Presentation on theme: "Chapter 30 Disorders of Hepatobiliary and Exocrine Pancreas Function"— Presentation transcript:
1Chapter 30 Disorders of Hepatobiliary and Exocrine Pancreas Function Essentials of PathophysiologyChapter 30 Disorders of Hepatobiliary and Exocrine Pancreas Function
2Pre lecture quiz true/false The liver does not play a role in glucose homeostasis.Jaundice results from an abnormally high accumulation of bile in the blood.Hepatitis, inflammation of the liver, is of bacterial origin.Cholelithiasis, or gallstones, is caused by precipitation of substances contained in bile, mainly cholesterol and bilirubin.Chronic pancreatitis is a severe, life-threatening disorder associated with the escape of activated pancreatic enzymes into the pancreas and surrounding tissues.
3Pre lecture quiz C Cirrhosis Kupffer salts urea The __________ cells are capable of removing and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid.One of the metabolic functions of the liver is the conversion of ammonia, which is produced by deamination of amino acids, into __________. Pruritus is the most common presenting symptom in persons with cholestasis, probably related to increased bile __________ in the blood.Hepatitis __________ is the most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer in the world.__________ represents the end stage of chronic liver disease in which much of the functional liver tissue has been replaced by fibrous tissue.CCirrhosisKupffersaltsurea
6Liver StructureBlood from hepatic portal vein and hepatic artery mix in sinusoidsThe sinusoids empty into central veins, which send the blood to the hepatic vein and inferior vena cava
7Liver Structure(cont.) Hepatic cells lie along the sinusoids and pick up chemicals from the bloodThey modify the blood’s composition
8Liver Structur e(cont.) At the back end of each hepatic cell, bile is released into a canaliculusThe bile is carried to the bile duct and then to the gallbladder
9Liver Structure (cont.) Many sinusoids come together to empty into one veinThe section of the liver emptying into one vein is a lobule
10QuestionTell whether the following statement is true or false. The gallbladder stores bile that has been produced by the liver.
11AnswerTrue Rationale: The liver makes bile and secretes it into the small intestine via the common bile duct. Excess bile is stored in the gallbladder, where it also enters the small intestine through the common bile duct when it is needed.
12Metabolic Functions of the Liver Carbohydrate, protein, and lipid metabolismSugars stored as glycogen, converted to glucose, used to make fatsProteins synthesized from amino acids; ammonia made into ureaFats oxidized for energy, synthesized, packaged into lipoproteins
13Metabolic Functions of the Liver (cont.) Drug and hormone metabolismBiotransformation into water-soluble formsDetoxification or inactivationBile production
14QuestionWhich of the following substances does bile make more susceptible to digestive enzymes?CarbohydrateProteinFatAll of the above
15AnswerFatRationale: 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.
16Scenario Mr. M had a donut for breakfast. Question: Explain how the sugar in the donut left his small intestine and ended up as fat in his carotid artery, giving the:Anatomical structuresChemical processesHormones that controlled them
17ScenarioMs. 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 wine with a friend right after taking the prescribed dosageQuestion:Ms. B got terribly ill. Why? She said, “I drink that kind of wine all the time.”
18Liver FailureHematologic disorders as the liver fails the spleen takes over some of the function of the liverAnemia- due to splenomegalyThrombocytopenia- due to splenomegalycoagulation defects-leukopenia due to splenomegalyAs your spleen grows larger, it begins to filter normal red blood cells as well as abnormal ones, reducing the number of healthy cells in your bloodstream. It also traps too many platelets. Eventually, excess blood cells and platelets can clog your spleen, interfering with its normal functioning.
19Liver Failure Endocrine disorders Fluid retention, hypokalemia, Lack of metabolism of aldosterone, too much remains in the systemdisordered sexual functionsWhich hormones would cause these endocrine disorders? Failure of Cholesterol/Steroid formation
20Liver Failure (cont.) Skin disorders Jaundice, red palms, spider nevi Hepatorenal syndrome-Deteriorating liver function is believed to cause changes in the circulation altering blood flow in the kidneys. The renal failure of HRS is a consequence of these changes in blood flowAzotemia, increased plasma creatinine, oliguria- decreased production of urineHepatic encephalopathy- caused by accumulation in the bloodstream of toxic substances that are normally removed by the liverAsterixis, confusion, coma, convulsionsAsterixis : An uncontrollable flapping of the hands that becomes noticeable when patients stretch out their arms, palms out, as if stopping traffic.
23AnswerIncreased 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).
24Hepatitis Viral hepatitis Hepatitis A virus (HAV) Hepatitis B virus (HBV)Hepatitis B–associated delta virus (HDV)Hepatitis C virus (HCV)Hepatitis E virus (HEV)
25Which hepatitis viruses are most likely to be the problem in: DiscussionWhich hepatitis viruses are most likely to be the problem in:An asymptomatic drug abuser?A nursing student who has spent the last two months volunteering in an orphanage in Mali?An infant whose mother has hepatitis?CEB
26Chronic Viral Hepatitis Caused by HBV, HCV, and HDVPrincipal worldwide cause of chronic liver disease, cirrhosis, and hepatocellular cancerChief reason for liver transplantation in adults
27Alcoholic Liver Disease Fatty liver (steatosis)Liver cells contain fat deposits; liver is enlargedAlcoholic hepatitisLiver inflammation and liver cell failureCirrhosisScar tissue partially blocks sinusoids and bile canaliculi
31QuestionWhich of the following is the least virulent strain of hepatitis?HAVHBVHCVHDV
32AnswerHAVRationale: 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).
33Veins Draining into the Hepatic Portal System Portal hypertension causes pressure in these veins to increaseVaricosities and shunts developOrgans engorge with blood
36Effects of Portal Hypertension HemorrhoidsAscites &Caput medusae
37Cholestasis and Intrahepatic Biliary Disorders Bile flow in the liver slows downBile accumulates and forms plugs in the ductsDucts rupture and damage liver cellsAlkaline phosphatase released into bloodLiver is unable to continue processing bilirubinIncreased bile acids in blood and skinPruritus (itching)
38The Fate of BilirubinHemoglobin from old red blood cells becomes bilirubinThe liver converts bilirubin into bileWhy would a man with liver failure develop jaundice?unconjugatedbilirubin inbloodbilirubinemialiver links ittogluconuridejaundiceconjugatedbilirubinbile
39Biliary Tract Gallbladder Hepatic duct Cystic duct Common bile duct Ampulla of VaterSphincter of OddiPancreatic duct
40Disorders of the Gallbladder Cholelithiasis (gallstones)Cholesterol, calcium salts, or mixedAcute and chronic cholecystitisInflammation caused by irritation due to concentrated bileCholedocholithiasisStones in the common bile ductCholangitisInflammation of the common bile duct
41Bile in the Intestines Emulsifies fats so they can be digested Passes on to the large intestineBacteria convert it to urobilinogenSome is lost in fecesMost is reabsorbed into the bloodReturned to the liver to be reusedFiltered out by the kidneys urine
42The Pancreas Pancreas Exocrine Endocrine pancreas pancreas releases digestivereleases hormonesjuices through ainto the bloodductto theduodenum
43Exocrine Pancreas Acini produce: Inactive digestive enzymesTrypsin inactivatorBicarbonate (antacid)These are sent to the duodenum when it releases secretin and cholecystokininIn the duodenum, the digestive enzymes are activated
44QuestionTell whether the following statement is true or false. The exocrine pancreas produces insulin.
45AnswerFalse Rationale: Beta cells of the endocrine pancreas produce insulin; the exocrine pancreas produces digestive enzymes that are secreted into the small intestine through the common bile duct.
46Biliary Reflux5. Bile in pancreas disrupts tissues; digestive enzymes activated1. Gallbladder contracts2. Bile is sent down common bile duct3. Blockage forms in ampulla of Vater: bile cannot enter duodenum4. Bile goes up pancreatic duct
47Autodigestion of the Pancreas Activated enzymes begin to digest the pancreas cellsSevere pain resultsInflammation produces large volumes of serous exudate hypovolemiaEnzymes (amylase, lipase) appear in the bloodAreas of dead cells undergo fat necrosisCalcium from the blood deposits in themHypocalcemia
48Chronic Pancreatitis and Pancreatic Cancer Have signs and symptoms similar to acute pancreatitisOften have:Digestive problems because of inability to deliver enzymes to the duodenumGlucose control problems because of damage to islets of LangerhansSigns of biliary obstruction because of underlying bile tract disorders or duct compression by tumors