Diff Dx Hepatic, Pancreatic, & Biliary Systems

Front 1

functions of the liver

Back 1

Convert bilirubin to bile
Sole source of albumin, also other plasma proteins
Produces clotting factors
Stores vitamins
Metabolizes drugs, steroids, hormones, various toxins, carbs, fats, & proteins

Front 2

how much bile/day does the liver produce

Back 2

500-1500mL

Front 3

fcns of the pancreas

Back 3

Endocrine & exocrine gland
Primary role in digestion- secretion of digestive enzymes & pancreatic juices through the pancreatic duct to the duodenum

Front 4

fcns of the gall bladder

Back 4

reserve for bile

Front 5

fcn of bile

Back 5

alkalizes intestinal contents
helps with emulsification, absorption, & digestion of fat

Front 6

signal for gall bladder to contract

Back 6

cholecystokinin

Front 7

S & S of general liver dysfcn

Back 7

dark urine
light clay colored stools
R upper abd p!
skin changes
neurologic changes
pain

Front 8

various skin changes assoc with liver dysfcn

Back 8

jaundice
palor
orange-green
bruising
spider anginoma

Front 9

neurologic changes assoc with liver dysfcn

Back 9

confusion
mm tremors
sleep disturbances
hyperactive reflexes
asterixis

Front 10

what is asterixis

Back 10

abn mm tremor

classic sign is when arm is extended & try to extend wrist . . . hand starts to flap

Front 11

cause of neurologic signs due to liver dysfcn

Back 11

liver is unable to process ammonia; ammonia reacts with glutamate (taking up excitatory neurotransmitter from system) and creates glutamine = impairment of neurotransmitter/ability to signal in brain

Front 12

liver normally transfers ammonia into 3 things

Back 12

urea, glutamine, & asparagine

Front 13

common location of pain due to liver dysfcn

Back 13

thoracic p! btw scapulas
R sh p!
R u/t p!
R subscap p!

Front 14

describe hepatic osteodystrophy

Back 14

abn dev of bone due to disruption of osteoblastic formation

Front 15

general guidelines for PT for pts w/liver disease

Back 15

high intensity exercise contraindicated
may bruise easily due to liver's role in producing clotting factors

Front 16

effects of aging on the hepatic system

Back 16

dec size & mass of liver-->dec blood flow--> harder to eliminated drugs so drugs stay in body longer

Front 17

describe how the liver heals to acute vs chronic injury

Back 17

acute- regeneration of cells with some scarring
chronic- destroys ECM over time

Front 18

what 2 types of hepatitis are most assoc with jaundice

Back 18

B & C

Front 19

risk factors for developing jaundice

Back 19

Occupation that involves alcohol consumption
Hx of jaundic, hepatitis, or anemia
Origin of Africa, far east, Mediterranean
Travel to an area where jaundice is highly prevalent
Injections w/in last month
Consumption of raw shell fish
Drug abuse

Front 20

3 types or classifications of liver dysfunction

Back 20

pre-hepatic, hepatic, post-hepatic

Front 21

describe pre-hepatic dysfcn

Back 21

bilirubin inc b4 it reaches the liver

Front 22

common cause of pre-hepatic dysfcn

Back 22

hemolysis of RBCs (ex: blood incompatibility)

Front 23

what type/classification is hyperbilirubinemia

Back 23

pre-hepatic

Front 24

describe hyperbilirubinemia & S & S

Back 24

assoc w/unconjugated bilirubin

weakness
abd p!
back p!
acute hemolytic crisis
stool & urine may be normal color
mild jaundice

Front 25

describe hepatic liver dysfcn

Back 25

pathology in the liver cells; interfering or impairing the ability of the liver to excrete bilirubin

Front 26

describe post-hepatic liver dysfcn

Back 26

obstruction
ex: bile duct obstruction that impairs bilirubin transport (could be due to gall stones or carcinomas)

Front 27

what is unconjugated bilirubin and how is it formed

Back 27

fat soluble; due to an accumulation of bilirubin in the blood b/c obstruction is stopping the liver cells from absorbing the bilirubin so the bilirubin binds w/albumin to form unconjugated bilirubin

Front 28

where can unconjugated bilirubin be found in the body

Back 28

cannot be excreted in urine or converted to bile so gets taken up by fatty tissues inc brain; easily binds to skin, sclera, blood or synovium causing the yellow tint of jaundice

Front 29

what does bilirubin bind with under normal conditions to form conjugated bilirubin

Back 29

glucoronic acid

Front 30

what happens with conjugated bilirubin (how is it excreted)?

Back 30

excreted in bile or converted to urobilinogen (yellow pigment of urine)

Front 31

characteristics of hepatic or post-hepatic disease

Back 31

conjugated hyperbilirubinemia
light color stool
malaise
pruritis

Front 32

what causes pruritis

Back 32

buildup of bile salts in skin

Front 33

S & S/conditions assoc with hepatocellular damage

Back 33

malaise
anorexia
low grade fever
R UQ p!
dk urine
jaundice
spider anginoma
white nails
loss of sexual hair
yellow spots on eye lids

Front 34

S & S/conditions assoc w/ biliary obstruction

Back 34

R UQ p! that comes in waves due to rapid distention following a meal
Wt loss
Jaundice
Dk urine
Light colored stools

Front 35

causes of hepatitis

Back 35

viral
chemical
drug rcn
alcohol abuse

Front 36

3 stages of hepatitis

Back 36

pre-icteric stage
icteric (jaundice) stage
recovery stage

Front 37

describe the pre-icteric stage

Back 37

1-3w; urine darkens, stools lighten

Front 38

describe the icteric (jaundice) stage

Back 38

appearance of jaundice that peaks @ 1-2w & persists for 6-8w

Front 39

as jaundice fades during the icteric phase- what is that a sign of?

Back 39

acute inflammation resolving

Front 40

describe HAV

Back 40

infectious hepatitis

Front 41

describe HBV

Back 41

serum hepatitis

Front 42

describe HCC

Back 42

assoc w/post transfusion

Front 43

describe fulminant hepatitis

Back 43

severe hepatitis leading to hepatic failure with stage 3 or 4 encephalopathy

Front 44

name the hepatotoxins that cause fulminant hepatitis

Back 44

acetominophen
mushroom toxins
carbon tetrachloride