1. Copyright © 2015 Cengage Learning ®. Chapter 12 Liver, Gallbladder, and Pancreatic Diseases and Disorders

2. Copyright © 2015 Cengage Learning ®. Anatomy and Physiology Liver – Largest solid organ – Plays role in: Digestion Absorption Metabolism Blood clotting Manufacture of chemicals Storage of nutrients

3. Copyright © 2015 Cengage Learning ®. Blood flow into and out of the Liver

4. Copyright © 2015 Cengage Learning ®. You should be moving your bowels at least once a day and a big reason for this is because your body uses your colon to excrete many of these toxins. Otherwise, these toxins will literally float around your colon only to be re-absorbed into your body again, further congesting your liver.

5. Copyright © 2015 Cengage Learning ®. Liver Weighing in at around 3 pounds, the liver is the body’s second largest organ; only the skin is larger and heavier. The liver performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. These functions make the liver a vital organ without which the tissues of the body would quickly die from lack of energy and nutrients. Fortunately, the liver has an incredible capacity for regeneration of dead or damaged tissues; it is capable of growing as quickly as a cancerous tumor to restore its normal size and function.

6. Copyright © 2015 Cengage Learning ®. Liver Glucose Metabolism : Insulin generally functions to maintain normal levels of glucose in the blood by transporting glucose into the cells. When the glucose is depleted, Glucose metabolism usually then takes place to provide fuel to most tissues and muscles inside the body, including the heart muscles as they typically need energy constantly to perform their normal functions. There are a number of different areas of functionality when it comes to metabolism and the liver. The liver is involved in the breakdown of fats, proteins, and carbohydrates, splitting them into components the body can use with a series of chemical reactions.

7. Copyright © 2015 Cengage Learning ®. The liver produces coagulation factorThe liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin. In the first trimester fetus, the liver is the main site of red blood cell productions I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin. In the first trimester fetus, the liver is the main site of red blood cell production

8. Copyright © 2015 Cengage Learning ®.

9. Because we live in a society that is literally full of toxins everywhere you look, it is becoming more and more difficult for your liver to keep up with the growing number of toxins you encounter on a daily basis. Toxic chemicals are in your… Meat, vegetables, grains, and any other food Soaps, shampoos, and conditioners Toothpaste, deodorant, and other personal hygiene products Makeup Cleaning products Carpet Car Water Plastics and the list goes on…

10. Copyright © 2015 Cengage Learning ®. Anatomy and Physiology Gallbladder –Lies just under the liver –Stores bile until needed Pancreas –Lies behind the stomach –Produces and excretes most intestinal enzymes

11. Copyright © 2015 Cengage Learning ®. According to the Chinese medicine system, the following functions are mostly the responsibility of your child's gall bladder energy circuit: Chinese medicine all bladder energy related symptoms are shown below and these are some of the things I look out for when learning about a child's history and current situation. http://www.principlesforparents.com/gall-bladder-energy.html SOME INTERESTING CONCEPTS

12. Copyright © 2015 Cengage Learning ®. The liver produces bile, which flows through the bile ducts and into the gallbladder, says Rogula. After a meal, bile is released by the gallbladder when the small intestine secrets a hormone called cholecystokinin. Then the bile flows into the small intestine and helps to break down fats — for example, that big cheeseburger you just ate. People who undergo surgical removal of the gallbladder rarely have any problems with biliary system function after surgery, says Rogula. The body can cope with losing its extra storage space for bile by filling the bile ducts — which transport bile from the liver (by way of the cyctic duct taking to the gallbladder first) and the bile duct to the small intestine — and using them to store the excess bile. Sometimes, as a result of this surgery, Rogula notes that the bile ducts may become slightly distended, but this generally isn't a big concern.

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14. Enzyme Type EffectsA shortage may cause: Lipase Lipase works with bile from the liver to break down fat molecules so they can be absorbed and used by the body. Lack of needed fats and fat- soluble vitamins. Diarrhea and/or fatty stools. Protease Proteases break down proteins. They help keep the intestine free of parasites such as bacteria, yeast and protozoa. Allergies or the formation of toxic substances due to incomplete digestion of proteins. Increased risk for intestinal infections. Amylase Amylase breaks down carbohydrates (starch) into sugars which are more easily absorbed by the body. This enzyme is also found in saliva. Diarrhea due to the effects of undigested starch in the colon. Types of Pancreatic Enzymes and Their Effects

15. Copyright © 2015 Cengage Learning ®. Some of the symptoms associated with pancreatic enzyme insufficiency include : feelings of indigestion cramping after meals large amounts of gas foul smelling gas or stools floating or greasy/fatty stools light-colored, yellow or orange stools frequent stools loose stools weight loss

16. Copyright © 2015 Cengage Learning ®. Common Signs and Symptoms Liver disease – Jaundice Gallbladder and pancreas disease – Pain Most common symptom

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18. Undergo testing For adults suffering from jaundice, testing is needed to determine the cause of the condition. The most common test used is the CT scan (Computed Tomography Scan). A liver biopsy may be required if blood serum and medical imaging tests do not provide a definitive diagnosis

19. Copyright © 2015 Cengage Learning ®. Signs of Gallbladder Attack Gallbladder attack is associated with minimal to moderate pain felt just below the right rib cage, especially when inhaling Belching can be one of the gallbladder attack signs Hyperactive stomach, which can cause nausea and may eventually lead to vomiting. Headaches, fever and chills Exaggeration of pain right after eating or at night. The pain associated with gallbladder attacks may last for several minutes up to several hours up to several days. In some cases, the pain felt may radiate to the location of the small intestines. This is due to the acidity of the food contents that passes through the intestines. This can happen when bile is absent

20. Copyright © 2015 Cengage Learning ®. Gallbladder Pain Location

21. Copyright © 2015 Cengage Learning ®. Diagnostic Tests Liver function tests measure bilirubin, albumin, and alkaline phosphatase Ultrasound, X-rays, CT scan Biopsy Blood tests to measure pancreatic function

22. Copyright © 2015 Cengage Learning ®. Blood tests can evaluate the function of the gallbladder, liver, and pancreas. Levels of the pancreatic enzymes amylase and lipase can be measured. Blood tests can also check for signs of related conditions, including infection, anemia (low blood count), and dehydration.

23. Copyright © 2015 Cengage Learning ®. Adults age 60 and younger: 10–140 units per liter (U/L) or 0.17–2.3 microkatals/liter (mckat/L)units per liter (U/L) Adults older than age 60: 18–180 units per liter (U/L) or 0.30–3.0 mckat/L High values A high lipase level may be caused by: Diseases of the pancreas, such as pancreatitis or cancer of the pancreas.pancreaspancreatitiscancer Problems with the gallbladder, such as gallstones and inflammation (cholecystitis).gallbladdergallstonescholecystitis Chronic kidney disease. Chronic kidney disease Problems with the intestines, such as bowel blockage (obstruction) or tissue death (infarction).intestinesobstruction Infection, inflammation, or cancer of a salivary gland.cancer Peptic ulcer disease. Peptic ulcer disease Primary biliary cirrhosis, a serious condition that damages the liver and keeps it from working the way it should. Primary biliary cirrhosisliver Alcohol or drug abuse.

24. Copyright © 2015 Cengage Learning ®. Liver Diseases Liver disease – Can range from mild inflammation to those that destroy the liver and result in liver failure Hepatitis – Inflammation of liver – Causes: Chemical actions of drugs or toxic substances Chronic alcoholism Group of viruses – The most common cause

25. Copyright © 2015 Cengage Learning ®. Liver Diseases Hepatitis – Viral hepatitis Most prevalent disease in the world Asymptomatic to vague symptoms Five types of viral hepatitis – A, B, C, D, E Hepatitis A – Benign – Spread by oral–fecal contact

26. Copyright © 2015 Cengage Learning ®. Liver Diseases Hepatitis B – Formerly called serum hepatitis – Spread by blood, urine, feces, saliva, and semen – Considered a sexually transmitted disease – 100 times more infectious than HIV Hepatitis C – Spread by blood or sexual contact – Progresses very slowly, usually chronic Hepatitis D – Delta virus requires presence of hepatitis B to replicate

27. Copyright © 2015 Cengage Learning ®. Liver Diseases Hepatitis E – Spread by oral–fecal contact Commonly due to water contamination – Symptoms: Jaundice and liver enlargement Malaise Anorexia Fever Myalgia and abdominal pain Dark-colored urine Clay or light-colored stools

28. Copyright © 2015 Cengage Learning ®. Liver Diseases Hepatitis – Treatment: Rest Good nutrition Antiviral medications – Prevention: Good hygiene Special care when handling needles and body fluids

29. Copyright © 2015 Cengage Learning ®. Liver Diseases Cirrhosis – Chronic, irreversible, and degenerative – Also known as end-stage liver disease – Replacement of normal liver cells with nonfunctioning scar tissue Hobnail liver

30. Copyright © 2015 Cengage Learning ®. Liver Diseases Cirrhosis – Most common cause: Chronic alcoholism – Symptoms: Loss of appetite Nausea Indigestion Weakness Weight loss

31. Copyright © 2015 Cengage Learning ®. Liver Diseases Cirrhosis – Complications of severe cirrhosis: Portal hypertension Esophageal varices with caput medusa Splenomegaly Gastrointestinal hemorrhage – hematemesis Ascites Edema Jaundice

32. Copyright © 2015 Cengage Learning ®. Visit pageView image Portal Hypertension Caput Medusae and esophageal varices

33. Copyright © 2015 Cengage Learning ®. Caput Medusae spleenomegaly

34. Copyright © 2015 Cengage Learning ®. Complications of Cirrhosis: Ascites

35. Copyright © 2015 Cengage Learning ®. ICD-10ICD-10 ICD-9ICD-9 782.3782.3 DiseasesDBDiseasesDB 91489148 MedlinePlusMedlinePlus 0031000310 MeSHMeSH D004487D004487 Oedema

36. Copyright © 2015 Cengage Learning ®. Liver Diseases Cirrhosis – Complications of severe cirrhosis: (continued) Altered sex hormone metabolism – Gynecomastia – Palmar erythema – Spider angiomas – Female hair distribution – Testicular atrophy Hepatic encephalopathy – Delirium tremens

37. Copyright © 2015 Cengage Learning ®. ← Previous Patient ← Previous Patient Next Patient → Next Patient →

38. Copyright © 2015 Cengage Learning ®. Spider Angiomaspider-angioma-3.jpg

39. Copyright © 2015 Cengage Learning ®. Liver Diseases Liver cancer – Primary and benign tumors of liver rare – Usually discovered late or end stage – Diagnosis by biopsy – Treatment: Radiation Surgery Chemotherapy – Prognosis: very poor

40. Copyright © 2015 Cengage Learning ®. Gallbladder Diseases Cholecystitis – Inflammation of gallbladder usually caused by obstruction of bile due to gallstone – Symptoms: pain in the upper right quadrant of the abdomen – Diagnosis by ultrasound or cholecystogram – Complication: rupture of the gallbladder leading to peritonitis – Treatment: surgical removal called cholecystectomy

41. Copyright © 2015 Cengage Learning ®. Gallbladder Diseases Cholelithiasis – Gallstones in gallbladder or bile ducts – Important risk factors called the 5 F’s of cholelithiasis Female Fair complexion Fat or obese Fertile or has children Forty years of age – Symptoms: Nausea Vomiting RUQ pain following meals with fat

42. Copyright © 2015 Cengage Learning ®. Cholelithiasis

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44. Pancreatic Diseases Pancreatitis – Inflammation of pancreas – Commonly caused by alcoholism – Symptoms: Severe abdominal pain radiating to back Nausea Vomiting Diaphoresis Tachycardia Elevated blood sugar due to decrease in insulin

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46. Pancreatic Diseases Pancreatitis – Symptoms of chronic pancreatitis similar to acute – Diagnosis by high blood amylase – Treatment and prognosis depend on cause Gallstones – cholecystectomy Idiopathic – palliative, symptomatic treatment Alcoholism – palliative, symptomatic treatment – Quit drinking alcohol – this will not cure pancreatitis

47. Copyright © 2015 Cengage Learning ®. Pancreatic Diseases Pancreatic cancer – Usually adenocarcinoma occurring in head of pancreas – Cause is unknown but carcinogens include cigarette smoking, high coffee consumption, chemical exposure, and consumption of high-fat diet – Symptoms: Abdominal and back pain Nausea and vomiting Loss of appetite Weakness and fatigue Jaundice

48. Copyright © 2015 Cengage Learning ®. Pancreatic Diseases Pancreatic cancer – Diagnosis by biopsy – Treatment: Surgical resection Radiation Chemotherapy – Prognosis: very poor

49. Copyright © 2015 Cengage Learning ®. Rare Diseases Primary biliary cirrhosis – Chronic liver disease that gradually destroys bile ducts in liver Gilbert’s syndrome – Congenital liver disorder Hemochromatosis – Body absorbs and stores excessive amounts of iron

50. Copyright © 2015 Cengage Learning ®. Hemochromatosis, also known as hereditary hemochromatosis, causes the body to absorb too much iron from foods you eat. The excess iron then gets stored in your organs, especially the liver, heart, and pancreas, which over time can damage them and lead to life-threatening illnesses such as cancer, heart problems, and liver disease.

51. Copyright © 2015 Cengage Learning ®. Effects of Aging Increased seriousness of infections Lifestyle risk factors contribute to health outcome Increased bile stones Decreased pancreatic enzymes