Hepatobiliary System Consists of:
Work together to get enzyme and hormones into sm intestine for proper digestion and absorption of nutrients
Function of the Gallbladder
Sgtoreage place for bile (previous synthesized by the liver)
Diseases of the Gallbladder
AKA Gall Stones
Most gallstones are UNPIGMENTED: made up of cholesterol, bilirubin and calcium salts. Pigmented gallstones are made up primarily of bilitubin and calcium
Bile becomes "SUPERSATURATED" and the stone is formed
Cholesterol in Gallstones
Usually kept in soln by bile acids (salts), lecithins and phospholipids. When biosalts become supersaturated with cholesterol, it solidifies
Epidemiology of Cholelithiasis
1. Highest prevalence in Pima Indians.. 75% of elderly have had
2. Premenopausal Women. 4x more likely in men due to variation in estrogen that cause an increase in cholesterol and progesterin, leading to bile stasis and then supersaturation. Stones end of forming
Cause of Cholelithiasis
Risk Factors for Cholelithiasis
3. Age (older)
7. Rapid weight loss thru VLCD and fasting
8. Prolonged TPN due to biliary stasis (no use of gallbladder)
The Four F's in Gall Bladder Dz
Symptoms of Gallstones
Difficult to notice if not prevalent.
May be asymptomatic
May have a little abdominal pain if lodged in bile duct or pain when eating fatty food.
Inflammation of the gallbladder usually due to obstruction causing bile to back upinto gallbladder.
Walls become inflamed and infection can occur.
Usually a complication of gallstones
Symptoms of Cholecystitis
1. Epigastric pain
3. Jaundice can occur due to obstruction and causes increase of bilirubin in the blood. Turn yellow
Inflammation of the biliary ducts, usually secondary to obstruction of the common bile duct leading to infection
Can ascend into the hepatic ducts, then hepatic veins and perhepatic lympatics leading to sepsis
Two Major Functions of the Pancreas
Exocrine Function of the Pancreas
Produces enzymes necessary for digestion. I.E. Pancreatic lipase, amylase, protease. If not functioning cannot break down.
Endocrine Function of the Pancreas
Produces hormones to regulate the use of body fuels (mainly glucose) I.E. insulin... regulation of blood sugars
Inflammation of the pancreas that can be acute or chronic
Etiology of Pancreatitis
The most common causes are alcoholism and cholelithiasis.Alcohol stimulates increase in pancreatic enzymes and causes edema which can block the flow of enzymes into the intestine and they back up and autodigestion occurs.
Exact mechanism is not fully understood but common characteristic is autodigestion of the pancreas is caused by pancreatic enzymes getting backed up into pancreas. Although they are secreted in enzyme form with a trypsin inhibitor (prohibits activation), a large amt of enzymes will override the inhibitor.
Primarily caused by biliary tract dz (gallstones) or alcoholism
Can be caused also by drugs, surgical procedures, cancer, virus.
Common with a history of (h/o) alcoholism, metabolic stress (CF... constantly have metabolic stress because they have mucus that covers organs including pancreas so gets backed up with enzymes and can't secrete them into intestine)
90% of fxn usually gone before dz
Clinical signs of pancreatitis
1. Weight loss
2. Steatorrhea (Fatty stools)
Common symptoms of pancreatitis
1. Upper absdominal pain radiating to the back
2. Worsening indigestion with food
4. Abdominal distension
Nutritiion and Cholelithiasis
Decreased ability to ability to digest fat can cause abdominal gas. May have inadequate intake. Modise protein<30% may help.
Nutrition and Acute Pancreatitis
IV fluids and analgesics
Nutrition and Care Chronic Pancreatitis
Intensive care because of so many complications including multiorgan failure. Fat intake is limite. May alter GI fxn, manutrition, inadequate oral intake, and incease nutrient needs.