2536- Digestive system Part 2 Patho
Acessory Organ- Liver
Consists of Left and the Right Lobe
Right Lobe is further split into Caudate which independanelt supplies drainage to the IVC and the Quadrate is associated with the billiary system of bile production and secretion
Acessory Organ- Liver Dual blood supply
The Liver receive blood supply fom two sources:
- Hepatic Artery: supplys 25% and is O2 rich
- Hepatic Portal vein: supplies 75% and is nutrient rich
Acessory Organ- Liver roles
Emulsifies fat
Regulates BV
Metabolizes nutrients- macros and vitamins,minerals
Immune regulation
Removes Waste
Acessory Organ- Bile
Bile is composed of Bile salts that form minecelles (h20 soluble)
Minecells aid in the function of dissolving fat and removing bilirubin
Acessory Organ- Gallbladder
Lies inferior to the liver
holds 90ml of bile
responsible for bile contraction of 30 mins after eating a meal
Acessory Organ- Pancreas
Exocrine function- acinar cells secretes enzymes to assist in digestion (breaking down food)
Endocrine Function- Islet of langerhams (alpha & Beta) that produce glucagon and insulin (blood sugar regulation)
Acessory Organ- Bilirubin
Occurs from the breakdown of RBC where then Kupffer cells in the liver seperate the hemeglobin where heme is converted into irn where it;s by product is bile
Acessory Organ- Bilirubin: unconjugated vs conjugated
Unconjugated: not h20 soluble and is before it is processed by the liver
Conjugated: h20 solube, after it is processed by the liver
Jaundice & Types
when serum bilirubin is x>2.9mg/dL
TYPES
Physiologic: newborn and due to immature liver
Hemolytic: exessive breakdown of RBC (unconjugated overload), triggered by anemia
Hepatocellular: liver dysfunction and can't conjugate
Obstructive Jaundice: blockage/ obstruction of the bile duct
Progression of Liver disease
1) Healthy Liver
2) Fatty liver- reversible (lifestyle changes)
3) Fibrosis- connective tissue replaces normal tissue
4) Cirrhosis- nodular texture, liver scarring, irreverible
Liver diease- cirrhosis
Irreversible inflammatory liver disease obstructs billiary channels that causes a main manfiestation- portal hypertension
DIAGNOSIS
Stool examination
Liver panel: increase in AST,ALT,ALP,GTT,ALB,bili
Clotting studies: prolonged INR, PTT
MANIFESTATIONS
clay coloured stool, clotting changes
femenization in men, menses changes in women
Liver disease- cirrhosis--> Portal Hypertension
Increase BP inportal vein due to increase resistace in liver and sphlanic BF
this can lead to severe other disorders
Portal hypertension "disorder"- Ascites
Accumulation of fluid in the peritoneal cavity
if with cirrhosis: 25% mortality in year
MANIFESTATIONS
Wt gain
Abd distention
CAUSES
Splanhic vasodilation
NA+ retention
TREATMENT: Paracentisis
Portal hypertension "disorder"- Esophageal Varices
enlarged veins in the esophagus
if it bursts, medical emergency
TREATMENT: balloon tamponade
Portal hypertension "disorder"- Hepatroneal syndrome
kidney failure caused by renal vasoconstriction that leads to build up of toxins in the body since kidney cant filter
Portal hypertension "disorder"- Hepatic Encephalopathy
Ammonia build up
MANIFESTATIONS
confusion, mood swings, irritability
TREATMENT
AB, lactulose
Liver Disorder- Viral hepatitis
often a virus affects the liver
TYPES: H A,B,C,D,E V
TREATMENT
Antivirals
HepAB
hydration and rest
Liver Disorder- Viral hepatitis: Phases
Prodormal: highly contagious phase, symptoms are not prevelant , flu like symptoms
Icentric: onset of jaundice
Recovery: fatugue, jaundice gradually decreases
Liver Disorder- Viral hepatitis: characteristics
Acute: one asymptomatic, three symptomatic phase
Chronic: 6months
Fuliminant: uncommon, rapide progression, death within 3 weeks
Liver Disorder- Acute Liver failure
severe necrosis of liver cells
Acetaminophen overdose is common
Gallbladder Disorders- Gallstones
fromed from impaired metabolism of cholestrol, bili, bile
TYPES
cholestrol
pigmented
mixed
Gallbladder Disorders- cholecystitis
lodged gallstone in cystic duct
Gallbladder Disorders- choledocholithiasis
stone incommon duct without inflammation
may be emergent
Gallbladder Disorders- cholangitis
inflammtion of the bile duct
Possible sepsis
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Dye to visualize pancratic/ bile
can also be a gallstone removal treatment
Disorders of the Pancreas- Pancreatitis
Inflammation of the pancreas that can result in dysfunction of the islet langerham cells, edema, hemmorhage, pancreatic cancer
Acute and chronic
MANIFESTATIONS
cullens, grey turner