Term
| What are are 7 common patterns of hepatic injury? |
|
Definition
-Degeneration and intracellular accumulation
-Necrosis and apoptosis
-Regeneration
-Inflammation
-Fibrosis
-Cirrhosis
-Ductular reaction |
|
|
Term
| What organ produces bile and what are the two major functions of bile? |
|
Definition
-produced by the liver
-elimination of bilirubin, excess cholesterol, and xenobiotics that are insufficiently water soluble to be excreted into urine
-bile salts promote emulsification of dietary fat in the gut |
|
|
Term
| What is a common manifestation of liver disease? what are two of the main signs and symptoms |
|
Definition
-Jaundice
-Yellowish discoloration of the skin and of the whites of the eyes caused by abnormally high levels of bilirubin in the bloodstream
-serum levels of bilirubin above 2.0 mg/dL |
|
|
Term
| If jaundice is caused by excessive production of bilirubin what is usually the underlying pathology? Is it unconjugated or conjugated? |
|
Definition
-hemolytic anemias
-unconjugated hyerbilirubinemia |
|
|
Term
| If jaundice is caused by reduced hepatic uptake, what type of hyperbilirubinemia is it? |
|
Definition
|
|
Term
| If jaundice is caused by impaired conjugation, what is usually the underlying pathology? What type of hyperbilirubinema is it? |
|
Definition
-neonatal jaundice
-unconjugated |
|
|
Term
| If jaundice is caused by decreased hepatocellular excretion what is often the pathology? What type of hyperbilirubinemia is it? |
|
Definition
|
|
Term
| If jaundice is caused by impaired bile flow, what is usually the underlying pathology? What type of hyperbilirubinemia? |
|
Definition
inflammatory destruction of bile ducts
conjugated |
|
|
Term
| What is cholestasis? What is often the cause? |
|
Definition
-systemic retention of not only bilirubin, but also other solutes eliminated in bile, particularly bile salts and cholesterol
-impaired bile flow due to hepatocellular dysfunction or biliary obstruction |
|
|
Term
| What are 3 signs and symptoms of cholestasis? |
|
Definition
-sometimes pruritis
-sometime skin xanthomas (focal deposits of CHO under the skin)
-elevated serum alkaline phosphatase |
|
|
Term
| 80-90% of hepatic functional capacity must be lost before what occurs? |
|
Definition
|
|
Term
| WHat are two causes of massive hepatic necrosis? |
|
Definition
-fulminant viral hepatitis
-drugs and chemicals (APAP, carbon tetrachloride, mushroom poisoning) |
|
|
Term
| What is the most common route of hepatic failure? |
|
Definition
| Chronic liver disease (usually chronic liver damage ending in cirrhosis) |
|
|
Term
| What are 3 causes of hepatic dysfunction without over necrosis? |
|
Definition
-acute fatty liver of pregnancy
-tetracycline toxicity
-reye syndrome |
|
|
Term
| What are 4 clinical signs of severe hepatic dysfunction due to estrogen metabolism issues? |
|
Definition
-palmar erythema (red nodules that form on the hands)
-spider angiomas
-hypogonadism
-gynecomastia |
|
|
Term
| In severe hepatic dysfunction describe your albumin, ammonia, and glucose levels. |
|
Definition
-hypoalbuminemia
-hyperammonemia
-hypoglycemia |
|
|
Term
| Hepatic failure can lead to ________ organ failure and _________ |
|
Definition
multiple
coagulopathy (due to coag factors made in the liver not being synthesized) |
|
|
Term
| What are two other major complications of hepatic failure? |
|
Definition
-Hepatic encephalopathy (metabolic disorder of CNS and NMS, elevated blood ammonia level and altered amino acid metabolism, deranged neurotransmission; confusion, stupor, coma, death; rigidity, hyper-reflexia, asterixis)
-Hepatorenal syndrome (idiopathic renal failure; drop in urine output, very low in sodium) |
|
|
Term
| Scarring and fibrosis of the liver, with altered liver architecture and function, caused by chronic liver disease, and among the top ten causes of death in the US is characteristic of what? |
|
Definition
|
|
Term
| What are the three defining characteristics of cirrhosis? |
|
Definition
-bridging fibrous septa (formation of scars around multiple adjacent lobules)
-parenchymal nodules (proliferating hepatocytes that are encircles by fibrotic bands)
-disruption of the architecture of the entire liver |
|
|
Term
| What are the 3 most common causes of cirrhosis? |
|
Definition
-chronic alcoholism (70%)
-chronic hep B and C
-biliary disease and hemochromatosis |
|
|
Term
| What are the clinical features of cirrhosis? What does the progression or improvement of the disease depend on? What does death result from? |
|
Definition
-may be clinically silent, anorexia, weight loss, weakness
-P or I depends on the extent of the disease and the causes of it
-D: liver failure, portal HTN, hepatocellular CA |
|
|
Term
| What is portal HTN? What are some causes of pre-heaptic, intra-hepatic, and post-hepatic portal HTN? |
|
Definition
-high blood pressure in the port an vein
-pre: occlusive thrombosis, narrowing of portal vein
-intra: CIRRHOSIS, schistosomiasis, massive fatty change, diffuse granulomatous diseases (sarcoidosis, miliary TB)
-post: R sided heart failure, constrictive pericarditis, hepatic vein outflow obstruction |
|
|
Term
|
Definition
| collection of excess fluid in the peritoneal cavity, often secondary to portal HTN |
|
|
Term
| What are portosystemic venous shunts? |
|
Definition
-bypasses where portal and systemic circulations share capillaries often secondary to portal HTN
-esophageal varicies in 65%
-hemorrhoids
-caput medusae |
|
|
Term
| What are two other clinical features of portal HTN? |
|
Definition
| -splenomegaly, hepatic encephalopathy |
|
|
Term
| What is an infection of the liver by a small group of viruses that have a particular affinity for the liver? |
|
Definition
viral hepatitis
-A, B, and C most common |
|
|
Term
| What is the for most primary liver infection, the leading cause of liver cancer, and the most common reason for a liver transplant? |
|
Definition
-viral hepatitis
-B and C: cancer
-C: transplant |
|
|
Term
| What is the incubation period for Hep A? |
|
Definition
| 28 days on avg (range of 15-50 days) |
|
|
Term
| How is Hep A transmitted? |
|
Definition
| -HAV replicates in the liver and is shed in high concentrations in feces from 2 weeks before to 1 week after the onset of clinical illness: FECAL ORAL |
|
|
Term
| What is the prognosis of Hepatitis A infxn (HAV)? |
|
Definition
| self-limited disease that does not result in chronic infxn or chronic liver disease |
|
|
Term
| The majority of Hep A cases fall in people in what populations? |
|
Definition
-MSM
-illegal drug users
-international travelers |
|
|
Term
| What is the incubation period for Hep B (HBV)? |
|
Definition
|
|
Term
| Where is HBV found in the body of an infected person? How is transmitted? |
|
Definition
-highest concentrations in the blood and in lower concentrations in other body fluids (semen, vaginal secretions, saliva, sweat, tears, breast milk, and wound exudates)
-Transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood |
|
|
Term
| What is the prognosis for HBV? |
|
Definition
| -can be self limited or chronic (10%) |
|
|
Term
| Risk of chronic HBV infection is __________ related to age at infxn |
|
Definition
|
|
Term
| Among persons with CHRONIC HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma is ______-_______% |
|
Definition
|
|
Term
| What is the most common chronic bloodborne infection in the US? |
|
Definition
| Hep C (HCV), 3-4 million people chronically infected |
|
|
Term
| What are the main causes of chronic liver disease in the US? |
|
Definition
| Hep C and chronic alcoholism |
|
|
Term
| What is the condition that most frequently requires liver transplantation in the US? |
|
Definition
|
|
Term
| What is the incubation period of HCV? |
|
Definition
|
|
Term
| The major route of HCV transmission is through _____________/______________, with illegal _______/________/_______ accounting for 40% of cases |
|
Definition
-blood inoculation
-IV drug use |
|
|
Term
-60-70% of newly infected people are usually _________ or have mild clinical illness
-_________ HCV infection develops in 70-85% of HCV infected people
-60-70% of chronically infected people have active _________ disease, and 20% will develop _________ |
|
Definition
asymptomatic
chronic
liver
cirrhosis |
|
|
Term
| What is a clinical feature of ACUTE viral hepatitis? |
|
Definition
|
|
Term
| What are some clinical features of CHRONIC viral hepatitis? Clinical Outcomes? |
|
Definition
-fatigue, sometimes malaise, loss of appetite, bouts of mild jaundice
-remission; slow progression; or cirrhosis and death |
|
|
Term
| WHat are some clinical outcomes for fulminant viral hepatitis? |
|
Definition
| a small percent of people infected with HAV or HBV infection may develop massive liver necrosis and acute liver failure |
|
|
Term
| Autoimmune hepatitis is characterized by mild to severe _______ hepatitis. What sex predominantly is effected? What are the serological markers? What immunglobulin is elevated? THere are high titers of ______ in 80% of cases. Other _________ diseases present in 60% of patients. What is the response to immunsuppressive tx? What is the overall risk for cirrhosis? |
|
Definition
-chronic
-female
-absence of serological markers of viral infxn
-IgG
-autoantibodies
-autoimmune
-good, but remission unusual
-5% |
|
|
Term
| What causes ~70% of chronic liver disease in US and up to 50% of deaths due to cirrhosis? |
|
Definition
excessive alcohol consumption
-more than 10 million americans are alcoholics |
|
|
Term
| What percentage of hospitalized pt's have problems related to alcohol abuse? |
|
Definition
|
|
Term
| What are 3 major effects of alcoholism on the liver? |
|
Definition
| steatosis, hepatitis, cirrhosis |
|
|
Term
| What is the prognosis of alcoholic liver disease? |
|
Definition
-With abstinence, 5 yr survival is 90% if jaundice, ascites, or hematemesis have not developed
-with continued drinking: 5 yr survival drops to 50-60% |
|
|
Term
| What are 5 common causes of death in end stage alcoholism? |
|
Definition
-liver failure
-massive GI hemorrhage
-infection
-hepatorenal syndrome
-hepatocellular carcinoma (3-6% of cases) |
|
|
Term
| THe liver is the major drug metabolizing and detoxifying organ in the body, because of this there is _______/______ with drugs leading to drug-induced liver disease |
|
Definition
|
|
Term
| Depending on the drug, what are some immune mechanisms that may occur in drug-induced liver disease? |
|
Definition
-cholestasis
-hepatitis
-steatosis
-fibrosis
-necrosis
-liver failure |
|
|
Term
| Why is drug induced hepatitis indistinguishable from chronic viral or autoimmune hepatitis? |
|
Definition
| it has both serological markers of viruses and autoantibodies |
|
|
Term
| What type of liver disease is most often associated with insulin resistance, type 2 diabetes, obesity, and dyslipidemia? |
|
Definition
| nonalcoholic fatty liver disease |
|
|
Term
| In nonalcoholic liver fatty liver disease the fat-laden hepatocytes are highly sensitive to ________/_______ |
|
Definition
|
|
Term
| What is a more severe form of non-alcoholic fatty liver disease that some pt's may present with? What are some signs and symptoms? |
|
Definition
Non-alcoholic steatohepatitis
-fatigue, upper right quadrant pain, weight loss,
-inflammation and scarring in the liver
-severe cases can progress to liver failure |
|
|
Term
| What disease is characterized by excessive accumulation of iron in tissues and organs, especially in the liver and pancreas? |
|
Definition
| hereditary hemochromatosis |
|
|
Term
| What is the most common type of hereditary hemochromatosis? What type of mutation causes it? |
|
Definition
Type 1
autosomal recessive mutations in the hemochromatosis (HFE) gene |
|
|
Term
| What is the job of the HFE protein? |
|
Definition
| It regulates the production of another protein called hepcidin, which is considered the "master" iron regulatory hormone |
|
|
Term
| What is the job of hepcidin? What doe mutations in the HFE gene result in with regards to hepcidin? |
|
Definition
-it is produced in the liver and it determines how much iron is absorbed from the diet and released from storage sites in the body
-reduced levels of hepcidin production and excessive iron absorption |
|
|
Term
| Excessive iron causes what three things? |
|
Definition
-lipid peroxidation
-collagen formation
-DNA damage |
|
|
Term
| WHat sex is more greatly affected with hereditary hemochromatosis? What are some early symptoms? Late? What are 3 causes of death? Tx? |
|
Definition
-men
-fatigue, joint pain, abd pain, loss of sex drive
-cirrhosis, DM, and skin pigmentation
-cirrhosis, hepatocellular carcinoma, cardiac disease
-phlebotomy, iron chelators |
|
|
Term
| What is a inherited disorder in which excessive amounts of copper accumulate in the body, especially in the liver, brain and eye? |
|
Definition
|
|
Term
| What is the mutation in Wilson Disease? |
|
Definition
| -autosomal recessive mutations in the ATPase Cu++ transporting, beta polypeptide (ATP7B) gene |
|
|
Term
| Where is the ATP7B protein found and what is its function? |
|
Definition
-found in golgi of liver cells
-supplies copper to ceruloplasmin which transports copper to other parts of the body via the blood
-WHen copper levels are too high, ATP7B transfers copper to vesicles for elimination in bile |
|
|
Term
| Defective ATP7B protein leads to..? |
|
Definition
| failure to add copper to ceruloplasmin, which accumulates in the liver and failure to excrete copper into bile |
|
|
Term
| What does excessive cope accumulation cause? |
|
Definition
|
|
Term
| What is the most common presentation of Wilson disease? |
|
Definition
-acute or chronic liver disease
-jaundice, fatigue, loss of appetite, and abdominal swelling |
|
|
Term
| OFten younger patients with WIlson Disease present with what? |
|
Definition
| neuropsychiatric manifestations (clumsiness, trembling, difficulty walking, speech problems, deteriorating school work, depression, anxiety, and mood swings) |
|
|
Term
| What is a common sign of Wilson Disease in the eye? |
|
Definition
| Kayser-Fleischer ring around the cornea, a greenish brown deposit of copper |
|
|
Term
| WHat dramatically diminishes wilson disease progression? |
|
Definition
| early recognition and long term copper chelation therapy |
|
|
Term
| What mutation in what gene cause alpha 1-antitrypsin deficiency? |
|
Definition
SERPINA 1
autosomal recessive |
|
|
Term
| Where is alpha 1-antitrypsin produced and then transported to? What is its job? |
|
Definition
-produced in the liver and then transported to the lungs in blood
-protects the liver and lungs from neutrophil elastase, a protein released from WBCs to fight infection |
|
|
Term
| Can hepatocytes secrete mutant alpha 1-antitrypsin? |
|
Definition
|
|
Term
| Pt's with alpha 1-antitrypsin deficiency often develop _________ disease between ages of 20-50 years of and can lead to _________ |
|
Definition
|
|
Term
| 15% of adults with alpha 1-antitrypsin deficiency develop what from development of what? What are the signs? |
|
Definition
cirrhosis from development of scar tissue
-swollen abd, swollen feet or legs, jaundice |
|
|
Term
| What disorder is characterized by failure of bilirubin secretion, resulting in conjugated hyperbilirubinemia and jaundice? |
|
Definition
|
|
Term
| Neonatal cholestasis usually presents in the first 2 weeks of life with what 4 signs and symptoms? |
|
Definition
jaundice
dark urine (conjugated bilirubin)
acholic stools (stools w/o bile)
hepatomegaly |
|
|
Term
| What are the 2 most common causes of neonatal cholestasis? |
|
Definition
| idiopathic hepatitis or biliary atresia |
|
|
Term
| What is a rare disorder characterized by a fatty change in the liver and acute onset encephalopathy that typically develops in children less than 4 yoa, during recovery from a viral illness? |
|
Definition
|
|
Term
| Using what during viral illnesses increases the risk for Reye syndrome? |
|
Definition
|
|
Term
| WHat are some common signs and symptoms that characterize the onset of reye syndrome? |
|
Definition
persistent vomiting
listlessness
irritability or combativeness
disorientation or confusion
delirium
convulsion
loss of consciousness |
|
|
Term
| the recovery of reye syndrome is directly related to what? |
|
Definition
| the severity of swelling of the brain |
|
|
Term
| What is reye syndrome caused by? |
|
Definition
| generalized loss of mitochondrial function |
|
|
Term
| What is a condition caused by obstruction of the large bile ducts outside the liver most commonly caused by cholelithiasis (gallstones)? |
|
Definition
| secondary biliary cirrhosis |
|
|
Term
| What are 3 signs and symptoms of secondary biliary cirrhosis? |
|
Definition
cholestasis
bile duct perforation with surrounding neutrophils
periportal inflammation with progressive fibrosis |
|
|
Term
| What is the disorder characterized by immune-mediated non-suppurative destruction of small and medium-sized intrahepatic bile ducts? |
|
Definition
| primary biliary cirrhosis |
|
|
Term
| What is the median age for primary biliary cirrhosis? sex? how does it present? |
|
Definition
-50 (30-70)
-females 90%
-insidious, presenting as pruritis; later jaundice |
|
|
Term
| What are 3 other disorders that are associated with primary biliary cirrhosis? |
|
Definition
sjorgen syndrome (autoimmune: dry eye/mouth)
scleroderma
thyroid disease |
|
|
Term
| WHat disorder is characterized by immune mediated fibrosis and destruction of extra hepatic and large intrahepatic bile ducts? |
|
Definition
| primary sclerosing cholangitis |
|
|
Term
| What is the median age for primary sclerosing cholangitis? sex? symptoms? |
|
Definition
-30
-males 70%
-progressive fatigue, pruritis, jaundice |
|
|
Term
| What are 2 disorders associated with primary sclerosing cholangitis? |
|
Definition
chronic ulcerative colitis
pancreatitis |
|
|
Term
| Why are liver infarcts rare? |
|
Definition
| because of the dual blood supply in the liver |
|
|
Term
| Why does thrombosis of hepatic artery not always produce ischemic necrosis? What is the exception? |
|
Definition
retrograde arterial flow through accessory vessels and the portal venous supply may sustain the liver
-in a transplanted liver this usually results in loss of the organ bc it may not have the accessory blood flow |
|
|
Term
| WHat are 3 things that intra- or extra-hepatic portal vein obstruction may cause? |
|
Definition
portal HTN
esophageal varices
ascites |
|
|
Term
| What are 4 causes of extra hepatic portal vein obstruction? |
|
Definition
peritoneal sepsis
pancreatitis
thrombogenic events
cancer |
|
|
Term
| what are three causes of intrahepatic portal vein obstruction? most common? |
|
Definition
-cirrhosis (most common)
-sickle cell anemia
-DIC |
|
|
Term
| What causes Hepatic Vein Thrombosis (Budd Chiari Syndrome)? |
|
Definition
| thrombosis of two or more major hepatic veins |
|
|
Term
| What are 3 characteristics of Budd-Chiari syndrome? |
|
Definition
hepatomegaly
weight gain
ascites
abd pain |
|
|
Term
| What are 6 disorders/risk factors associated with Budd-Chiari? |
|
Definition
-polycythemia vera
-other myoproliferative disorders
-pregnancy
-post partum state
-oral contraceptive use
-intra-abdominal cancers |
|
|
Term
| Budd-Chiari can lead to what? What is the treatment? |
|
Definition
-centrilobular congestion and necrosis
-portosystemic venous shunt |
|
|
Term
| What is a hepatic vein outflow obstruction that occurs primarily in the first 20-30 days after a bone marrow transplant? |
|
Definition
| sinusoidal obstruction syndrome |
|
|
Term
| What is sinusoidal injury believed to be caused by? What is the pathophysiology? |
|
Definition
toxic endothelial injury secondary to chemotherapy and radiation therapy
-damaged endothelial cells sough off and create emboli that block blood flow |
|
|
Term
| What are the most common hepatic neoplasms? |
|
Definition
| Metastatic carcinomas (colon, lung, breast) |
|
|
Term
| What is the most common benign liver tumor? |
|
Definition
|
|
Term
| What do cavernous hemangiomas consist of? |
|
Definition
| multiple vascular channels lined by a single layer of endothelial cells |
|
|
Term
| What are the symptoms of cavernous hemangiomas? What is the chief clinical significance? |
|
Definition
-usually asymptomatic and discovered at imaging, surgery, or autopsy
-NOT to mistake them for a metastatic tumor and perform blind percutaneous needle biopsy, which could cause severe intra-abdominal bleeding |
|
|
Term
| What benign liver tumor is often seen in women of child bearing age who have used oral contraceptives? |
|
Definition
|
|
Term
| Is there a risk for rupture of hepatic adenomas? |
|
Definition
| yes, especially during pregnancy |
|
|
Term
| WHat are some risks for hepatocellular carcinoma (HCC)? |
|
Definition
HBV, HCV (chronic)
chronic alcoholism
aflatoxin exposure
hemochromatosis and tyrosinemia to lesser extent |
|
|
Term
| HCC is relatively uncommon in the west, but increasing with the spread of what? |
|
Definition
|
|
Term
| In the US 90% of HCC cases develop in people with _________ |
|
Definition
|
|
Term
| Why are more than 85% of HCC occurring in parts of ASia and Africa? |
|
Definition
| HBV infection is high and exposure to aflatoxin more common |
|
|
Term
| What are 3 things that HCC causes? |
|
Definition
rapid increase in liver size
sudden worsening of ascites or bloody ascites
fever and pain |
|
|
Term
| What causes death in HCC? |
|
Definition
cachexia
variceal bleeding
liver failure with hepatic coma |
|
|
Term
| what is the best tx option ? |
|
Definition
for smaller tumors: surg
liver transplantation |
|
|
Term
| What are the two different types of gallstones? |
|
Definition
-cholesterol (West-80%)
-pigment stones- calcium biurbinate salts (asian more than western), unconjugated bilirubin |
|
|
Term
| What are 4 signs and symptoms of cholelithiasis (gallstones) |
|
Definition
-asymptomatic in 70-80%
-intense pain from gallbladder obstruction
-cholecystitis
-erosion of large stone into bowel causing obstruction |
|
|
Term
| What almost always occurs in association with cholelithiasis? |
|
Definition
|
|
Term
| What is the most common reason for emergency cholecystectomy? |
|
Definition
| acute calculous cholecystitis |
|
|
Term
| WHat is the term for the presence of stones in the biliary tree? |
|
Definition
|
|
Term
| In the west where are most gallstones found? In Asia? |
|
Definition
|
|
Term
| What are 5 symptoms of choledocholithiasis? |
|
Definition
-biliary obstruction
-pancreatitis
-cholangitis
-liver disease
-acute calculous cholecystitis
*10% asymptomatic |
|
|
Term
| What is the term for acute inflammation of wall of bile ducts? |
|
Definition
|
|
Term
| What is almost always the cause of cholangitis? |
|
Definition
| bacterial infection either due to biliary obstruction (choledocholithiasis) or from the gut |
|
|
Term
| Why are prompt diagnosis and intervention imperative for cholangitis? |
|
Definition
|
|
Term
| What is complete obstruction of bile flow caused by destruction or absence of all or part of the extra hepatic ducts? |
|
Definition
|
|
Term
| What is the most common cause of death from liver disease in early childhood? What is the tx? |
|
Definition
biliary atresia
liver transplant |
|
|
Term
| WHat is the sign of biliary atresia? |
|
Definition
| normal stools become acholic, a liver biopsy is required to distinguish between biliary atresia and cholestasis |
|
|
Term
| What is the most frequent malignant tumor of the biliary tract? |
|
Definition
|
|
Term
| Why are adenocarcinomas of the GB so dangerous? |
|
Definition
they are rarely detected when they can be resected
5 yr survival= 5%
gallstones present in 60-90% |
|
|
Term
| What are the presenting symptoms of adenocarcinoma of the GB similar to? |
|
Definition
|
|
Term
| What is a name for the adenocarcinoma arising from the epithelial cells lining the bile ducts? |
|
Definition
|
|
Term
| What are some risk factors for cholangiocarcinomas? |
|
Definition
| chronic cholestasis and inflammation |
|
|
Term
| prognosis of cholangiocarcinomas? |
|
Definition
| usually asymptomatic until advanced age, unresectable tumor often--> poor prognosis |
|
|
Term
| What comprises most of the pancreas the exocrine or endocrine parts? |
|
Definition
|
|
Term
| What cells are considered exocrine pancreas cells? What is the purpose of the exocrine pancreas? |
|
Definition
-acinar cells, ductules, ducts
-release digestive enzymes into duodenum |
|
|
Term
| What are the cells of the endocrine pancreas? Job? |
|
Definition
-islets of langerhans
-release hormones into the blood |
|
|
Term
| What are the cell types of the islets of langerhans and their functions? |
|
Definition
-alpha: produce glucagon
-beta: produce insulin and amylin
-delta: produce somatostatin
-PP cells: produce pancreatic polypeptide |
|
|
Term
| What are the 2 most significant diseases related to the endocrine pancreas? |
|
Definition
diabetes mellitus
neoplasms |
|
|
Term
| What are 4 things produced by the acinar cells? |
|
Definition
-inactive digestive enzymes (proenzymes)
-amylase and lipase in active forms
-trypsin inactivator
-bicarbonate (antacid) |
|
|
Term
| THe products of the acinar cells are sent to the _________ when it releases _________ and _________. Where are the digestive enzymes activated? |
|
Definition
duodenum
secretin
cholecystokinin
duodenum |
|
|
Term
| What are the three most significant diseases having to do with the exocrine pancreas? |
|
Definition
-acute and chronic pancreatitis
-carcinomas of the pancreas
-cystic fibrosis |
|
|
Term
| What is acute pancreatitis? What are the two things that 80% of cases are caused by? |
|
Definition
-autodigestion of the pancreas caused by inappropriate activation of pancreatic enzymes (activation of trypsin is a critical triggering event): duct obstruction, acinar cell injury, defective intracellular transport
-cholelithiasis or alcoholism |
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|
Term
| What is the cardinal manifestation of acute pancreatitis? |
|
Definition
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Term
| Full blown acute pancreatitis is a significant _________/_________ |
|
Definition
|
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Term
| Systemic release of digestive enzymes and an explosive activation of the inflammatory response can lead to what 5 things? |
|
Definition
-increased vascular permeability
-leukocytosis
-DIC
-ARDS
-diffuse fat necrosis |
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Term
| Elevated plasma levels of what are indicative of acute pancreatitis? what can an enlarged, inflamed pancreas be visualized with? |
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Definition
amylase and lipase
CT or MRI |
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Term
| What is the tx for acute pancreatitis? |
|
Definition
| -supportive (maintain BP and alleviate pain, total restriction of food and fluids to rest pancreas) |
|
|
Term
| acute pancreatitis management? |
|
Definition
most recover eventually
5% die from shock with the first week of illness |
|
|
Term
| Describe chronic pancreatitis |
|
Definition
| longstanding inflammation, fibrosis, and destruction of the pancreas (irreversible destruction) |
|
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Term
| What are the symptoms of chronic pancreatitis? |
|
Definition
| silent, or bouts of jaundice and pain |
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Term
| How is chronic pancreatitis diagnosed? What are some complications? Prognosis? |
|
Definition
-difficult: acinar destruction is significant and enzymes may not be elevated
-secondary diabetes, malabsorption, severe chronic pain
-poor (50% mortality over 20 yrs) |
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Term
| What is the fourth leading cause of cancer death in the US? |
|
Definition
| pancreatic adenocarcinoma |
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|
Term
| Where do pancreatic adenocarcinomas develop |
|
Definition
| ductal epithelial cells of the exocrine pancreas |
|
|
Term
| What doubles the risk of getting pancreatic adenocarcinoma? |
|
Definition
|
|
Term
| Why is pancreatic adenocarcinoma so lethal? |
|
Definition
-typically silent until me stasis
-obstructive jaundice can be associated with CA of the head of the pancreas, but by this time it has usually metastasized
-fewer than 20% can be resected at diagnosis |
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Term
| What are sx of pancreatic adenocarcinoma? Tx? |
|
Definition
-weight loss, anorexia, generalized malaise, weakness
-surg, radiation, chemo |
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