Patho Exam 4 Hepatic, Pancreatic Biliary systems

How does liver function change with age

How does liver function change with age

capacity of liver to regenerate and respond to stress decreases

what happens to liver mass in older adults

liver mass decreases resulting in:

*less capacity to process LDLs

*changes in metabolism of medication which may require new dose prescriptions

what happens to liver function

remains normal along with enzyme levels

Common sign of liver pathophysiology

hepatomegaly (liver inflammation)

Signs of changes in liver enzymes in pathology

elevated liver enzyme profile: liver parenchyma

elevated aspartate aaminotransferase (AST) (liver Parenchyma)

Elevated alanine aminotransferase (ALT)

cardiovascular Liver signs

Caval obstruction caused by tumor or hepatomegaly

what is the result of a tumor that restricts the vena cava

venous insufficiency which leads to pedal edema

What is a cardiovascular sign of liver pathology resulting in esophageal varices ands stomach bleeding

portal hypertension

portal hypertension

Portal hypertension is high blood pressure in the portal vein system, often caused by liver cirrhosis. It can lead to serious complications like varices and ascites.

pressure in portal veins causes back up

liver pathology can cause what changes in clotting time

reduction in clotting times and resulting increase in bleeding

what happens to prothrombin during pathology of liver

decrease in level of prothrombin resulting in reduced fibrin for clotting and an increased INR

hypo albumenemia

decreased liver function results in reduction of albumin protein which prevents blood fluids from leaking into tissues

what happens if plasma protein decreases

fluid increases in the tissues resulting in generalized edema (anasarca)

what happens to the fluid if it pools in the peritoneal cavity

edema there known as ascites

what are three causes of ASCITES

hepatomegaly

hypoproteinemia

reduced kidney circulation

Hepatomegaly does what which results in ascites

passive congestion

congestion of lymph fluid that causes organs to weep fluid

how does hypoproteinemia cause ascites

resultes in changed in osmotic gradients causing fluid in vessels to flow to low concentrated areas

howdoes reduced kidne circulation result in ascites

results in increased sodium retention

what changes in skin occur as a result of elevated plasma bilirubin

jaundice or Icterus

what are two commonly elevated liver enzymes associated with liver disease

AST and ALT

what is pruritus

small crystals that lead to itching caused by elevated plasma bilirubin

what are signs and symptoms associated with end stage liver disease

Hepatocellular failure is also known as

end stage liver disease and is 1005 fatal and requires a liver transplant

what contributes to morbidity of esld

hemorrhage or internal bleeding due to increased prothrombin time and INR and low levels of cytokine thrombopoietin

failure to detoxify ammonia into UREA

What causes acidosis?

increased hydrogen ions inthe blood which result in a drop of PH

Metabolic acidosis can cause

hyperkalemia

changes in LOC

low Blood pressure

Kussmaul respirations

muscle twitching

hypokalemia

vasodilation

nausea diarrhea

how do we compensate for metabolic acidosis

increased respiration to blow off excess CO2

increase in urine production to pee off excess hydrogen which results in HYPOKALEMIA

Stage one of hepatocellular failure

personality changes

stage 2 of hepatocellular failure

muscle involvement, fasciculations, asterixis

stage 3 hepatocellular failure

confusion, bizarre behavior, muscle rigidity

stage 4 hepatocellular failure

coma with fetor hepaticus

Hepatitis A (Haverna)

type: HAV-RNA

transmission: oral fecal

common symptoms and signs:

CONSTITUTIONAL

nausea diarrhea

jaundice with pruritus

hepatomegaly (enlarged liver)

elevated liver enzymes (AST ALT LDH)

aversion to food

vaccine availablility: inactivated virus

Hepatitis B HeBVDNA

type: HBV-DNA

transmission: oral fecal, inoculation, STD, medical dental, childbirth

common symptoms and signs:

constitutional

nausea diarrhea

jaundice with pruritus

hepatomegaly (enlarged liver)

elevated liver enzymes (AST ALT LDH)

aversion to food

COURSE: 120 day incubation self limiting

vaccine availablility: modified virus

HEpB DNA prognosis

90% recovery

2% carriers

10% chroninc progressive hepatitis and cirrhosis

HeBDna may cause

hepatocellular cancer

liver cirrhosis with fatty liver

macronodular cirrhois

HepC HecVRNA

ype: HCV RNA

transmission: needles, blood transfusion, dent med, childbirth, tattoos, std

common symptoms and signs:

constitutional

nausea diarrhea

jaundice with pruritus

hepatomegaly (enlarged liver)

elevated liver enzymes (AST ALT LDH)

aversion to food

COURSE: - day incubation self limiting

vaccine availablility: NO VACCINE

HECVRNA prognosis

30% complete recovery

1-6 carriers

50% chronic progressive hepatitus

20% cancer or cirrhosis

HepD DNA

hep E RNA

ype: HBV-DNA

transmission: oral fecal,

common symptoms and signs:

constitutional

nausea diarrhea

jaundice with pruritus

hepatomegaly (enlarged liver)

elevated liver enzymes (AST ALT LDH)

aversion to food

COURSE: 120 day incubation self limiting

vaccine availablility: preventative only

HEp E

20% mortality if pregnant

Pancreatitis

inflammation of pancreatic tissue and ducts

Symptoms of pancreatitis

swelling and intense pain

refers to the back

Causes of pancreatitits

overuse of alcohol which causes apoptosis and necrosis in pancreatic cells

gall stones

How does pancreatitis resolve

few days to weeks

treat the symptoms

acute pancreatitis happens when

the pancreatic duct is blocked from inflammation and the duct fluid backs up long enough for the pancreas to begin digesting itself

what is necrotizing pancreatitis

Auto digestion caused by pancreatic duct blocked by inflammation

what is long term inflammation of the pancreatic duct and tissue known as

chronic pancreatits

what are two causes of chronic pancreatitis

chronic alcohol abuse

cystic fibrosis

how does cystic fibrosis cause chronic pancreatitis

increase in mucous deposits can block the pancreatic duct, leading to inflammation and scarring

pancreatic calcification can result from

chronic pancreatitis

cholelithiasis are also known as

gall stones

what are the risk factors for cholelithiasis

6 Fs

female

fat

fair

forty

flatulent

fertile

what is the pain pattern for gall stones

relief food pain caused by the pain of the

Gall stone pain

upper right quadrant

pain worse at night and goes away after eating

peptic ulcer

pain in lower upper quadrant and is worse after eating

gall stones

pain in left lower back and intense and can’t find relief

pancreatitits

pain in right lower quadrant and iliopsoas test and mcburneys point

appendicitis