Gastrointestinal, Hepatobiliary, and Pancreatic Systems Review

Flashcards for review of gastrointestinal, hepatobiliary, and pancreatic systems covering liver, pancreas, and gallbladder function.

Liver, Gallbladder, and Pancreas

Accessory organs of digestion that produce or store digestive secretions.

Hepatic portal circulation

The circulation where the liver receives oxygenated blood via the hepatic artery and nutrient-rich blood from digestive organs and the spleen via the hepatic portal vein.

Excretory function of the liver

The liver's function of carrying bilirubin and excess cholesterol to the intestines for elimination in feces.

Liver Functions

Metabolism of carbohydrates, amino acids, and lipids; synthesis of plasma proteins; phagocytosis by Kupffer cells; formation of bilirubin; storage; detoxification; activation of vitamin D.

Cholecystokinin (CCK)

Hormone secreted by the duodenal mucosa to stimulate gallbladder contraction.

Amylase

Enzyme that breaks down starch into maltose.

Lipase

Enzyme that breaks down emulsified fats into fatty acids and monoglycerides.

Trypsin

Enzyme that breaks down polypeptides into shorter chains of amino acids (peptides).

Laboratory tests for GI, hepatobiliary, and pancreatic disorders

Includes complete blood count, electrolytes, bilirubin (stool and urine), liver enzymes, ammonia, pancreatic enzymes, prothrombin time, and stool tests for fat content.

Radiographic tests

Radiographic tests include computed tomography (CT) scan, hepatobiliary scan (cholescintigraphy, HIDA, IDA).

Liver scan

Nuclear medicine procedure involving injection of a slightly radioactive medium to form a composite picture of the liver.

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic procedure to show pancreatic and biliary ducts, often used for biopsy, stone/tumor removal, and stent placement.

Percutaneous liver biopsy

Procedure where a needle is inserted through the skin into the liver to obtain a tissue sample.

Hepatitis

Inflammation of the cells of the liver, often caused by a virus but also by bacterial infection, medications, alcohol, or metabolic/vascular disorders.

HAV, HBV, HCV

Hepatitis types transmitted through fecal/oral route, blood/body fluids, and blood containing fluids.

Prevention of Hepatitis

Standard and transmission precautions, hand hygiene, vaccination (HAV, HBV), and immunoglobulin (IG) after exposure.

Prodromal stage of Hepatitis - Signs and Symptoms

Flu-like symptoms, right upper quadrant (RUQ) pain.

Icteric stage of Hepatitis - Signs and Symptoms

Jaundice, worsening symptoms, pale stools, pruritus, dark urine, RUQ pain.

Convalescent stage of Hepatitis - Signs and Symptoms

Return to normal liver function.

Complications of Hepatitis

Acute (sudden & severe) and chronic liver failure, chronic infection, carrier state, and increased risk of liver cancer.

Diagnostic tests for Hepatitis

Serum tests, liver enzymes, serum bilirubin, prothrombin time, and liver biopsy.

Therapeutic interventions for Hepatitis

Identify cause, monitor liver function, relieve symptoms, prevent cirrhosis, educate on hydration and nutrition, rest, and avoid alcohol and liver-toxic drugs.

Acute Liver Failure

Sudden massive loss of liver tissue leading to impaired liver function.

Acetaminophen Toxicity

Most Common cause of Acute Liver Failure

Hepatic Encephalopathy Treatment

Lactulose is often administered.

Cirrhosis/Chronic Liver Disease

The progressive replacement of healthy liver tissue with scar tissue, resulting from chronic liver disease.

Etiology of Cirrhosis/Chronic Liver Disease

Chronic alcohol use, chronic HBV or HCV, nonalcoholic steatohepatitis (NASH).

Pathophysiology of Cirrhosis/Chronic Liver Disease

Inflammation of liver cells, infiltration with fat and white blood cells, fibrotic scar tissue replaces liver tissue, abnormal regeneration of the liver, impaired liver blood flow, and impaired liver function.

Signs and symptoms of Cirrhosis/Chronic Liver Disease

Anorexia, nausea, weight loss, ascites, bruising, muscle cramping, weakness, fatigue, dull right upper quadrant pain, GI bleeding, itching, jaundice, spider angiomata, enlarged/firm/tender liver.

Complications of Cirrhosis/Chronic Liver Disease

Clotting defects, portal hypertension, ascites, hepatic encephalopathy, hepatorenal syndrome, Wernicke-Korsakoff syndrome.

Portal hypertension

Persistent elevated blood pressure in portal vein; scarring obstructs blood flow in portal vein, blood backs up into surrounding vessels; pressure causes abdominal veins to become enlarged & visible, rectal hemorrhoids, spleen enlargement, esophageal varices.

Diagnostic tests for Cirrhosis/Chronic Liver Disease

Elevated liver enzymes (ALT, AST), bilirubin, ammonia, prolonged PT, abdominal x-ray, CT scan, MRI, abdominal ultrasound, esophagogastroduodenoscopy (EGD), liver biopsy.

Therapeutic interventions for Ascites

Diuretics, sodium restriction, fluid restriction, albumin infusion, paracentesis, transjugular intrahepatic portosystemic shunt (TIPS).

Therapeutic interventions for Esophageal varices

Beta blockers (for prevention), variceal ligation, vasoconstrictors, TIPS, transfusion, antibiotic prophylaxis, balloon tamponade (temporarily).

Therapeutic interventions for Hepatic encephalopathy

Avoid narcotics, benzodiazepines, & alcohol; lactulose, rifaximin, K+ replacement.

Candidates for liver transplant

Cirrhosis, hepatitis, biliary disease, metabolic disorders, hepatic vein obstruction.

Signs of Liver Transplant Rejection

Pulse >100 bpm, temperature >101°F (38°C), RUQ pain, increased jaundice, elevated liver enzymes (ALT, AST), bilirubin, alkaline phosphatase (ALP), and PT.

Risk factors for Liver Cancer

Chronic HBV or HCV, nutritional deficiencies, heavy alcohol use or smoking, exposure to hepatotoxins.

Signs and symptoms of Liver Cancer

Encephalopathy, abnormal bleeding, jaundice, ascites.

Diagnostic tests for Liver Cancer

Elevated alkaline phosphatase (ALP) & alpha-fetoprotein, MRI, CT, ultrasound, biopsy.

Acute Pancreatitis

Inflammation of the pancreas caused by autodigestion; pancreatic enzymes are activated while still in the pancreas and begin to digest the pancreas.

Turner sign or Cullen sign

Purplish discoloration of flanks or around the umbilicus.

Diagnostic tests: Pancreatitis

Need to have the presence of abdominal pain; Serum amylase and/or lipase >3 times normal; Abdominal imaging

Therapeutic interventions: Acute Pancreatitis

Aggressive IV fluids (first 24 hours), nutrition (mild: oral, severe: enteral), analgesics, antibiotics for infection/sepsis.

Chronic Pancreatitis

Progressive fibro-inflammatory disease; pancreatic ducts become obstructed, dilated, and finally atrophied; ulceration of pancreatic cells and tissue death; pancreas becomes smaller and hardened; exocrine insufficiency occurs.

Diagnostic tests for Chronic Pancreatitis

CT scan, MRI, endoscopic ultrasound, pancreatic enzymes (normal or low), high fecal fat level.

Therapeutic interventions for Chronic Pancreatitis

Stop alcohol use, small low-fat meals, NSAIDs, analgesics, PPIs, pancreatic enzyme supplements, stents, surgery.

Risk factors for Pancreatic Cancer

Smoking, obesity, work exposure to chemicals, physical inactivity, diabetes mellitus, chronic pancreatitis, cirrhosis, H. Pylori infection, heredity.

Weight loss

Classic sign of pancreatic cancer.

Diagnostic tests for Pancreatic Cancer

Serum amylase/lipase, ALP, bilirubin, coagulation studies, carbohydrate antigen 19-9 (confirms the presence of cancer), CT, MRI, PET, ultrasound, ERCP, pancreatic biopsy.

Surgical Therapeutic interventions: Pancreatic Cancer

Whipple procedure (pancreatoduodenectomy), distal pancreatectomy (tail of the pancreas), total pancreatectomy (rare).

Cholecystitis

Inflammation of the gallbladder.

Cholelithiasis

Stones in the gallbladder, formed from cholesterol or calcium.

Choledocholithiasis

Stones in the common bile duct.

Biliary Colic

Epigastric pain that may radiate back to behind the right scapula or right shoulder

Diagnostic tests for Gallbladder Disorders

Ultrasound (endoscopic), CT scan, magnetic resonance cholangiopancreatography (MRCP), ERCP, cholescintigraphy (HIDA), elevated WBC count, elevated direct bilirubin.

Therapeutic interventions for Gallbladder Disorders

Analgesics, bile acid dissolution agents (ursodiol/Actigall), itch relief (colestipol/Colestid, cholestyramine/Questran), antiemetics.

Cholecystectomy

Laparoscopic surgery (most common) or traditional surgery (open with T-tube).