Unit 2: Chapter 38

Question 1

Liver

Answer 1

Larges visceral organ in body
1.3 kg
Located below the diaphragm
Recieves 25% of resting cardiac output
Major exocrine function: bile secretion

Question 2

Lobules

Answer 2

Functional unit of the liver
50,000 to 100,000.
Each is organized around a central vein that empties into the hepatic veins and from there to vena cava.

Question 3

Metabolic Function of the Liver

Answer 3

Produces bile, metabolizes hormones and drugs; synthesizes proteins, glucose, and clotting factors; stores vitamins and minerals; changes ammonia produced by deamination of amino acids to urea; and converts fatty acids to ketones. The liver also degrades excess nutrients and converts them into substances essential to the body.
Metabolizing drugs and hormones

Question 4

Cholestatsis

Answer 4

Cholestasis represents a decrease in bile flow through the intrahepatic canaliculi and a reduction in secretion of water, bilirubin, and bile acids by the hepatocytes. As a result, the materials normally transferred to the bile, including bilirubin, cholesterol, and bile acids, accumulate in the blood.

Question 5

Cholestasis: 2 Main Causes

Answer 5

The condition may be caused by intrinsic liver disease: intrahepatic cholestasis, or by obstruction of the large bile ducts: extrahepatic cholestasis.

Question 6

Pruritis

Answer 6

Most common presenting symptom in people with cholestasi realted to an elevation in plasma bio acids

Question 7

Bilirubin

Answer 7

final product of the breakdown of heme contained in aged red blood cells.
Substance that gives bile its color.

Question 8

Bilirubin Process of Degradation

Answer 8

The hemoglobin from the red blood cell is broken down to form biliverdin, which is rapidly converted to free bilirubin (insoluble in plasma).
Transported in the blood attached to plasma albumin. Even bound to albumin, this bilirubin is still called free bilirubin, to distinguish it from conjugated bilirubin. As it passes through the liver, free bilirubin is absorbed through the hepatocytes’ cell membrane and released from its albumin carrier molecule. Inside the hepatocytes, free bilirubin is converted to conjugated bilirubin, making it soluble in bile. Conjugated bilirubin is secreted as a constituent of bile, and in this form it passes through the bile ducts into the small intestine.

Question 9

Normal Serum Bilirubin

Answer 9

1.5 mg/dL

Question 10

Jaundice

Answer 10

Yellowish discoloration of the skin and deep tissues results from abnormally high levels of bilirubin in the blood.
Occurs when there is an imbalance between the synthesis of bilirubin and the clearance of bilirubin.
Becomes evident when the serum bilirubin levels rise above 2 to 2.5 mg/dL (34.2 to 42.8 μmol).
The eye is the first structure that it can be detected.

Question 11

5 Major Causes of Jaundice

Answer 11

1. excessive destruction of red blood cells
2. impaired uptake of bilirubin by the liver cells
3. decreased conjugation of bilirubin
4. obstruction of bile flow in the canaliculi of the hepatic lobules or in the intrahepatic or extrahepatic bile ducts
5. excessive extrahepatic production of bilirubin

Question 12

Viral Hepatitis

Answer 12

Refers to inflammation of the liver caused by hepatotropic viruses that primarily affect liver cells or hepatocytes, autoimmune mechanisms, or reactions to drugs and toxins, or are secondary to other systemic disorders.

Question 13

Known Hepatotropic VIrsues that cause Hepatitis

Answer 13

hepatitis A virus (HAV), hepatitis B virus (HBV), the hepatitis B–associated delta virus (HDV), hepatitis C virus (HCV), and hepatitis E virus (HEV). Although all of these viruses cause acute hepatitis, they differ in the mode of transmission and incubation period; mechanism, degree, and chronicity of liver damage; and ability to evolve to a carrier state.

Question 14

Viral Hepatitis Manifestations

Answer 14

can be divided into three phases:
1. the prodromal or preicterus period
2. the icterus period
3. the recovery period.

Question 15

Manifestations of Prodromal Period

Answer 15

Vary from abrupt to insidious, with general malaise, myalgia, arthralgia, easy fatigability, and anorexia.
Gastrointestinal symptoms such as nausea, vomiting, and diarrhea or constipation may also occur.

Question 16

Manifestations of the Icterus Phase

Answer 16

If it occurs, usually follows the prodromal phase by 7 to 14 days.
People have tenderness around the area of the liver, mild weight loss, and spider angiomas.
Approximately 80% of people with acute Hepatitis C do not have any symptoms.

Question 17

Manifestations of The Recovery Phsae

Answer 17

Characterized by an increased sense of well-being, return of appetite, and disappearance of jaundice.

Question 18

Hepatitis A

Answer 18

caused by the HAV, a small, unenveloped, single-stranded ribonucleic acid (RNA) virus. Fecal oral route contraction.
It usually is a benign, self-limited disease, although it can cause acute fulminant hepatitis and death or need for transplantation in 0.15% to 0.2% of cases.

Question 19

Hepatitis A Manifestations

Answer 19

Usually is abrupt and includes fever, malaise, nausea, anorexia, abdominal discomfort, dark urine, and jaundice.
The presentation of symptoms is dependent on age, with the severity of symptoms increasing in older age groups

Question 20

Hepatitis A Serology

Answer 20

Antibodies HAV appear early
IGM appear during the 1st week and decline over 3 to 4 months.
Peak levels of IgG occur after 1 months and may persist for life

Question 21

Hepatitis A Treatment

Answer 21

Immunization is available for international travel

Question 22

Hepatitis B

Answer 22

Caused by the HBV, a double-stranded deoxyribonucleic acid (DNA) virus.34 The complete virion, also called a Dane particle, consists of an outer envelope and an inner nucleocapsid that contains HBV DNA and DNA polymerase.
Can produce both acute and chronic hep, cirrhosis, hep D.
Transmission: infected blood or serum, body secretions

Question 23

Hepatitis B Serology

Answer 23

Three well-defined antigens are associated with the virus: a core antigen, HBcAg, which is contained in the nucleocapsid; a longer polypeptide transcript with precore and core regions, designated HBeAg; and a surface antigen, HBsAg, which is found in the outer envelope of the virus.

Question 24

Hepatitis C

Answer 24

HCV is a single-stranded RNA virus, with properties similar to those of the flaviviruses, a genus of the family of Flaviviridae that includes yellow fever and St. Louis encephalitis viruses.
The virus is genetically unstable, which leads to multiple genotypes and subtypes.

Question 25

Hepatitis C Manifestations

Answer 25

incubation period for HCV infection ranges from 2 to 26 weeks (average, 6 to 12 weeks). Most children and adults who acquire the infection usually are asymptomatic. Jaundice is uncommon, and only 10% of symptomatic adults have jaundice.54 These symptoms usually last for 2 to 12 weeks.

Question 26

Hep C Serology

Answer 26

antibody and viral tests are available for detecting the presence of HCV infection. False-negative results can occur in immunocompromised people and early in the course of the disease before antibodies develop.

Question 27

Hepatitis D

Answer 27

Of the Deltaviridae family, is the sole RNA virus of the genus. is an incomplete virus, in that it requires the assistance of HBV to replicate. It can cause acute or chronic hepatitis. Infection depends on concomitant infection with HBV, specifically the presence of HBsAg.33 Acute hepatitis D occurs in two forms: co-primary infection that occurs simultaneously with acute hepatitis B and a superinfection in which hepatitis D is imposed on chronic hepatitis B infection.

Question 28

Hepatitis E

Answer 28

An unenveloped, single-stranded RNA virus. It is transmitted by the fecal–oral route and causes manifestations of acute hepatitis that are similar to those of hepatitis A. Genotype 3 of the virus has been linked to chronic HEV infection

Question 29

Chronic Viral Hepatitis

Answer 29

Defined as chronic inflammation reaction of the liver of more than 3-6 months duration Characterized by persistently elevated serum aminotransferase levels and characteristic histologic findings on liver biopsy.

Question 30

Chronic Viral Hepatitis Manifestations

Answer 30

Most common symptoms: fatigue, malaise, loss of appetite, and occasional bouts of jaundice. Elevation of serum aminotransferase concentrations depends on the level of disease activity.

Question 31

Cirrhosis

Answer 31

represents the end-stage chronic liver disease, in which much of the functional liver tissue has been replaced by fibrous tissue. Usually is associated with alcoholism Can develop in other disorders: viral hepatitis, toxic reactions to drugs and chemicals, biliary obstruction, and NAFLD.

Question 32

Cirrhosis and Metabolic Disorders

Answer 32

Accompanies metabolic disorders that cause the deposition of mineral int he liver 1. Hemochromatosis (iron deposition) 2. Wilson disease (copper deposition)

Question 33

Cirrhosis Characterization

Answer 33

characterized by diffuse fibrosis and conversion of normal liver architecture into nodules containing proliferating hepatocytes encircled by fibrosis. The formation of nodules, which vary in size from very small (<3 mm, micronodules) to large (several centimeters, macronodules), represents a balance between regenerative activity and constrictive scarring.

Question 34

Cirrhosis Manifestation

Answer 34

Asymptomatic hepatomegaly to hepatic failure There are no symptoms until the disease is far advanced. The most common is weight loss (sometimes masked by ascites), weakness, and anorexia. Diarrhea +/- consitpation Hepatomegaly and jaundice Abdominal pain because of liver enlargement or stretching of the Glisson capsule. This pain is located in the epigastric area or in the upper right quadrant and is described as dull, aching, and causing a sensation of fullness.

Question 35

Portal Hypertension

Answer 35

is characterized by increased resistance to flow in the portal venous system and sustained portal vein pressure.

Question 36

Portal Hypertension Causes

Answer 36

caused by a variety of conditions that increase resistance to hepatic blood flow, including prehepatic, posthepatic, and intrahepatic obstructions

Question 37

Splenomegaly

Answer 37

spleen enlarges progressively in portal hypertension because of shunting of blood into the splenic vein. The enlarged spleen often gives rise to sequestering of significant numbers of blood elements and development of a syndrome known as hypersplenism.

Question 38

Hypersplenism

Answer 38

characterized by a decrease in the lifespan of all the formed elements of the blood and a subsequent decrease in their numbers, leading to anemia, thrombocytopenia, and leukopenia.

Question 39

Liver Failure

Answer 39

Most severe clinical consequence of liver disease is hepatic failure. It may result from sudden and massive liver destruction, as in fulminant hepatitis, or be the result of progressive damage to the liver, as occurs in alcoholic cirrhosis.

Question 40

Liver Failure Manifestations

Answer 40

Reflect the various synthesis, storage, metabolic, and elimination functions of the liver. Fetor hepaticus refers to a characteristic musty, sweetish odor of the breath in the person in advanced liver failure, resulting from the metabolic by-products of the intestinal bacteria.

Question 41

Hepatic Encephalopathy

Answer 41

Refers to the totality of central nervous system manifestations of liver failure. Characterized by neural disturbances ranging from a lack of mental alertness to confusion, coma, and convulsions. Early sign of hepatic encephalopathy is a flapping tremor called asterixis. Suspected neurotoxin: ammonia

Question 42

Hepatobiliary System

Answer 42

consists of: Gallbladder Left and right hepatic ducts, which come together to form the common hepatic duct; Cystic duct, which extends to the gallbladder Common bile duct, which is formed by the union of the common hepatic duct and cystic duct.

Question 43

Cholelithiasis

Answer 43

Or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin. 80%: cholesterol 20% mucin glycoproteins

Question 44

2 Factors that Contribute to Gallstone Formation

Answer 44

1. abnormalities in the composition of bile (particularly increased cholesterol) Due to obesity 2. stasis of bile

Question 45

Cholelithiasis Manifestations

Answer 45

People with gallstones have no symptoms. Symptoms occur when they obstruct bile flow or cause inflammation. Small stones (i.e., <8 mm in diameter) pass into the common duct, producing symptoms of indigestion and biliary colic. Larger stones are more likely to obstruct flow and cause jaundice. Pain of biliary colic is located in the upper right quadrant or epigastric area and may be referred to the upper back, the right shoulder, or midscapular region.

Question 47

Acute Pancreatitis

Answer 47

Represents a reversible inflammatory process of the pancreatic acini brought about by premature activation of pancreatic enzymes. Disease process may be limited to pancreatic tissue, it also can involve peripancreatic tissues or those of more distant organs.

Question 48

Pancreatitis Pathogenesis

Answer 48

Involves the autodigestion of pancreatic tissue by inappropriately activated pancreatic enzymes. Thought to begin with the activation of trypsin. Once activated, trypsin can then activate a variety of digestive enzymes that cause pancreatic injury, resulting in an intense inflammatory response.

Question 49

Pancreatitis Manifestations

Answer 49

Range from mild with minimal organ dysfunction to severe and life-threatening. 20% of people with acute pancreatitis have a severe course. Abdominal pain is a cardinal manifestatation, located in the epigastric or periumbilical region and may radiate to the back, chest, or flank areas. Other include fever, tachycardia, hypotension, severe abdominal tenderness, respiratory distress, and abdominal distension.

Question 50

Cancer of the Pancreas

Answer 50

most common: adenocarcinoma 85% Unknown cause. Occur early in younger than 50 years. Moist significant factor: smoking

Question 51

Cancer of the Pancreas Manifestation

Answer 51

Early stage has no symptoms but spreads quickly making it difficult to detect. adenocarcinomas of the ductal epithelium, and symptoms are primarily caused by mass effect rather than disruption of exocrine or endocrine function. manifestationss depend on the size and location of the tumor as well as its metastasis. Pain, jaundice, and weight loss are classic presentation. The most common pain is a dull epigastric pain often accompanied by back pain, often worse in the supine position, and relieved by sitting forward.

Question 52

Pathways of Lipid Metabolism

Answer 52

Occur mainly in the liver including the oxidation of free fatty acids to keto acids that supply energy for other body functions; synthesis of cholesterol, phospholipids, and lipoproteins; and formation of triglycerides from carbohydrates and proteins. Liver cant use all CoA formed so its converted to ace to acetic acid used for energy.