40 terms

Gastrointestinal Pathology II

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
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
elevated with liver damage (hepatitis, toxins)
elevated with alcohol induced liver disease; statins, tylenol, acne drugs
decreased in hepatitis, liver tumors, cirrhosis, ascites
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
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
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
common finding is excessive iron storage which can result in cellular damage in liver
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
releases cholecystokinin in response to lipids, amino acids, and alcohol consumption; steatorrhea
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
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