 hours; steady in RUQ with tenderness, muscle guarding, or rebound pain, and radiates to upper back and into right scapula or right shoulder