HLTH 201: Ch. 38 - Disorders of Hepatobiliary and Exocrine Pancreas Function

what are the metabolic functions of the liver?

production and excretion of bile, detoxification, drug metabolism, storage of carbs, lipids, proteins, production of plasma proteins

What does bile do?

digest fat, absorbs fat soluble vitamins

what is conjugated bilirubin?

water soluble

What is unconjugated bilirubin?

fat soluble

which type of bilirubin causes jaundice?

unconjugated bilirubin (attaches to sclera and fat in skin)

why is it important to decrease bilirubin levels in children?

bilirubin can cross blood brain barrier and attach to the fat in the brain (kernicterus)

What is kernicterus?

bilirubin crosses blood brain barrier and attaches itself to the brain

why is it common for babies to develop jaundice?

fetal hemoglobin is being converted into adult hemoglobin so many RBCs are being recycled and excessive bilirubin is being produced

what are the types of jaundice?

prehepatic jaundice, intrahepatic jaundice, posthepatic jaundice

What is prehepatic jaundice?

increased destruction of RBCs that is not the livers fault (seen in hemolytic anemia)

What is intrahepatic jaundice?

seen in patients with liver disease, is the livers fault

What is posthepatic jaundice?

obstruction of bile flow into the gallbladder or duodenum, is not the livers fault

What is cholestasis?

bile flow in liver slows down

How are gallstones formed?

overconcentrating the bile (extrahepatic cholestasis)

why does cholestasis cause pirutis?

bilirubin irritates nerve endings causing itchyness

What is hepatitis?

inflammation of the liver

what are the liver enzymes?

alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, gama glutamyltransferase (CGT), alkaline phosphate (ALP)

What is cirrhosis?

scarring of the liver

how is cirrhosis developed?

liver continues to fail and becomes inflamed

what is the main reason why people need a liver transplant?

viral hepatitis

what are the ways liver cells become damaged in viral hepatitis?

direct action of the virus, cell mediated immune response

when the liver becomes damaged, do the levels of liver enzymes increase or decrease?

increase

what are the three stages of hepatitis?

peritectic/prodromal period, icteric/jaundice period, convalescent period

what occurs during the preicteric/prodromal period of hepatitis?

begin to not feel well. Developing fever, malaise. Increased liver enzymes

what occurs during the icteric phase of hepatitis?

jaundice, feces becomes lighter (no longer has bilirubin), urine becomes darker (urine contains excessive amounts of bilirubin), pruritus (deposition of bilirubin in the skin causes itchiness)

what occurs during the convalescent phase of hepatitis?

reduction in signs and symptoms

How is viral hepatitis treated?

give gamma globulin antibodies to try to destroy the virus before it infects the rest of the body

how is chronic hepatitis treated?

give glucocorticoids to suppress immune system and decrease inflammation

what is fatty liver disease?

increased fat deposition in the lover causing enlargement and a decrease in function

what is alcoholic hepatitis?

inflammation of the liver caused by excessive alcohol consumption

what is a sign that a liver disease is progressing?

cirrhosis

can the liver regenerate itself once it has been cirrhosed?

no

what are the causes of cirrhosis?

alcohol, hepatitis, non-alcoholic liver disease

what are some s/s of cirrhosis?

low plasma proteins (because liver makes plasma proteins), low clotting factors (liver makes clotting factors), weight loss, weakness, ascites

What is ascites?

accumulation of fluid in the abdominal cavity

what are the causes of ascites?

low plasma proteins, increased pressure on the liver (pushes fluid out of the hepatic portal system and into the abdominal cavity causing ascites)

how do you treat ascities?

catheterize abdominal cavity to drain fluid, give IV fluid high in plasma proteins (causes fluid to be drawn out of the abdominal cavity and into the vasculature)

what indicates the end stage of liver failure?

cirrhosis

what are the hematologic disorders of liver failure?

anemia, thrombocytopenia, leukopenia

what are the endocrine disorders of liver failure?

fluid retention, hypokalemia

what are the skin disorders of liver failure?

spider nevi, hepatic encephalopathy (tremors in hands, confusion, coma due to high levels of toxins in body because liver cannot remove them), increased plasma creatinine, oliguria

what is the only organ that has endocrine and exocrine functions?

pancreas

what are the exocrine functions of the pancreas?

release digestive enzymes

What are the endocrine functions of the pancreas?

release insulin and glucagon

what is the function of acinar cells?

store digestive enzymes in an inactive state in zymogens

What is acute pancreatitis?

bile and pancreatic enzymes cannot get into the small intestine causing backup into the pancreas causing autodigestion of the pancreas

what are the main causes of acute pancreatitis?

Gallstones, alcohol

why does alcohol abuse cause acute pancreatitis?

alcohol prevents the sphincter of Oddi from relaxing or opening up causing pancreatic enzymes and bile to backup into the pancreas

what are the signs and symptoms of acute pancreatitis?

severe abdominal pain, scan showing inflammation of the pancreas, pancreatic enzymes in the circulation

what can chronic pancreatitis lead to?

pancreatic cancer