Liver, Biliary System, & Pancreas

What do the bile ducts connect?

connect liver to duodenum

What produces bile?

liver

What stores bile?

gallbladder

Where is bile secreted?

small intestine

What connects the liver to the digestive tract?

bile ducts and portal veins and its tributaries

What is the blood supply of the liver?

-receives dual blood supply from the hilum (hepatic artery and portal vein)

-sinusoids

What results in anastomoses of the liver?

portal hypertension

How do anastomses of the liver form?

-obstruction of portal blood flow, a low-pressure venous system, results in portal hypertension

-to bypass a block in the portal blood flow, the body develops anastomoses between the portal and systemic venous circulation

What results from obstruction of the common bile duct?

jaundice

What are the 3 ways to classify jaundice?

• prehaptic

• hepatic

• posthepatic

What is hemolysis?

destruction of RBC

What is hematoma?

pool of mostly clotted blood in an organ, tissue, or body space due to a broken blood vessel

What is Gilbert's disease?

body cannot properly process bilirubin

What results in prehepatic jaundice

-increased breakdown of RBCs (hemolysis)

-overloads the livers ability to conjugate all of the bilirubin

-hematoma

What type of jaundice is viral hepatitis?

hepatic jaundice

What are examples of hepatic jaundice?

-viral hepatitis

-alcoholic liver disease

-drug-induced liver disease

-cirrhosis

What type of jaundice do gallstones in the common bile duct result from?

posthepatic jaundice

How does jaundice of the sclera appear?

sclera (white of eye) appears yellow

How is jaundice best recognized?

on the sclera (white of eye)

What is cirrhosis?

chronic liver damage; loss of normal liver structure and function

What is cirrhosis a synonym for?

end-stage liver disease

What is the only cure for cirrhosis?

liver transplantation

How is cirrhosis characterized morphologically?

by fibrosis and regenerating liver cell nodules that replace the normal parenchyma (functional tissue)

What is the pathogenesis of cirrhosis?

-liver infected with viruses (HBV and HCV) initially appears normal

-alcohol use leads to fatty transformation of liver which appears yellow

-progression of injury to cirrhosis is marked by the appearance of nodules on the surface of the liver and throughout the functional tissue

Why does the liver feel firm on palpation in cirrhosis?

because of the extensive fibrosis

How does alcoholic cirrhosis appear?

yellow nodules have replaced normal liver tissue because of high-fat content

What is ascites a complication of?

portal hypertension

What is ascites?

the accumulation of fluid in the peritoneal cavity causing abdominal swelling

What is the pathogenesis of ascites?

-decreased albumin production reduces oncotic pressure of plasma

-results in portal hypertension and increased transduation of fluid into the abdomen

-hyperaldosteronism (Na+ and H2O retention in kidneys)

What does ascites cause?

bulging of the anterior abdominal wall

What is portal hypertension associated with?

dilated periumbilical veins (known as caput medusae- Medusa's head)

What are some autoimmune disorders affecting the liver?

-autoimmune hepatitis

-primary biliary cirrhosis

-primary sclerosing cholangitis

What is autoimmune hepatitis?

antibodies are attacking self cells

What population does autoimmune hepatitis occur in?

young women

What antibodies are in the serum of autoimmune hepatitis?

ANA (anti-nuclear) and ASM (smooth muscle)

What is primary biliary cirrhosis?

chronic jaundice, hypercholesterolemia

What antibodies are in the serum in primary biliary cirrhosis?

AMA (anti-mitochondrial)

What does primary biliary cirrhosis begin as and how does it progress?

-begins as inflammation of the intrahepatic bile ducts

-infiltrates of lymphocytes and macrophages destroy bile ducts

-destruction of bile ducts is accompanied by intrahepatic cholestasis (liver disease) and fibrosis

-ultimately leads to cirrhosis

What population does primary sclerosing cholangitis occur?

men less than 40 years old

What antibodies are in the serum of primary sclerosing cholangitis?

no specific antibodies

What population does primary biliary cirrhosis occur in?

middle-aged women

What does primary biliary biliary cirrhosis lead to?

destruction of intrahepatic ductules

What is primary sclerosing cholangitis associated with?

ulcerative colitis causing formation of scar tissue in the ducts

What is the pathogenesis of primary sclerosing cholangitis?

-associated destruction of intrahepatic and extrahepatic bile ducts by lymphocytes and macrophages (cell-mediated immune reaction)

-cellular phase of disease followed by fibrosis that obliterates bile ducts inside and outside the liver

What does primary sclerosing cholangitis lead to?

constriction of extraheaptic and intrahepatic ducts

What are the 3 types of gallstones?

• cholesterol stones

• black pigmentary stones

• brown pigmentary stones

How do cholesterol gallstones appear?

• typically solitary

• 1-5cm diameter

• round, yellow, and firm

How do cholesterol gallstones appear in cross-section?

glistening, radiating, crystalline appearance

How do black pigmentary gallstones appear?

-5-10 mm diameter

-multiple, jet black, ovoid or polygonal, and faceted

-soft and can be crushed between fingers

How do brown pigmentary gallstones appear?

• irregularly shaped

• 1-3 cm in diameter

How do brown pigmentary gallstones appear in cross-section?

often laminated

What type of gallstones show darker and lighter layers around a central core?

brown pigmentary gallstones

What are some complications of gallstones?

cholecystitis (inflammation of gallbladder) or obstruction of the cystic or common bile duct (only 20% of all patients will gallstones present with clinical symptoms

What makes up more than 98% of the entire pancreas?

exocrine tissue

What does amylase breakdown?

starch

What does lipase break down?

fat

What does peptidase break down?

proteins

What are some exocrine enzymes the pancreas secretes?

amylase, lipase, peptidase

What are the types of pancreatitis?

acute and chronic

What is a main characteristic of chronic pancreatitis?

fibrosis of pancreas

What are clinical features of chronic pancreatitis?

-insidious onset

-pain in upper abdomen; radiates into back

-malabsorption caused by pancreatic insufficiency

-x-ray evidence of calcifications

-secondary diabetes mellitus

What causes chronic pancreatitis?

-chronic alcoholism (70%)

-trauma

-systemic metabolic or endocrine disease

-unknown (20%)

What is the pathology of chronic pancreatitis?

-fibrosis of pancreas

-atrophy, loss of acini

-intraductal stones

-parenchymal calcifications

What cells are preserved in chronic pancreatitis?

islets of langerhans (in late stages, numbers are reduced and replaced by fibrous tissue)

What type of tumor does chronic pancreatitis increase the risk 2x for?

adenocarcinoma of pancreas

What type of diabetes is insulin-dependent?

type 1

What type of diabetes is noninsulin-dependent?

type 2

What are some complications of diabetes related to the cardiovascular system?

atherosclerosis

What are some complications of diabetes related to the kidney?

scarring glomerulus and infection (pyelonephritis)

What are some complications of diabetes related to the eye?

retinopathy (damage to blood vessels of retina) and cataracts (clouding of eye lens)

What are some complications of diabetes related to the nervous system?

cerebrovascular disease and peripheral neuropathy