Liver, Gall Bladder, and Pancreatic Disease - PowerPoint PPT Presentation

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Liver, Gall Bladder, and Pancreatic Disease

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and Pancreatic Disease ... HCV Fulminant Hepatitis Hepatitis Tests LFTs AST ... Icterus include yellowing of sclera Decreased liver function Decreased ... – PowerPoint PPT presentation

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Title: Liver, Gall Bladder, and Pancreatic Disease


1
Liver, Gall Bladder, and Pancreatic Disease
2
Manifestations of Liver Disease
  • Inflammation - Hepatitis
  • Elevated AST, ALT
  • Steatosis
  • Enlarged Liver
  • Portal Hypertension
  • Functional
  • Jaundice
  • Lowered albumin (and other proteins)
  • Cirrhosis
  • Scarring
  • Small liver

3
Hepatitis
  • Alcohol
  • Hepatitis A,B,C,D,E,G
  • 44 Hep B (present in all secretions, STD)
  • 37 Hep A (oral-fecal route)
  • 19 Hep C (percutaneous)
  • Liver damage Immune mediated necrosis
  • Systemic effects Type III reaction

4
Hepatitis
  • Symptoms
  • Latent 30 HBV, 80 HCV
  • Acute Phase 1 4 months
  • Malaise, anorexia, fatigue, NV, abd pain
  • Fever, H/A, Icterus (optional)
  • Convalescence 2 4 months
  • Chronic
  • Uncommon for HAV
  • Most common HCV
  • Fulminant Hepatitis

5
Hepatitis Tests
  • LFTs
  • AST, ALT (SGOT, SGPT)
  • Albumin
  • Globulins
  • Specific
  • Antibodies surface and core, IgM, IgG
  • e.g., HBcIgM, HBcIgG
  • Antigens surface and core
  • e.g., HBsAg, HBcAg

6
Portal Vein System
7
Portal Hypertension
  • Etiology
  • Intrahepatic
  • Thrombosis
  • Inflammation
  • Fibrosis (cirrhosis)
  • Posthepatic
  • Cardiac insufficiency
  • Prehepatic
  • Narrowing of portal vein
  • Increased splanchnic artery vasodilation

8
Pathophysiology
  • Blood backs up
  • Mesenteric veins
  • Spleen (splenomegaly)
  • Collateral circulation
  • Esophagus (varices)
  • Abdominal wall (caput medusa)
  • Rectum (hemorrhoids)
  • Splanchnic artery dilation
  • Drop in blood pressure
  • RAAS activation, epinephrine
  • Ascites
  • Hepatic Encephalopathy

9
Splenomegaly
  • Premature erythrocyte removal

10
Esophageal Varices
11
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16
Splanchnic Artery Dilation
  • Inappropriate dilation of gut arteries
  • Lowers systemic BP
  • Increased Epi and Norepi
  • Increased RAAS
  • Even though fluid overloaded, at risk for
    hypotension
  • Increased Portal Pressure
  • Worsens portal hypertension
  • Increases ascites

17
Ascites
  • Transudate
  • Accumulation of
  • Increased portal hydrostatic pressure
  • Decreased oncotic pressure
  • Manifestations
  • Distended abdomen
  • Fluid wave
  • Respiratory distress
  • Electrolyte imbalance
  • Treatment
  • Underlying cause
  • Paracentesis

18
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19
Paracentesis
20
Other Hepatic Manifestations
  • Jaundice
  • Excess bilirubin
  • Liver cannot conjugate bilirubin
  • Liver cannot excrete conjugated bilirubin
  • Icterus include yellowing of sclera
  • Decreased liver function
  • Decreased plasma enzymes
  • Edema, increased bleeding, increased infection
  • Decreased removal of waste
  • Drug levels become toxic
  • Increased ammonia levels

21
Hepatic Encephalopathy
  • Ammonia buildup from protein digestion
  • Manifestations
  • Changes in personality
  • Memory, confusion
  • Asterixis (Hand flapping)
  • Stupor, Coma
  • Treatment
  • Low protein diet
  • Lactulose

22
Gall Bladder Diseases
  • Cholecyst
  • fills from biliary tract
  • Stores and secretes bile into the common bile
    duct
  • Cholelithiasis/Cholecystitis
  • Genetic component
  • High fat diets
  • Cholecystectomy
  • Requires diet modification

23
Acute Pancreatitis
  • Ranges from mild edema to necrosis
  • May resolve completely or
  • Become chronic/episodic
  • Etiology
  • Biliary tract disease (most common in women)
  • Alcoholism (most common in men)
  • Trauma, surgery, drugs, vascular disease

24
Acute Pancreatitis
  • Pathophysiology
  • Autodigestion lipase, amylase, trypsin
  • Clinical Manifestations
  • Painunbelievable pain
  • Worse with eating
  • Patient often writhes
  • Other
  • Fever, leukocytosis
  • Hypotension, tachycardia, jaundice
  • Complications
  • Pseudocyst, pancreatic abcess

25
Acute Pancreatitis
  • Eval
  • Amylase and lipase levels
  • Various radiographic tests
  • Treatment
  • PAIN management
  • Antispasmodics
  • NPO
  • Support blood pressure
  • Surgery

26
Chronic Pancreatitis
  • Progressive inflammatory replacement of
    parenchyma with fibrous tissue
  • Chronic obstructive pancreatitis
  • Gall bladder disease
  • Chronic calcifying pancreatitis
  • Alcholic
  • Eval Same
  • Tx
  • Dietary/alcohol modification
  • Cholecystecomy
  • Pancreatic Enzymes
  • Treat flares like acute pancreatitis
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