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liver's functions

carb, protein, fat and bilirubin metabolism; production of bile salts; metabolic detoxification; storage of minerals and vitamins (D, A, E, K); blood reservoir; clotting factors

metabolism of liver

metabolism and waste disposal--albumin, clotting factors, vitamin K; cytochrome P450; fats - fatty acids - energy

signs of liver dysfunction

jaundice; ascites; symptoms related to portla hypertension, ammonia elevated in failure

portal hypertension

hypertension in vessels tha tdrain into liver due to obstruction of flow through the kidney; long term causes varices, ascites, splenomegaly, hepatic encephalopathy

esophageal varices

complication of liver disease relataed to elevated portal pressure causing backflow of blood into GI structures; mortality associated with hemorrhage is 50%; prophylaxis recommended for those with cirrhosis and screening every 2-3 years

ascites

accumulation of fluid in peritoneal cavity; third spacing; low albumin reduces vascular pull and decreased Na and water excretion in kidney increases in hydrostatic push; liver disease/portal hypertension

ALT (SGPT)

elevated with liver damage (hepatitis, toxins)

AST (GGT)

elevated with alcohol induced liver disease; statins, tylenol, acne drugs

albumin

decreased in hepatitis, liver tumors, cirrhosis, ascites

jaundice

caused by hyperbilirubinemia; excessive hemolysis of blood cells; occlusion of bile ducts; liver damage

jaundice of the newborn

immature liver unable to handle breakdown of red cells from birth trauma

liver failure

acute or chronic; acute develops suddenly and 75% die within first few days; function lost; related to multiple organ failure; organ transplant or extracorporeal devices

liver abscess

amebic liver abcesses-Entamoeba histolytica; organisms: pseudomonas, proteus, klebsiella, escherichia coli, staphylococcus, streptococcus

hepatitis

toxic caused by adverse drug reactions or other substances; polypharmacy can induce toxic type; nausea, vomiting, lethargy early

hepatitis A (HAV)

contaminated food; institutions; lifetime immunity; fecal/oral, blood; incubation 2-6 weeks

hepatitis E (HEV)

epidemic areas; fecal/oral

hepatitis B (HBV)

parenteral/sexual/perinatal transmission; immunization available; 90% death of infants; 4-24 weeks; develops chronic hepatitis

hepatitis C (HCV)

parenteral/sexual/perinatal transmission; can be chronic

hepatitis D (HDV)

parenteral/sexual/perinatal transmission; actually coinfection with HBV

viral hepatitis-parenteral/sexual/perinatal transmission

blood exposure; sexual activity; hemodialysis; health care workiers; IV drug users; organ transplant

autoimmune hepatitis

chronic inflammatory disorder related to circulating antibodies and high serum globulin levels

cirrhosis

characterized by diffuse inflammation and fibrosis; liver cell death with normal cells replaced by scar tissue; predisposing factors

Laennec's cirrhosis

related to alcoholism

cardiac cirrhosis

related to congestive heart failure

post necrotic cirrhosis

related to hepatoxins and viral hepatitis

complications of cirrhosis

portal hypertension; esophageal varices; ascites; hepatorenal syndrome-renal failure related to liver disease

hemochromatosis

common finding is excessive iron storage which can result in cellular damage in liver

thalassemia

patients that do not receive chelation have excess iron stores

chelation therapy

may be give to lower iron overload potential

gall bladder

stores and concentrates about 50 mL of bile which is formed in liver

sphincter of Oddi

controls the flow of bile into the duodenum

duodenum

releases cholecystokinin in response to lipids, amino acids, and alcohol consumption; steatorrhea

cholelithiasis/gallstones

more common in women; increased with age and obesity; form over 2-3 years; up to 2.5 cm; obstrn of duct results in complications

cholecystitis

inflammation of gall bladder usually related to stones and obstruction; RUQ pain with chills and fever with Murphy's sign (RUQ pain with temp respiratory arrest)

functions of pancreas

exocrine: secretion of enzymes; endocrine: insulin production and release

acute pancreatitis

inflammation of the pancrase resulting in varying stages of pancreatic injury; causes: biliary stones and alcohol, 10%-no identifiable cause; activation of enzymes before entering the duodenum, producing autodigestion; elevated serum amylase and lipase; leukocytosis and hyperglycemia

acute pancreatitis con.

pain, N/V; alcohol intake; physical exam findings-fever, abdominal symptoms, decreased peristalsis, Cullen's sign (purplish periumbilical ecchymosis)

acute pancreatitis complications

pseudocysts-can obstruct other structures or rupture; pancreatic infection; chronic pancreatitis

chronic pancreatitis

persistent and progressive damage to tissue; often alcohol related; recurrent bouts with progressive injury and scarring; destruction of the exocrine paenchyma and replacement w/fibrous tissue; symptoms similar to acute

cancers of GI tract

esophagus; stomach; liver; pancreas; gall bladder; small intestine; colon (3rd most common CA) and is familial adenomatous polyposis; rectum; usually adenocarcinoma

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