GI Disorders 2 (1)

Largest visceral organ in the body

Liver

In the liver, the venous (portal) supplies through the ____ vein while the arterial supplies through the ____ artery

Portal, hepatic

The liver produces ___, synthesizes ____, plasma proteins, and ___

Bile, cholesterol, urea

The liver stores ____ before breaking it down and converting excess carbohydrates to ____

Glycogen, triglycerides

____ contributes to plasma colloidal osmotic pressure

Albumin

____ ____ is characterized by increased resistance to flow in portal venous system; liver gets fibrotic

Portal hypertension

____ ____ are pre-existing vessels that normally have little or no blood flow

Collateral vessels

____ ____ venous is high pressure in the portal vein causing collateral vessels to open/develop between the portal vein and systemic veins

Portal-systemic

_____ is increased sequestering of all blood cell types

Hypersplenism

_____ is the most common symptom of congestive splenomegaly

Thrombocytopenia

____ is when fluid accumulates in the peritoneal cavity

Ascites

_____ is obstructive thrombosis, narrowing of portal vein, and massive splenomegaly with increased splenic blood flow

Pre-hepatic

____ is right-sided heart failure and hepatic vein outflow obstruction (thrombosis)

Post-hepatic

_____ is cirrhosis with bands of fibrous tissue/nodules distorting structures and increasing resistance to BF; vascular remodeling

Intra-hepatic

____ distend collateral veins

Varices

3 places that are prone for bleeding in portal hypertension

Lower esophagus, stomach, abdominal wall

A damaged liver will not be producing what

Sufficient clotting factor proteins

3 effects of portal hypertension

1. Increased pressure in peritoneal capillaries

2. Portosystemic shunting of blood

3. Splenomegaly

_____ is splenic vein moved to drain into left renal vein while _______ is portal vein moved to drain into IVC

Splenorenal, portocaval shunt

____ is a stent passed over wire to connect portal vein to hepatic vein and bypass liver capillaries

TIPS

What is the most common cause of ascites

Cirrhosis

Pathophysiology of ascites

1. PHT

2. Increased NO

3. Vasodilation

4. Renal sodium retention

5. Increased renin and aldosterone

6. Overfill of intravascular volume

____ ____ is translocation of bacteria in gut to the peritoneal cavity

Bacterial peritonitis

____ is aspirate ascitic fluid for bacterial culture, microscopic analysis; may cause peritonitis

Paracentesis

____ is essential for the digestion of dietary fats and absorption of fats

Bile

Over ___ of bile salts that enter the intestine are reabsorbed into the portal circulation that takes place in the distal ileum called _____ ____

905, enterohepatic circulation

_____ gives bile its color and is formed from senescent RBCs

Bilirubin

Free bilirubin is ____ in plasma and is transported in the blood attached to albumin

Insoluble (cannot be used by the body)

____ bilirubin is soluble in bile

Conjugated

50% of Conjugated bilirubin is converted into a highly soluble substance called ____ by the intestinal flora

Urobilinogen

Urobilinogen turns into ____ in the urine but turns into ____ in feces

Urobilin, stercobilin

_____ results from an abnormally high amount of bilirubin in blood

Jaundice

Bilirubin has a strong affinity for what

Elastic fibers (sclera of eyes)

_____ jaundice is intrahepatic (in liver) obstruction and post-hepatic (stasis in gallbladder) obstruction to bile flow

Obstructive

____ jaundice is pre-hepatic and rate of RBC destruction exceeds the liver’s ability to remove the bilirubin from blood

Hemolytic

_____ ____ involves disturbances in hepatocyte function and obstruction of bile canaliculi

Intrahepatic obstructive

___ _____ develops if the common bile duct is occluded preventing conjugated bilirubin from entering the duodenum

Extrahepatic obstructive

What 2 liver diseases cause intrahepatic jaundice

Hepatitis and cirrhosis

______ ______ jaundice are caused by disorders that affect the ability of the liver to remove bilirubin from the blood or to conjugate it so it can be eliminated in the bile; enzymes not available

Intrahepatic hepatocellular

______ ____ jaundice (regurgitating) is cholestatic jaundice that occurs when bile flow is obstructed between the liver and intestine; strictures of bile duct, gallstones, tumors

Extraposthepatic obstructive

Major cause of pre-hepatic jaundice is excessive ____ of RBCs

Hemolysis

____ is a pathologic condition of impaired bile formation and bile flow, leading to accumulation of bile pigment in the parenchymal tissues of liver

Cholestasis

Prolonged obstructive cholestasis leads to destruction of supporting connective tissue with ____ and end-stage ___ ___

Fibrosis; biliary cirrhosis (immune system attacks bile ducts inside liver)

____ ____ may occur inn the course of other viral infections like EBV and CMV

Acute hepatitis

____ _____ are caused by chronic alcoholism, drug toxicities, and autoimmune disorders

Chronic hepatitis

Acute hepatitis involves what viruses

Hepatitis A, B, C, D, and E

Chronic hepatitis involves which viruses

Hepatitis C and B (C most common)

What 3 viral hepatitis viruses can produce a carrier state

HBV, HCV, and HDV

Which viral hepatitis virus does not have a carrier state

HAV (and E)

Hepatitis seq.: in ______ phase, it begins about 2 wks. after exposure and ends w. jaundice, fatigue, anorexia, malaise, nausea, vomiting, low-grade fever; HIGHLY TRANSMISSIBLE

Prodromal (preicteric)

Hepatitis seq.: in ____ phase, it starts w. jaundice and lasts 2-6 wks; enlarged liver with pain on percussion; acute phase

Icteric

Hepatitis seq.: in ___ phase, it is 6-8 wks. after exposure and is the disappearance of jaundice but the liver is still enlarged and tender; return of appetite

Recovery

Hepatitis ___ is usually benign and self-limiting; symptoms are abrupt and includes fever, malaise, nausea, anorexia, dark urine, and jaundice; endemic

A

Hepatitis A risk factor is

Fecal-oral route

Hepatitis ___ is direct contact and immunoglobulins before exposure or immediately after can prevent it

B

Which hepatitis has a longer incubation period and represents more serious health problems than HAV

HBV

HBV also participates in the development of Hep __

D

Hepatitis ___ is post-transfusion and is related to IV drug use, needle stick injuries, and unprotected sex; results in chronic hepatitis, cirrhosis, liver failure, and hepatocellular cancer

C

_____ hepatitis is chronic/progressive and may show hepatomegaly, splenomegaly, jaundice and other S/S of chronic liver disease

Autoimmune

____ hepatitis causes acute liver failure resulting in impairment/necrosis of liver cells; mortality rate is 85% w/o liver transplant

Fulminant

What is the leading cause of acute liver failure in the US

Acetaminophen overdose

Acute fulminant hepatitis or failure progresses from onset of hepatitis to hepatic _____

Encephalopathy

____ _____ results in decreased brain function from hepatic failure and elevated ammonia levels

Hepatic encephalopathy

What 3 disorders cause cirrhosis (fibrosis)

HBV, HCV, hemochromatosis (body stores too much iron)

Ascites and cirrhosis causes what

Spontaneous bacterial peritonitis

____ ____ _____ is when peritoneal fluid is seeded w. bacteria from blood/lymph; can lead to SHOCK

Spontaneous bacterial peritonitis

____ ____ liver is the mildest form and has fat deposition within the liver by increased lipogenesis + decreased FA oxidation by hepatocytes; oxidation of alcohol → acetaldehyde = damaged hepatocytes

Alcoholic fatty

_____ ____ is a precursor of cirrhosis and has inflammation, degeneration, and necrosis of hepatocytes; irreversible fibrosis

Alcoholic steatohepatitis

____ ____ causes immunologic alterations, inflammatory cytokines, oxidative stress from lipid peroxidation, and malnutrition on the liver

Alcoholic cirrhosis

Acetaldehyde in liver activates hepatic ____ cells involved in fibrosis and excessive ____ formation leading to ___

Stellate, collagen, obstruction

Spectrum of alcoholic liver disease includes what 3

Fatty liver ( = steatosis), alcoholic hepatitis, cirrhosis

What is the intermediate stage between fatty changes and cirrhosis characterized by inflammation/necrosis of liver cells; fever and tenderness over RUQ

Alcoholic hepatitis

What is the end result of repeated bouts of drinking-related hepatocyte injury/regeneration with a gross appearance of liver changes to larger/irregular nodules; liver is re-lobulize

Alcoholic cirrhosis

Cirrhosis is most commonly caused by ?

Ethanol

____ ____ is musty order of the breath resulting from metabolic byproducts of intestinal bacteria

Fetor hepaticus

____ cirrhosis begins in the bile canaliculi/ducts

Biliary

____ ____ cirrhosis (autoimmune) is caused by autoimmune T-lymphocytes and antibody-mediated destruction of the small intrahepatic bile ducts

Primary biliary

____ ____ cirrhosis (obstruction) is partial or complete obstruction of common bile duct by gallstones, tumors, fibrotic strictures

Secondary biliary

What is the most common cause of gallbladder problems

Cholecystitis

____ stones are the most common and form in bile + reduce motility

Cholesterol

_____ (cirrhosis) stones form from increased levels of unconjugated bilirubin binding to Ca2+; associated with liver disease

Pigmented

____ ____ leakage causes autodigestion of pancreatic tissue activating trypsin → chymotrypsin, lipase, and elastase

Pancreatic enzymes

____ _____ releases pro-inflammatory cytokines into the circulation and progresses with activated stellate cells → fibrosis → chronic

Acute pancreatitis

Release of vasoactive ___ causes vasodilation, hypotension, and shock

Peptides

S/S of pancreatitis

• Epigastric constant pain radiating to the back

• Fever

• Hypovolemia

• Hypotension

• Tachycardia

• MI/shock

Cancer inn the liver is usually caused by ____ spread

Metastatic

____ hepatocellular carcinoma consists of multiple nodules

Nodular

____ hepatocellular carcinoma consists of a large tumor mass w. satellite nodules

Massive

____ hepatocellular carcinoma consists of small nodules distributed throughout the liver

Diffuse

_____ ____ is closely associated w. chronic hepatitis and cirrhosis

Hepatocellular carcinoma

_____ _____ (cholangiocarcinoma) develops in bile ducts and is associated w. primary sclerosing cholangitis and liver fluke infestation

Cholangiocellular carcinoma

Pancreatic cancer has a mortality rate of

100%

Most pancreatic tumors arise from the exocrine cells in the ducts ___ ____

Ductal adenocarcinomas (80%)

____ _____ infiltrate superior mesenteric artery, vena cava, aorta, and form EMBOLI

Ductal adenocarcinomas