Disorders of Liver, Pancreas, & Gallbladder

cholelithiasis

stones formed in gallbladder

etiologies of cholecystitis

obesity

oral contraceptives

family history

hyperlipidemia

pathogenesis of cholecystisis

stones form when cholesterol or bilirubin & Ca+ form solid crystals

manifestations of cholecystitis

pain radiates to subscapular & back - steadily increases for several hours

jaundice

nausea & vomiting

heartburn/belching/bloating

clay-colored stools

may cause gangrene & rupture

often precipitated by fatty meal

pancreatitis

inflammation of pancreas

etiologies of pancreatitis

gallstones

hypertriglyceridemia

ETOH abuse

aute pancreatitis

inflammation of pancreas

pancreatic enzymes begin autodigestion

chronic pancreatitis

inflammatory lesions cause calcification & obstruct flow of pancreatic juices, most often d/t ETOH abuse

occurs over weeks and months

manifestations of acute pancreatitis

steady & severe epigastric or LUQ pain radiating to back

nausea

abdominal distention

tachycardia

hypotension

fever

decreased BS

jaundice

weakness

pallor

manifestations of chronic pancreatitis

insidious onset of LUQ pain radiating to back

nausea

vomiting

weight loss

flatulence

constipation

malabsorption

risk factors for pancreatic cancer

cigarette smoking

obesity

manifestations of pancreatic cancer

pancreatic head tumors - jaundice, malabsorption & weight loss

pancreatic tail - abdominal pain & nausea

manifestations of liver dysfunction

impaired protein synthesis - bleeding, edema, immune deficiency

accumulation of toxins & hormones

inadequate urea synthesis

release of marker enzymes

inadequate bile synthesis - increased bilirubin level, jaundice

etiology of jaundice

increased RBC breakdown or impaired bilirubin metabolism

jaundice results from ______

dysfunction anywhere along pathway

evaluation of jaundice

complete history and physical exam

underlying causes - alcoholic liver disease

diagnostic tests

hepatitis

inflammation of the liver parenchyma

etiology of hepatitis

many viruses

hepatitis A

abrupt onset

fecal-oral transmission

14-28 day incubation period

jaundice, malaise, RUQ pain, anorexia, nausea, fever

hepatitis B

insidious onset

blood & body fluids transmission

6 week to 6 month incubation period

jaundice, rash

hepatitis C

insidious onset

body fluids & blood transmission

2-26 week incubation period

3% worldwide infected - 6 types

usually asymptomatic

cirrhosis of the liver

irreversible end stage of many hepatic injuries

most common cirrhosis of the liver

chronic ETOH

biliary cirrhosis of the liver

obstruction in bile drainage

postnecrotic cirrhosis of the liver

viral, toxic hepatitis

cardiac cirrhosis of the liver

CHF

liver congestion

etiology of biliary cirrhosis

end result of ongoing inflammation of bile ducts d/t obstruction results in backup of bile into liver

manifestations of biliary cirrhosis

weakness, fatigue

fever

anorexia, weight loss

nausea, vomiting, indigestion

change in LOC

edema, ascites

bruising, spider angiomas, jaundice

hepatic encephalopathy

portal hypertension

pathogenesis of biliary cirrhosis

results in inflammation & scarring of liver with obliteration of bile ducts, diffuse, widespread fibrosis & nodule formation

portal hypertension

increase in pressure within the portal vein

etiology of portal hypertension

sluggish blood flow results in increased pressure in portal circulation

congested venous drainage of much of the GI tract

abnormally high BP in portal venous system

pathogenesis of portal hypertension

blood flow through portal system is obstructed, causing blood to back up into portal circulation and increase pressure

manifestations of portal hypertension

anorexia

varices

ascites

hemorrhage - major complication

ascites

accumulation of fluid in peritoneal cavity seen in advanced liver disease

complications with ascites

usually complicated by portal hypertension & hypoalbuminemia

hepatic encphalopathy

damage to brain tissue occurring as a complication of cirrhosis of liver d/t too much ammonia in brain tissue

manifestations of hepatic encephalopathy

dementia

psychotic symptoms

cerebellar/extrapyramidal signs

asterixis “liver flap” - classic sign

mild confusion and lethargy to stupor and coma

varices

distended, tortuous collateral veins resulting from portal HTN

manifestations of varices

bleeding

melena

hematemesis

anemia

shock