Liver, Gallbladder and Pancreas diseases

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Liver, Gallbladder and Pancreas diseases. Premed 2 Pathophysiology. Pancreas. Acute Pancreatitis Autodigestion of the pancreas due to activation of the enzymes Hemorrhagic fat necrosis, calcium soaps, pseudocysts Increased risk in gallstones, alcohol intake Increased serum amylase. - PowerPoint PPT Presentation

Transcript of Liver, Gallbladder and Pancreas diseases

  • Liver, Gallbladder and Pancreas diseases

    Premed 2Pathophysiology

  • Pancreas

  • PancreatitisAcute PancreatitisAutodigestion of the pancreas due to activation of the enzymesHemorrhagic fat necrosis, calcium soaps, pseudocystsIncreased risk in gallstones, alcohol intakeIncreased serum amylase

    Chronic PancreatitisAlmost always associated with alcohol intakeFibrosis of the parenchyma, calcificationAbdominal pain, back painSteatorrhea (due to low lipase)Deficiency of fat-soluble vitamins

  • Cancer of the PancreasMost common type: adenocarcinomaCommon in smokersMost common site: head of the pancreasAbdominal pain radiating to the back

    Obstructive jaundicePalpable gallbladderDeath in 1 year

  • Gallbladder

  • CholecystitisAcute cholecystitisMost common type: pyogenicRight upper quadrant painEpigastric pain fever vomitingIncrease WBCChronic cholecystitisThick gallbladder wallFibrosisComplication of gallstones

  • GallstonesCholelithiasis4 Fs: fat, female, forty, fertileStone types:1. cholesterol stones: solitary, large2. pigment stones: excess unconjugated bilirubin; hemolytic anemia3. mixed stones: most common; cholesterol + calcium salts

  • GallstonesAsympotomatic, silent or with fatty food intoleranceComplications:Bilary colicJaundiceAscending cholangitisCholecystitisAcute pancreatitisGallstone ileusMucocoelemalignancy

  • Cancer of the GallbladderPrimary tumor: adenocarcinomaAssociated with gallstones

  • Liver

  • JaundicePhysiologic jaundice of the newborn1st week of lifeImmature liver has less glucoronyl transferase increased UNCONJUGATED bilirubinMore severe in preterm infants

    Congenital hyperbilirubinemiasGilbert syndrome: most commonCrigler-Najjar syndromeDubin-Johnson syndromeRotor syndrome

  • Congenital hyperbilirubinemiasUNCONJUGATED BILIRUBINCONJUGATED BILIRUBINGILBERT SYNDROMEREDUCED ENZYME ACTIVITYDECREASED UPTAKE OF BILIRUBINLIVER MAY BE NORMALMODERATE ELEVATION OFBILIRUBINCRIGLER-NAJJARSEVEREABSENCE OF THE ENZYMEEARLY DEATHKERNICTERUS

    DUBIN-JOHNSONDEFECTIVE BILIRUBIN TRANSPORTBLACK LIVER

    ROTORSIMILAR TO DJNO PIGMENT

  • Acute Viral HepatitisJaundiceIncreased levels of AST (aspartate aminotransferase) and ALT (alanine aminotransferase)Body weaknessFeverAbdominal painLoss of appetite

  • Hepatitis FThe occurrence of sporadic cases of non-ABCDE hepatitis gave reason to suspect the existence of another hepatotropic virus to of investigators in England, Northern Italy, France, United States and India. The infection was not only sporadic but also enterically transmitted. The first report came from India in 1983

  • Hepatitis GRNA virusMay coexist with other hepatitis virusesMostly with HCVBloodborneDiscovered 1995 in Chicago

  • Hepatitis H10-15% of chronic hepatitis patients do not fit into any of the other hepatitis virus categories.

  • Liver cirrhosis

    cessation of enzymatic processes in the liver Ascites, jaundice, internal bleeding, and hepatic encephalopathy Patients with decompensated cirrhosis are candidates for liver transplantation

  • Fulminant hepatitis. occurs in 1% of acutely infected individuals; more likely if HBV and HDV coinfect. more severe symptoms, can be fatal. severe liver damage: ascites and bleeding; liver shrinkage rather than hepatomegaly.

  • Chronic hepatitisPersistence of abnormalities for more than 6 monthsMay result from any of the hepatitis virus EXCEPT HAV and HEV

  • Fatty liverMicrovesicular type:pregnancytetracyclineAspirin toxicity: Reye syndromeMacrovesicular type:fatty change (steatosis) in alcholicsalcoholic hepatitis

  • Alcoholic hepatitisFatty changeFocal liver cell necrosisInfiltrates of neutrophilsMallory bodies: eosinphilic hyaline inclusions in the liver cell cytoplasm

  • CirrhosisScarring and nodule formation in the liverIncreased incidence of hepatocellular carcinomaEtiologic agents:prolonged alcholic intakedrugs, chemicalsviral hepatitisbiliary obstructionhemochromatosisWilson diseaseheart failure

  • Alcoholic cirrhosisJaundice, mixed typeLow serum albuminCoagulation problemsIncreased estrogen levelsEsophageal varicesRectal hemorrhoidsCaput medusae SplenomegalyPeripheral edema, ascites, hydrothoraxEncephalopathy-asterixis, confusion, coma

  • Alcoholic cirrhosisLiver enlarged OR small, shrunkenMicronodularhobnail

  • HemochromatosisHereditary type: mutation of Hfe gene on chromosome 6Defect of iron absorption in the intestinal mucosaBronze diabetes: cirrhosis diabetes increased skin pigmentationIncrease in serum ironDecreased TIBCIncreased transferrin iron saturationIncreased serum ferritin

  • Wilson diseaseHepatolenticular degenerationDecrease in serum ceruloplasmin, increase serum copperCopper deposits in liver, corneaAlso in brain and kidney

  • Cancer of the liverMost common: Hepatocellular carcinomaIn association with existing cirrhosis, especially by HBVOther cause: AflatoxinSerum marker: alpha-feto protein