patho- hepatic and biliary system

cholelithiasis

pigment stones and cholesterol stones in bladder

pigment stones

unconjugated pigments in bile precipitate to form stones

pigment stones must be __________ _______

surgically removed (cant be dissolved)

cholesterol stones

normal constituent of bile

cholesterol stones are _________ in water

insoluble

cholelithiasis patho

-dec bile acid synthesis
-inc cholesterol synthesis in liver
-bile supersaturated with cholesterol
-precipitate out of bile to form stones

cholelithiasis clinical manifestations

-no pain and mild symptoms
-epigastric distress (fullness)
-abdominal distress
-vague RUQ pain

cholelithiasis: epigastric distress may follow a

meal rich in fried/fatty food

cholelithiasis stool characteristics

gray/clay-colored

cholelithiasis risk factors

-cystic fibrosis
-diabetes
-changes in weight
-illeal resection/disease
-estrogen

cholecystitis

inflammation of gallbladder (acute/chronic)

cholecystitis clinical manifestations

-pain
-tenderness
-rigidity of RUQ (can radiate to right shoulder)

cholecystitis patho

-gallstones = obstructs bile outflow
-blood vessels become compressed
-vascular supply compromised
-gangrene with risk of perforation

liver function tests

-serum aminotransferase
-alanine aminotransferase (ALT)
-aspartate aminotransferase (AST)
-gamma-glutamyl transferase (GGT)

serum aminotransferase

indicators of injury to liver cells

serum aminotransferase detects _______

hepatitis

alanine aminotransferase (ALT)

-levels inc in liver disorders and alcohol
-monitors course of hepatitis, cirrhosis, effects of treatments may be toxic to liver

ALT is very _______ _______

liver specific

aspartate aminotransferase (AST)

-not specific to liver diseases
-inc levels in cirrhosis, hepatitis, and liver cancer

gamma-glutamyl transferase (GGT)

levels associated with cholestasis
-alcohol liver disease

hepatic dysfunction

-acute/chronic cirrhosis of liver
-alcohol liver failure
-infection
-fatty liver disease

2 types of fatty liver disease

-non alc fatty liver disease (NAFLD)
-non alc steatohepatitis (NASH)- most common

metabolic function of liver

-glucose metabolism
-ammonia conversion
-protein metabolism
-fat metabolism
-vitamin and iron storage
- bile formation
-bilirubin excretion
-drug metabolism

symptoms related to hepatic dysfunction

-jaundice
-portal hypertension
-ascites and varices
-hepatic encephalopathy or coma
-nutritional deficiencies

jaundice

yellow/greenish-yellow sclera and skin caused by inc serum bilirubin levels

jaundice bilirubin levels

> 2 mg/dL

types of jaundice

-hemolytic
-hepatocellular
-obstructive
-hereditary hyperbilirubinemia

hemolytic jaundice

inc destruction of RBC; plasma rapidly flooded with bilirubin so liver cant excrete bilirubin as quickly as its formed

hepatocellular jaundice

inability of damaged liver cells to clear normal amounts of bilirubin from blood

obstructive jaundice

extrahepatic obstruction may be caused by occlusion of bile from a gallstone, inflammatory process, tumor, pressure from enlarged organ

hereditary hyperbilirubinemia

inc serum bilirubin levels, resulting from several inherited disorders
(can produce jaundice)

which jaundices are most associated with liver disease

hepatocellular and obstructive

hepatocellular clinical manifestations

-mild/severely ill
-lack of appetite
-nausea/vomiting
-weight loss
-malaise
-fatigue
-weakness
-headache, chills, fever, infection

obstructive clinical manifestations

-dark orange-brown urine
-clay-colored stool
-dyspepsia
-intolerance of fats
-impaired digestion
-pruritus

portal hypertension

obstructed flow through the liver results in inc pressure throughout portal venous system

portal hypertension symtpoms

-ascites
-esophageal varices

ascites

fluid peritoneal cavity

ascites causes

-portal hypertension
-vasodilation of splanchnic circulation
-changes in ability to metabolize aldosterone
-dec synthesis of albumin
-movement of albumin into peritoneal cavity

hepatic encephalopathy

2 major alterations underlie its development in cute and chronic liver disease
-hepatic insufficiency
-portosystemic shunting

hepatic insufficiency

inability of liver to detoxify toxic by-products of metabolism

portosystemic shunting

collateral vessels develop allowing elements of portal blood to enter systemic circulation

early signs of hepatic encephalopathy

-mental changes
-motor disturbances

esophageal varices clinical manifestations

-hematemesis
-malena
-general deterioration
-shock

viral hepatitis

systematic viral infection causes necrosis and inflammation of liver cells

hepatitis pairings

-A + E
-B + C

A + E route

fecal-oral route

B + C route

bloodborne

hepatitis D only occurs in

pt w hepatitis b

nonviral hepatitis

toxic and drug induced

hepatitis A incubation

2-6 weeks

hepatitis A lasts for

4-8 weeks

hepatitis A clinical manifestations

-mild flue-like symptoms
-low-grade fever
-anorexia
-jaundice and dark urine (late)
-indigestion/epigastric distress
-enlargement of liver and spleen

hepatitis B transmitted by

blood, saliva, semen, and vaginal secretions

hepatitis B cause

cirrhosis and liver cancer

hepatitis B incubation

1-6 months

hepatitis B manifestations

-variable
-similar to HAV
-loss of appetite
-dyspepsia
-abdominal pain
-generalized aching
-malaise
-weakness
-jaundice ( maybe)

hepatitis C transmitted through

needle sticks and sharing of needles

hepatitis C is _____ ________ bloodborne infection

most common

hepatitis C causes _____ cases of liver cancer

1/3

hepatitis C= most common reason of _______ _________

liver transplant

hepatitis c incubation

15-160 days (variable)

hepatitis c symptom's are

mild

hepatitis E transmitted through

contaminated water

hepatitis E incubation

15-65 days

hepatitis E resembles A by

-self limiting
-abrupt onset
-not chronic

hepatitis D transmitted

blood and sexual contact
-IV/injection drugs
-hemodialysis
-multiple blood transfusions

hepatitis D incubation

30-150 days

hepatitis D drug treatment

interferon alfa

hepatitis D likely to develop

fulfillment liver failure/chronic active hepatitis and cirrhosis

types of hepatic cirrhosis

-alcoholic
-post necrotic
-biliary

alcoholic cirrhosis

scar tissue surrounds portal area

post necrotic cirrhosis

broad bands of scar tissue

biliary cirrhosis

scarring occurs in liver around bile ducks

cirrhosis manifestations

-liver enlargement
-portal obstruction
-ascites
-infection and peritonitis
-varices
-GI varices
-edema
-vitamin deficiency
-anemia
-mental deterioration

cirrhosis: men ____ more affected

twice

cirrhosis: women _____ risk for ETOH liver disease

greater

ETOH cirrhosis

episodes of necrosis of liver cells
more scar tissue than healthy tissue

primary liver tumors

-hepatis B and C
-hepatocellular carcinoma

liver metastasis

-few cancers originate in liver
-frequent site of metastatic cancer

liver cancer clinial manifestations

-dull persistent pain in RUQ, back or epigastrium
-weight loss
-anemia
-anorexia
-weakness
-jaundice
-bile ducts occluded
-ascites
-obstructed portal veins

acute pancreatitis

pancreatic duct becomes obstructed and enzymes back up
causing autodigestion and inflammation of pancreas

chronic pancreatitis

progressive inflammatory disorder with destruction of pancreas
-cells replaced by fibrous tissue
-pressure with in pancreas inc
-obstructs pancreas and common bile ducts

pancreatitis patho

-self digestion of pancreas (trypsin) causes acute pancreatitis
-gallstones enter common bile duct and obstruct flow of bile into pancreatic duct
-activated enzymes leading to vasodilation, necrosis, erosion, and hemorrhage

pancreatitis causes

-bacterial/ viral infections
-blunt abdominal trauma
-PUD
-meds (corticosteroids, oral contraceptives)

pancreatic cysts

local necrosis occurs bc of acute pancreatitis
-collections of fluid wailed off by fibrous tissue

pancreatic cancer: sites of lesions

head, body, tail of pancreas

pancreatic cancer clinical manifestations

-pain
-jaundice
-weight loss (rapid)

pancreatic cancer risk factors

-age
-smoking
-environment/occupational chemicals
-diet inc fat and meat

pancreatic cancer treatment

-palliative
-chemo
-radiation (limited)
-surgery

vitamin K deficiency

-synthesis of coagulation factors depend on vitamin K
-common in malnourished pt