Patho Exam 5 lecture 13

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Patho Exam 5 lecture 13
2011-06-04 14:02:56

Hepatobiliary and Pancreatic disorders
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  1. Disease of the liver
    can affect the hepatocytes of the biliary drainage system
  2. Disorders of the hepatocyte function
    • impair the metabolic and synthetic function of the liver, causing disorders in carbs, protein,and fat metabolism
    • metabolism and removal of drugs, hormones, toxin, ammonia, and bilirubin from the blood
    • interconversions of amino acids and synthesis of protein
    • elevations in serum amnotransferase levels signal the presence of hepatocyte damage
  3. disorders of the biliary drainage system
    • obstruct the flow of bile
    • interfere with the elimination of bile salts and bilirubin
    • produce cholestatic liver damage bc of the backup of bile into th elobules of the liver
    • elevations in bilirubin and alkaline phosphotase signal the presence of cholestatic liver damage
  4. jaundice
    • common symptoms of liver problems
    • results from an abnormally high accumulation of bilirubin in the blood
    • produces a yellowish discoloration to the skin and deep tissues
    • types:prehepatic, posthepatic,and intrahepatic
  5. prehepatic jaundice
    • excessive red blood cell distribution
    • ie anemia
  6. intrahepatic
    pathology of the tissue of the liver
  7. posthepatic
    • obstruction of bile flow
    • gallstone formation
  8. bilirubin
    • A substance formed from the degradation of hemoglobin from erythrocytes by the reticuloendothelial cells
    • result from old red blood cells
  9. metabolism of bilirubin
    • processed by the liver and excreted as bile
    • bile is eventually removed in feces or urie
    • bile that is not exceted returns to the liver
  10. Hepatitis
    inflammation of the liver
  11. possible causes of hepatitis
    • autoimmune disorders
    • reactions to drug or toxins (most common is alcohol)
    • infectious disorders (malaria, salmonellosis)
    • hepatotrophic viruses
  12. hepatotrophic disorders
    • hepatitis A
    • hepatitis B
    • hepatitis C
    • hepatitis D
    • hepatitis E
  13. Hepatitis A Virus
    • RNA virus usually spread by fecal-oral transmission
    • brief incubation period
    • does not cause a carrier state or a chronic state
    • can cause fulminating hepatitis
  14. fulminating hepatitis
    accelerated immune response that can lead to severe necrosis
  15. Hepatitis B Virus
    • DNA virus transmitted through infected blood or serum
    • can also be spread by oral or sexual contact, longer incubation period
    • Can produce acute hepatitis, chronic hepatitis, fulminant hepatitis, and the carrier state
    • Infants born to HBV-infected mothers are particularly at risk of becoming carriers and up to 25% die of chronic liver disease as adults
    • highly prevalent among IV-drug users and persons with multiple sex partners
  16. Hepatisis C Virus
    • RNA virus, transmission by IV-drug use, longer incubation period
    • Most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer in the world
  17. Hepatisis D Virus
    • Defective RNA virus, transmission similar to HBV
    • Infection with HDV requires a co-infection with HBV
    • HDV infection worsens the HBV infection (can convert mild HBV to severe, fulminating hepatitis)
    • HDV infection increases the tendency to progress to chronic hepatitis and cirrhosis
  18. Hepatitis E Virus
    • similar to Hepatitis A in that it does not form chronic or carrier states
    • RNA virus, fecal-oral route of transmission
    • has a fairly high mortality rate in pregnant women
  19. Viral Hepatitis
    • chronic viral hepatitis
    • fulminant hepatitis
  20. chronic viral hepatitis
    • Principal cause of chronic liver disease, cirrhosis, and hepatocellular cancer in the world
    • caused by HBV, HCV, and HDV
    • Most cases are due to HCV (infection becomes chronic)
    • constitutes a carrier state in which persons does not have symptoms, but harbors the virus and can transmit the disease
  21. fulminant hepatitis
    • Characterized by a rapid progression from the onset of symptoms to hepatic encephalopathy within 2-3 weeks
    • Overall, mortality rate ranges from 25-90%, in the absence of liver transplantation
  22. Autoimmune Hepatitis
    • A chronic inflammatory liver disease of unknown origin
    • Accounts for about 10% of chronic hepatitis in US
    • Occurs in association with other autoimmune diseases (rheumatoid athritis - disease in young women)
    • Mainly, a disease of young women
  23. Intrahepatic biliary disorders
    • disrupt the flow of bile through the liver
    • ie. primary biliary cirrhosis, primary sclerosing cholangitis, and secondary biliary cirrhosis
  24. Primary Biliary Cirrhosis
    Inflammation and scarring of small intrahepatic bile ducts, portal inflammation, and progressive scarring of liver tissue
  25. intrahepatic bile ducts
    bile ducts in the liver
  26. Primary Sclerosing Cholangitis
    Inflammation of hepatic bile ducts
  27. secondary biliary cirrhosis
    prolonged obstruction of the extrabilliary tree
  28. alcoholic liver disease
    • Manifested by fatty liver, hepatitis, and cirrhosis.
    • One or more of these manifestations may be found in alcoholic patients.
  29. Stages of alcoholic liver disease
    • fatty liver disease
    • alcoholic hepatitis
    • alcoholic cirrhosis
  30. fatty liver disease
    • accumulation of fat in hepatocytes ( liver cells)
    • liver becomes fatty and enlarged
  31. alcoholic hepatitis
    • inflammation and necrosis od liver cless
    • characteristics of this stage:causes hepatic tenderness and pain
  32. alcoholic cirrhosis
    • breakdown of the liver
    • Designates the onset of end-stage alcoholic liver disease
    • Early cirrhotic liver exhibits fine, uniform nodules on its surface
    • As cirrhosis progresses, nodules become larger and more irregular
    • Nodules may compress hepatic veins, curtailing blood flow out of the liver and producing portal hypertension, extrahepatic portosystemic shunts, and cholestasis
  33. Nonalcoholic Fatty Liver Disease
    • Fatty liver disease, with its progression to cirrhosis and end-stage liver disease, arising from causes other than alcohol
    • coexisiting conditions: Obesity, type 2 diabetes
    • Condition is also associated with other nutritional abnormalities, surgical conditions, drugs and occupational exposure to toxins
  34. Cirrhosis
    • End stage of chronic liver disease in which much of functional liver tissue has been replaced by fibrous tissue
    • develops in connection with alcoholism, but, it can develop in the course of other disorders, including viral hepatitis, toxic reactions to drugs and chemicals, biliary obstruction, and heart failure
    • accompanies metabolic disorders that cause the deposition of minerals in the liver:
    • ¨Hemochromatosis (i.e., iron deposition)
    • ¨Wilson disease (i.e., copper deposition)
    • late manifestations are related to portal hypertension and liver failure
  35. portal hypertension
    • blood is backed up into portal system
    • venal blood from GI tract empties into the portal vein and travels thru the liver before moving into the general venous circulation
  36. Obstruction of blood flow and development of portal hypertension
    • produces an increase in hydrostatic pressure within the peritioneal capillaries
    • contribute to development of ascities, splenic engorgement with sequestration and destruction of the blood cells and platelets
    • shunts of blood to collateral venous channels cause varicosities of the hemorrhoidal and esophageal veins
  37. cirrhosis: heart failure
    back up of blood on right side of hear in superior vena cava
  38. portosystemic shunts
    • thin wall veins
    • prone to rupture causing massive hemorrhage
    • 30% will die
  39. Ascites
    Abnormal accumulation of fluid in the peritoneal cavity
  40. Manifestations of Liver Failure
    • hematologic disorders
    • endocrine disorders
    • skin disorders
    • hepatorenal syndrome
    • hepatic encephalopathy
  41. hematologic disorders
    Anemia, thrombocytopenia, coagulation defects, and leukopenia
  42. endocrine disorders
    Particularly, disturbances in sex hormone function
  43. hepatorenal syndrome
    • Renal failure that occurs during the terminal stages of liver failure
    • hypothesis: due to decrease in renal blood flow due to back up
  44. skin disorders
    Jaundice is a late manifestation of liver failure
  45. hepatic encephalopathy
    Ammonia accumulation in blood leads to neurological disorders
  46. primary liver cancers
    • hepatocellular carcinoma
    • cholangiocarcinoma
  47. hepatocellular carcinoma
    • arises from the liver cells and is the more common type
    • Associated with chronic viral hepatitis (HBV, HCV, HDV), cirrhosis, long-term exposure to environmental agents (such as aflatoxin), and drinking water contaminated with arsenic
  48. cholangiocarcinoma
    arises from the bile duct cells
  49. Metastatic tumors of the liver
    • much more common than primary tumors
    • Common sources include colorectal cancer and spread from breast, lung, or urogenital cancers
  50. Disorders of the Gallbladder and Extrahepatic Bile Ducts
    • Cholelithiasis (Gallstones)
    • Cholecystitis
    • Choledocholithiasis
    • Cholangitis
    • Cancer of the Gallbladder
  51. Cholelithiasis (Gallstones)
    • inflammation of the gallbladder
    • due to altered composition of bile
    • complaint of pan in RUQ due to obstruction caused by gallstones
    • sometimes pain referred to right shoulder, back, or both
    • 80% of gallstones are composed primarily of cholesterol; the other 20% consist of calcium salts with bilirubin
  52. Cholecystitis
    • Acute - due to partial or complete blocking (obstruction) of bile duct by gallstone
    • Chronic - repeat episodes of acute cholecystitis
  53. Choledocholithiasis
    • stone in common bile duct
    • have RUQ pain, chills, fever, and jaundice
    • responsible for 80-85% cancer in gallbladder
  54. Cholangitis
    • inflammation of the common bile duct
    • complication of Choledocholithiasis
  55. Disorders of the Exocrine Pancreas
    • Acute Pancreatitis
    • Chronic Pancreatitis
  56. Acute Pancreatitis
    • A severe, life-threatening disorder associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues
    • Fat necrosis of pancreas occurs due to auto-digestion
    • Associated with alcoholism, hyperlipidemia, hyperparathyroidism, infections (particularly viral), abdominal and surgical trauma, and drugs such as steroids and certain diuretics (can be triggered from overeating large meals)
  57. Chronic Panncreatitis
    • Progressive destruction of the pancreas
    • Associated with alcoholism, cholelithiasis, and cystic fibrosis
  58. Cancer of the Pancreas
    • One of most deadly cancers (99% mortality rate)
    • Associated with cigarette smoking and high fat, low fiber diet
    • back pain worse supine and relieved by sitting forward