Hepato biliary

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  • 1. Chapter 29Disorders of Hepatobiliary and Exocrine Pancreas Function Copyright 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Liver Structure Blood fromhepatic portalvein and hepaticartery mix insinusoids The sinusoidsempty into centralveins, which sendthe blood to thehepatic vein andinferior vena cava 3. Liver Structure (cont.) Hepatic cells liealong the sinusoidsand pick upchemicals fromthe blood They modify thebloodscomposition 4. Liver Structure(cont.) At the back end ofeach hepatic cell,bile is released intoa canaliculus The bile is carriedto the bile ductand then to thegallbladder 5. Liver Structure(cont.) Many sinusoidscome together toempty into onevein The section of theliver emptying intoone vein is a lobule 6. QuestionTell whether the following statement is true orfalse.The gallbladder stores bile that has beenproduced by the liver. 7. TrueAnswerRationale: The liver makes bile and secretes itinto the small intestine via the common bileduct. Excess bile is stored in the gallbladder,where it also enters the small intestinethrough the common bile duct when it isneeded. 8. Metabolic Functions of the Liver Carbohydrate, protein, and lipid metabolism Sugars stored as glycogen, converted to glucose, used to make fats Proteins synthesized from amino acids; ammonia made into urea Fats oxidized for energy, synthesized, packaged into lipoproteins 9. Metabolic Functions of the Liver (cont.) Drug and hormone metabolism Biotransformation into water-soluble forms Detoxification or inactivation Bile production 10. QuestionWhich of the following substances makes bile more susceptible to digestive enzymes?b. Carbohydratec. Proteind. Fate. All of the above 11. a. FatAnswerRationale: Bile (produced in the liver) emulsifies fat molecules so that they are easier to digest. An emulsion is a mixture of two immiscible (unblendable) substances, in this case bile and fat. 12. ScenarioMr. M had a donut for breakfast.Question: Explain how the sugar in the donut left his smallintestine and ended up as fat in his carotid artery, givingthe: Anatomical structures Chemical processes Hormones that controlled them 13. ScenarioMs. B was prescribed an oral medication for her skin problem.She took it twice a day. The day after she started the medication, Ms. B drank winewith a friend right after taking the prescribed dosageQuestion: Ms. B got terribly ill. Why? She said, I drink that kind ofwine all the time. 14. Liver Failure Hematologic disorders Anemia, thrombocytopenia, coagulation defects, leukopenia Endocrine disorders Fluid retention, hypokalemia, disordered sexual functions Which hormones would cause these endocrine disorders? 15. Liver Failure (cont.) Skin disorders Jaundice, red palms, spider nevi Hepatorenal syndrome Azotemia, increased plasma creatinine, oliguria Hepatic encephalopathy Asterixis, confusion, coma, convulsions 16. QuestionWhat causes jaundice?b. Increased bilirubin levelsc. Anemiad. Thrombocytopeniae. Leukopenia 17. Answera. Increased bilirubin levelsRationale: Erythrocytes are normally broken down in the spleen at the end of their life span. The end product of RBC metabolism is bilirubin. Bilirubin is sent to the liver to be metabolized; if the liver is not functioning properly, the bilirubin accumulates and causes jaundice (an abnormal yellowing of the skin and mucous membranes). 18. Hepatitis Viral hepatitis Hepatitis A virus (HAV) Hepatitis B virus (HBV) Hepatitis Bassociated delta virus (HDV) Hepatitis C virus (HCV) Hepatitis E virus (HEV) 19. DiscussionWhich hepatitis viruses are most likely to be the problem in: An asymptomatic drug abuser? A nursing student who has spent the last twomonths volunteering in an orphanage inMali? An infant whose mother has hepatitis? 20. Chronic Viral Hepatitis Caused by HBV, HCV, and HDV Principal worldwide cause of chronic liver disease, cirrhosis,and hepatocellular cancer Chief reason for liver transplantation in adults 21. Alcoholic Liver Disease Fatty liver (steatosis) Liver cells contain fat deposits; liver is enlarged Alcoholic hepatitis Liver inflammation and liver cell failure Cirrhosis Scar tissue partially blocks sinusoids and bile canaliculi 22. QuestionWhich of the following is the least virulent strain of hepatitis?b. HAVc. HBVd. HCVe. HDV 23. a. HAVAnswerRationale: HBV, HCV, and HDV are all virulent strains that may lead to chronic viral hepatitis. HAV is most commonly transmitted by the fecal-oral route (e.g., contaminated food or poor hygiene) and does not typically have a chronic stage (it does not cause permanent liver damage). 24. Veins Draining into the Hepatic Portal System Portalhypertensioncauses pressurein these veins toincrease Varicosities andshunts develop Organs engorgewith blood 25. Portal Hypertension 26. Cholestasis and Intrahepatic BiliaryDisorders Bile flow in the liver slows down Bile accumulates and forms plugs in the ducts Ducts rupture and damage liver cells Alkaline phosphatase released into blood Liver is unable to continue processing bilirubin Increased bile acids in blood and skin Pruritus (itching) 27. unconjugated The Fate of Bilirubinbilirubin in blood Hemoglobin from old redblood cells becomesbilirubin bilirubinemia liver links it The liver convertstobilirubin into bilegluconuride Why would a man with jaundiceliver failure developjaundice?conjugated bilirubinbile 28. Biliary Tract GallbladderHepaticCystic duct ductCommon bileductAmpulla of VaterSphincter of OddiPancreaticduct 29. Disorders of the Gallbladder Cholelithiasis (gallstones) Cholesterol, calcium salts, or mixed Acute and chronic cholecystitis Inflammation caused by irritation due to concentrated bile Choledocholithiasis Stones in the common bile duct Cholangitis Inflammation of the common bile duct 30. Bile in the Intestines Emulsifies fats so they can be digested Passes on to the large intestine Bacteria convert it to urobilinogen Some is lost in feces Most is reabsorbed into the blood Returned to the liver to be reused Filtered out by the kidneys urine 31. The Pancreas PancreasExocrine Endocrinepancreaspancreasreleases digestive juices through a releases hormones duct into the blood to the duodenum 32. Exocrine Pancreas Acini produce: Inactive digestiveenzymes Trypsin inactivator Bicarbonate (antacid) These are sent to theduodenum when itreleases secretin andcholecystokinin In the duodenum, thedigestive enzymes areactivated 33. QuestionTell whether the following statement is true orfalse.The exocrine pancreas produces insulin. 34. FalseAnswerRationale: Beta cells of the endocrine pancreasproduce insulin; the exocrine pancreasproduces digestive enzymes that are secretedinto the small intestine through the commonbile duct. 35. Biliary Reflux5. Bile in1. Gallbladderpancreascontractsdisrupts2. Bile is sent tissues;down common digestivebile duct enzymesactivated3. Blockage formsin ampulla of Vater:4. Bilebile cannot enter goes upduodenumpancreaticduct 36. Autodigestion of the Pancreas Activated enzymes begin to digest the pancreas cells Severe pain results Inflammation produces large volumes of serous exudate hypovolemia Enzymes (amylase, lipase) appear in the blood Areas of dead cells undergo fat necrosis Calcium from the blood deposits in them Hypocalcemia 37. Chronic Pancreatitis and Pancreatic Cancer to acute pancreatitisHave signs and symptoms similar Often have: Digestive problems because of inability to deliver enzymes to the duodenum Glucose control problems because of damage to islets of Langerhans Signs of biliary obstruction because of underlying bile tract disorders or duct compression by tumors