Disorders Of Hepatobiliary For Final

Front 1

What is ascites?

Back 1

increased fluid in peritoneal cavity
( a late stage manifestation of cirrhosis and portal HTN )

Front 2

What are 3 contributing factors of ascites?

Back 2

1. increased capillary pressure from portal htn and obstruction of flow thru liver

2. retention of Na and H2O by kidneys

3. decreased colloidal pressure (impaired albumin synthesis from failing liver)

Front 3

3 types of tx for ascites?

Back 3

1. dietary restriction of Na and H2O

2. diuretics

3. paracentesis

Front 4

What is a complication of ascites?

Back 4

spontaneous bacterial peritonitis

Front 5

What is spontaneous bacterial peritonitis?

Back 5

-a complication of ascites

1. seen in persons with both cirrhosis and ascites

2. peritoneal infected with bacteria from blood, lymph, or thru bowel wall

3. serious infection; high mortality even with antibiotics

Front 6

What is splenomegaly?

Back 6

the result of shunting of blood into splenic vein

Front 7

What does splenomegaly cause?

Back 7

sequestering of large #s of blood elements and development of hypersplenism

-decreased life span and #s of formed elements of blood such as thrombocytopenia, anemia, and leukopenia

Front 8

What are collateral channels?

Back 8

the development of large collateral channels for flow caused by increased pressure in portal vein

Front 9

Where do collateral channels occur?

Back 9

between portal and systemic veins supplying lower rectum and esophagus and the umbilical veins of falciform ligament

Front 10

What are the results of collateral channels?

Back 10

1. hemorrhoids

2. caput medusae

3. portopulmonary shunts (bypass pulmonary caps)

Front 11

What is the clinically most important aspect of collateral channels?

Back 11

connections to the esophagus cause esophageal varices

Front 12

How are surgical shunts involved with collateral channels?

Back 12

portosystemic (connections between portal and systemic venous systems) or TIPS (transjugular intrahepatic portosystemic shunt)

Front 13

What are esophageal varices?

Back 13

pressure in the portal vein due to obstruction, causing collateral channel development

Front 14

What do esophageal varices cause?

Back 14

reversal of flow (back-up) and formation of thin-walled varicosities in submucosa of esophagus

Front 15

What are esophageal varices subject to?

Back 15

rupture

Front 16

Esophageal varices subject to rupture can result in massive what?

Back 16

fatal hemorrhage

Front 17

Esophageal varices subject to rupture are complicated by what 2 things?

Back 17

1. liver dysfunction (failure to produce coagulation factors)

2. splenomegaly (thrombocytopenia)

Front 18

Hepatic encephalopathy is seen in 50-70% of ? patients and 10% of patients with ??

Back 18

cirrhosis....systemic shunts

Front 19

What is hepatic encephalopathy?

Back 19

failing liver is unable to metaboize neurotoxins (ammonia, particularly)....the totality of CNS manifestations of liver failure

Front 20

What are some of the symptoms seen in hepatic encephalopathy?

Back 20

ranges from a lack of mental alertness to confusion, coma, convulsions

Front 21

What is the most severe clinical consequence of liver disease?

Back 21

liver failure

Front 22

In what 2 ways may liver failure occur?

Back 22

1. acutely (fulminant hepatitis)

2. chronic, progressive damage (cirrhosis)

Front 23

How much loss of hepatic function needs to occur for liver failure to occur?

Back 23

80 - 90%

Front 24

5 possible ways of tx liver failure?

Back 24

1. eliminate alcohol intake

2. prevent infections

3. carbos and calories to prevent protein breakdown

4. correct fluid/electrolyte imbalances

5. decrease ammonia production

Front 25

2 general manifestations/disorders of liver failure?

Back 25

1. disorders of synthesis and storage function

2. disorders of metabolic and excretory function


(both reflect liver functions)

Front 26

What 4 things are directly related to liver failure disorders of synthesis and storage function?

Back 26

1. glucose

2. proteins

3. lipoprotein cholesterol

4. bile salts

Front 27

In liver failure disorders of synthesis and storage function as it relates to glucose results in what?

Back 27

hypoglycemic events

Front 28

In liver failure disorders of synthesis and storage function as it relates to proteins results in what 2 things?

Back 28

1. hypoalbuminemia leading to edema/ascites

2. Coagulation factors leading to bleeding

Front 29

In liver failure disorders of synthesis and storage function as it relates to lipoprotein cholesterol results in what?

Back 29

decreased cholesterol

Front 30

In liver failure disorders of synthesis and storage function as it relates bile salts results in what?

Back 30

Impaired fat absorption which leads to A) deficiency in fat soluble vitamins and B) fatty stools

Front 31

Liver failure's cause of metabolic and excretory function as it relates to AAs can result in what?

Back 31

conversion to ammonia which leads to encephalopathy

Front 32

Liver failure's cause of metabolic and excretory function as it relates to steroid hormones can result in what?

Back 32

1. increased aldosterone that leads to edema/ascites

2. increased androgens/estrogens that leads to A) gynecomastia and testicular atrophy and B) menstrual irreg.

Front 33

Liver failure's cause of metabolic and excretory function as it relates to drugs can result in what?

Back 33

drug interactions/tox.

Front 34

Liver failure's cause of metabolic and excretory function as it relates to bilirubin can result in what?

Back 34

hyperbilirubinemia that leads to jaundice

Front 35

What is Cholelithiasis?

Back 35

gallstones

Front 36

What is the size of cholelithiasis (gallstones)?

Back 36

range from grain of sand to 1 inch

Front 37

What essentially is a gallstone?

Back 37

precipitation of substances in bile (especially cholesterol and bilirubin)

Front 38

What are 3 risk factors for cholelithiasis?

Back 38

1. women

2. native americans

3. over the age of 40

Front 39

3 contributing factors to cholelithiasis?

Back 39

1. bile composition abnormalities

2. bile stasis

3. gallbladder inflammation

Front 40

4 signs and symptoms of cholelithiasis (gallstones)?

Back 40

1. many are asymptomatic

2. symptoms when bile flow obstructed

3. small stones (<8mm in diameter) pass into common duct which causes indigestion and biliary colic (pain in the upper right quadrant)
-stone may become lodged: acute cholecystitis (repeated episode: lead to chronic cholecystitis)

4. larger stones: more likely to obstruct flow...causes jaundice

Front 41

The pancreatic enzymes trypsin and chymotrypsin acts on what substrate and produce what action?

Back 41

substrate = proteins

action = proteins to peptides

Front 42

The pancreatic enzyme carboxypeptidase acts on what substrate and produce what action?

Back 42

substrate = proteins

action = removes last aa from carboxy end of peptide

Front 43

The pancreatic enzyme lipase acts on what substrate and produce what action?

Back 43

substrate = fat

action = converts triglycerides into fatty acids and monoglycerides

Front 44

The pancreatic enzyme pancreatic amylase acts on what substrate and produce what action?

Back 44

substrate = polysaccharide

action = converts polysaccharides into glucose and maltose

Front 45

The pancreatic enzymes RNAase and DNAase acts on what substrate and produce what action?

Back 45

substrate = nucleic acid

action = convert nucleic acids into nucleotides

Front 46

What is acute pancreatitis? give an example.

Back 46

activated pancreatic enzymes escape into pancreas and surrounding tissue (ex. autodigestion of pancreas)

Front 47

What causes acute pancreatitis?

Back 47

usually develops from gallstones in common duct or alcohol abuse

Front 48

Describe the onset of acute pancreatitis?

Back 48

abrupt...initial symptom is severe epigastric pain radiating to back

Front 49

6 ways of diagnosing acute pancreatitis?

Back 49

1. serum amylase (rise w/n first 24 hours, elevated for 72 hrs)

2. serum lipase (rise within first 24-48 hours, elevated for 5-14 days)

3. urine amylase (increased urinary clearance)

4. increased wbc

5. hyperglycemia

6. increased bilirubin

Front 50

3 complications of acute pancreatitis?

Back 50

1. acute respiratory distress syndrome

2. acute tubular necrosis

3. hypocalcemia

Front 51

3 tx for acute pancreatitis?

Back 51

1. prophylactic antibiotics

2. fluid replacement

3. pain relief/smooth muscle relaxation