Term
|
Definition
-stores glucose as glycogen; can break down glycogen to be used as glucose
-stores and deaminates amino acids (proteins)
-metabolism of fatty acids and cholesterol
-produces and secretes bile
-detoxifies toxins (alcohol), drugs, and hormones (estrogen)
-synthesizes plasma proteins- clotting factors |
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Term
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Definition
- pigment formed by normal or abnormal breakdown of RBCs
-RBCs live for 120 days
-elevated blood levels of bilirubin cause jaundice (less RBCs)
-unconjugated bilirubin (unsoluble in water)- 90%
-conjugated bilirubin (soluble in water)- secreted as bile |
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Term
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Definition
-Greenish yellow fluid secreted by liver
-contains cholesterol, bile salts, waste products such as bilirubin**
-bile salts aid in the digestion of fats
-passes out of the liver via the bile duct (hepatic duct)
-stored in the gallbladder and released in response to fat-containing meals-- released in duodenum |
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Term
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Definition
-prehepatic: excessive destruction of RBCs- infants under bililight; transfussion reaction
Intrahepatic: inability of liver to remove bilirubin from blood
posthepatic: obstruction of bile flow- structural disorders of bile duct, cholelithiasis, tumors |
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Term
| Manifestations of Liver dysfunction |
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Definition
-increased in bilirubin levels (liver cant take out of blood)
-jaundice
-inadequate urea synthesis ( liver breaks down protein, ammonia in blodstream, liver turns ammonia into urea and ends up in urine- no process of urea, so ammonia is still in blood--> behavior and personality changes
-increased blood ammonia level
-hepatic encephalopathy--> ammonia to brain
-release of marker enzymes in blood
-AST-aspartate aminostransferase
-ALT-alanine aminotransferase (SGPT) |
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Term
| Manifestations of Liver dysfunction (cont..) |
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Definition
-Bleeding- no clotting factor (proteins)
-edema- swelling (no protein in capillaries, so no osmotic pressure to pull fluid back in on venous end)
-immune deficiency (antibodies are glycoproteins)
-accumulation of toxins and hormones (no processing)
-feminization (no breaking down hormones)
-poor metabolism of drugs (Dr. must be careful)
-spider nevi- vessels move to surface |
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Term
| Assessments of Liver function |
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Definition
-serum aminotransferase levels:
~assess injury to liver cells
-serum bilirubin, GGT and alkaline phosphatase: measures hepatic function
ultrasonography, CT scans, MRI
Angiography: visualizes the hepatic or portal circulation (dye in hepatic arteries)
liver biopsy |
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Term
|
Definition
| inflammation of liver and cellular injry |
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Term
| Acute Hepatitis presentation |
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Definition
- jaundice**
-Dark urine - bilirubin isn't processed by liver; filtered by kidney's; goes into urine |
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Term
|
Definition
-autoimmune disorders
-reactions to drugs and toxins
-infectious disorders
-malaria, infectious mononucleosis, salmonellosis, and amebiasis |
|
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Term
Hepatitis A
-Transmission
-S&S |
|
Definition
- Fecal- oral contamination (hands)
S&S: malaise (fatigue, discomfort), anorexia, nausea, low-grade fever, RUQ, jaundice in adults)
-gradually self-limiting
-child care centers, close living quarters
-takes time to recover; doesn't kill |
|
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Term
Hepatitis E
- Transmission
-S&S |
|
Definition
-common in developing countries
-transmission: fecal-oral (h20)
-S&S: malaise (discomfort), anorexia, nausea, low-grade fever, RUQ pain, jaundice
-generally self-limiting except high mortality rate in pregnant women (**significant risk of dying) |
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Term
Hepatitis B
-Transmission
-S&S |
|
Definition
Transmission: infected blood, saliva, urine, feces, semen, and transplacentally (drug users, needles, unprotected sex)
S&S:
-PRONOUNCED JAUNDICE****
-myalgai (muscle ache),
-athralgia (joint pain),
fatigue, malaise, vomiting, anorexia, nausea, vomiting, diarrhea, fever, abdominal pain
Similar to Hep A but much more SEVERE |
|
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Term
| Hepatitis B complications |
|
Definition
**Fulminant hepatitis--> SEVERE INFLAMMATION OF LIVER
glomerulonephritis, chronic hepatitis, liver failure
-carrier state (remains in body)
-Increased risk of cancer (death risk) |
|
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Term
|
Definition
"Delta" virus
requires presence of hep B
more serious with both B & D
** greater risk of chronic and fulminant hepatitis
**CO-infection |
|
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Term
Hepatitis C
-Transmission
-S&S |
|
Definition
Transmission through infection of blood, saliva, urine, feces, semen, placenta (same as Hep. B)
- S&S: asymptomatic
CHRONIC infections 85% of time
-leads to cirrhosis and liver failure |
|
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Term
| Acute Toxic Hepatitis (etiology & evaluation) |
|
Definition
Etiology: exposure to endotoxins or its metabolite
Evaluation: no definitive tests
-history of exposure is important
-negative viral serology screen
-improvement after discontinuing drug |
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Term
|
Definition
| Hepatitis inflammation and necrosis of liver for longer than 6 months |
|
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Term
| Chronic persistant Hepatitis |
|
Definition
-benign**
- minimal necrosis
-few symptoms |
|
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Term
|
Definition
-progressive liver destruction with cirrhosis
-chronic liver failure and death
-liver transplant** |
|
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Term
|
Definition
Malfunction of liver
Fibrotic liver
-loss of hepatocellular function
-obstruction to blood flow from gut |
|
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Term
|
Definition
-chronic alcohol use (most common)
-biliary (obstruction in bile drainage)
-postnecrotic (viral, toxic hepatitis)
-cardiac (right heart failure, liver congestion) |
|
|
Term
Manifestations of Cirrhosis
-S&S
-lab values |
|
Definition
-weight loss disguised by ascites (collection of fluid in peritoneal cavity) thin arms and big legs
-weakness, anorexia, diarrhea, constipation
-hepatomegaly (enlarged liver),Jaundice
-dull aching abdominal/ epigastric pain
S&S: PORTAL HYPERTENSION
Lab values:
-elevated liver enzymes
-decreased albumin and total proteins |
|
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Term
| Manifestations of Cirrhosis (continued) |
|
Definition
-edema
-fetor hepaticus- liver smell (smell ammonia in breath)
-personality and behavior changes
-spider angiomas
-testicular atrophy, gynecomastia (enlarged breast)
-palmar erythema (redness) |
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Term
|
Definition
carries venous blood from spleen, esophagus, stomach and intestines to the liver
-liver obstruction causes back up in portal circulation--increased pressure (portal hypertension)
-blood absorbed from GI tract goes to liver first--> filter any toxins out. when liver has scar tissue, blood backs up and increased portal hypertension** |
|
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Term
| Portal Hypertension & S&S |
|
Definition
-splenomegaly (enlarged spleen)
-increased blood cell destruction
-anemia, leukopenia, thrombocytopenia** breaks down blood components
-Esophageal Varicies***
-caput medusae (blood veins are visible on surface on skin because blood is backed up)
-hemorrhoids (hemorrhage)
-ascites --fluid in peritoneal cavity |
|
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Term
| Hepatocellular failure S&S |
|
Definition
consequence of cirrhosis for long time
-jaundice
-decreased clotting factors (hemorrhage)
-hypoalbumiemia (edema, ascites)
-Vit D and K deficiency (cant be processed)
-Altered hormone metabolism
(gynecomastia, testicular atrophy, palmar erythema, spider telangiectases, etc.) |
|
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Term
| Hepatocellular Failure S&S |
|
Definition
hepatic encephalopathy
-nitrogenous waste (ammonia) and other neurotoxins accumulate in blood (this affects the brain and causes damage
-Many CNS alterations: Confusion, dementia, lethargy, psychoses, irritability, slurred speech, etc
-Asterixis***: clapping temor of the hands; floppy; damage to the nerves from ammonia |
|
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Term
|
Definition
metastatic--> spread from some other area of body
-hepatocellular carcinoma (HCC) most common |
|
|
Term
|
Definition
sac-like structure located on ventral surface of liver
-function: stores and concentrates bile |
|
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Term
| Components of Hepatobiliary System |
|
Definition
Left and Right hepatic ducts
-come together to form common hepatic duct
-the cystic duct
-extends to the gallbladder
-Common bile duct
cystic duct and common hepatic duct form the common bile duct |
|
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Term
|
Definition
Gallstones
- present in at least 10% of patients (not all have S&S)
-Cholesterol stones (75%)
-calcium salts and bilirubin (25%)
-surgery cut open gallbladder- all gallstones look different |
|
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Term
|
Definition
40 year old woman with RUQ pain that is colicky, who is over weight
Inflammation of the GB
Etiology:
-95% associated with stone in cystic duct
Presentation:
-obese females**, RUQ pain***, with scapular or epigastric pain, COLICKY** (Sharp then disappears), nausea and vomiting, fever |
|
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Term
| Obstruction due to gallstones |
|
Definition
-biliary colic
RUQ pain/ shoulder/back
-indigestion
-jaundice
-chills, fever |
|
|
Term
|
Definition
-contains proteolytic enzymes that break down dietary proteins
- secretions include amylase (starch breakdown)
-lipases, hydrolyzes neutral fats into glycerol and fatty acids |
|
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Term
|
Definition
-inflammation of the pancreas
-mechanisms unknown
-enzymes that normally are not activated until intestine become activated and digest pancreatic tissue (auto-digestion)
-swelling, hemorrhage, damage to blood vessels
(back pain) |
|
|
Term
| Acute Pancreatitis: Etiology |
|
Definition
Etiology:
-alcohol abuse, biliar disease (gallstone) block duct and aggravates pancreas
-viral infections, trauma, some medications |
|
|
Term
| Acute Pancreatitis Presentation |
|
Definition
Severe epigastric pain and BACK PAIN
SEVERE BACK PAIN**** |
|
|
Term
| Evaluation of Acute pancreatitis |
|
Definition
-CBC, glucose, calcium, electrolytes, amylase, lipase (renal studies)
-severity index |
|
|
Term
|
Definition
-chronic pancreatitis involves persistant inflammation of the pancreas
-Inflammation and fibrosis cause the destruction of functioning glandular tissue in the pancreas
~lack of pancreatic enzymes
~inability to properly digest fats
~diabetes -no insulin being produced*** |
|
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Term
|
Definition
Etiology unknown
- SMOKING- Major risk factor
-Diet- Second major risk factor
-increasing total calorie intake
- high intake of fat, meat, salt, dehydrated foods, fried foods, refined sugars, soy beans, and nitrosamines
-if caught early a whipple procedure to remove cancer |
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