Disorders of the liver, pancreas and gallbladder

what is cholelithiasis?

• stones form in the gallbladder

• due too precipitation of cholesterol and bilirubin (they combine together and make stones)

• typically asymptomatic

• if the stones move into the common bile duct they may develop in cholecystitis

what are etiologies of cholecystitis?

• obesity

• oral contraceptives

• family history (typically when it shows up early)

• hyperlipidemia

what is the pathogenesis of chloecystitis?

• stones form when cholesterol and calcium form solid crystals - these crystals obstruct the cystic duct

• the gallbladder stores bile and when you need more bile it contracts and expels it - the stone can block the cystic duct and this can cause a blockage which can cause back up to the gallbladder or the gallbladder- liver or liver-pancreas

• the stone blocks the area so you have an increase in pressure in your gallbladder and this increased pressure leads to inflammation which can cause tissue damage

• pressure against the wall itself causes ischemia and possibly necrosis

what are clinical manifestations chloecystitis?

• pain radiates to subcapsular and back, steadily increases for hours

• jaundice

• may cause gangrene and rupture

• nausea and vomiting

• clay colored stool

• heartburn/bloating

what is pancreatitis?

• inflammation of the pancreas

• digestive enzymes and specific pancreatic enzymes become active and start to eat your own pancreas

what are the etiologies of pancreatitis?

• gallstones

• hypertriglyceridemia

• alc abuse

what are the pathologies of pancreatitis?

• acute: inflammation of the pancreas; pancreatic enzymes begin auto digestion

• chronic: inflammatory lesions cause calcification and obstruct flow of pancreatic juices. most often due too alc abuse, occurs over weeks to months

what are the clinical manifestations of acute pancreatitis?

• steady and severe epigastric or LLQ pain radiating to the back

• nausea

• abd distention

• tachycardia

• hypotension

• fever

• decrease bowels sounds

• jaundice

• weakness

• palor

what are clinical manifestations of chronic pancreatitis?

insidious onset of LLQ pain radiating to back, nausea, vomiting, wt loss due to poor intake, flatulence, constipation, malabsorption

what is pancreatic cancer?

• devastating outcomes, with a survival rate of 7%

• typically asymptomatic, symptoms don’t usually show up until its far too late to do something

• risk factors: cigarette, obesity

what are clinical manifestations for pancreatic cancer?

• pancreatic head tumors= jaundice

• malabsorption and wight loss

• pancreatic tail: abd pain and nausea

what is treatment for pancreatic cancer?

• surgery and chemo but most often caught too late to treat

what are manifestations of liver disease?

• impaired protein synthesis

• bleeding (clotting factor deficiency)

• edema (hypoproteinemia)

• immune deficiency

• accumulation of toxins and hormones

• feminization and spider Nervi

• poor metabolism of drugs

• inadequate urea synthesis

• increase in ammonia level

• hepatic encephalopathy

• release of marker enzymes

• AST and ALT (if these are elevated this can mean there’s liver damage)

what is ascites?

• accumulation of fluid in peripheral cavity seen in advanced liver dse

• usually complicated by portal HTN and hypoalbuminemia

• abd distended results from accumulation of sodium, water, and protein

• increase in pressure and lack in protein

• some people have 15-20 oz of fluid

what is portal hypertension?

• increase in pressure within the portal vein

what is the etiology of portal hypertension?

• sluggish blood flow results in increased pressure in portal circulation

• the cirrhosis, hepatitis, liver damage that may be going on is a combination of the inflammation and tissue damage that is interfering with blood flow so the blood is going to back up

• the congested venous drainage is going to back up into the GI tract

• abnormally high BP in venous system

• that blood gets backed up and BP gets too high and your body starts developing collateral circulation to try and clear the pressure and those veins tend to be very fragile

what is the pathogenesis of portal hypertension?

• blood flow to the portal vein is obstructed, causing blood to back up into portal circulation and increase pressure

what are clinical manifestations for portal hypertension?

• anorexia

• varices

• ascites

• major complications is hemorrhage

what is varices?

• big concerning complication from cirrhosis

• distended, tortuous collateral veins resulting from partial HTN

• they are the greatest clinical concern in the esophagus (the one in the esophagus will be very weak and thin walled)

• in patients with cirrhosis 30% will develop esophageal varices and of the 30% 50% of them will rupture which is fatal

what are clinical manifestations for varices?

• bleeding

• melena

• hematemesis

• anemia

• shock (everything will drop)

what is hepatic encephalopathy?

• you can have temporary changes due too anemia

• its a damage to brain tissue occurring as a complication of cirrhosis of the liver due to too much ammonia in brain tissue

• characterized by symptoms ranging from mild confusion and lethargy to stupor and coma

what are clinical manifestations for hepatic encephalopathy?

• dementia; psychotic symptoms; cerebral signs

• ammonia level correlates positively with levee of encephalopathy, mild confusion and lethargy to super and coma

• people can be psychotic