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Liver...

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Liver and Biliary Systems - Hepatic Injury-inflammation (hepatitis) - Degeneration - Ballooning - Foamy - Steatosis - Necrosis - Coagulative - Councilman bodies - Hydropic degeneration - Fibrosis - Cirrhosis Degeneration - Ballooning--edematous liver with clear areas - Foamy--accumulation of iron or copper - Steatosis--accumulation of fat droplets in liver cells Necrosis - Coagulative--ischemia with cell rupture and death - Councilman bodies (groups of death eosinophils with scattered nuclei formed due to apoptosis) - Hydropic degeneration (Lytic necrosis)--influx of water due to excessive osmosis with rupture and death of cells Fibrosis - Replacement of liver cells with collagen - Related to toxic insult to the liver - After blood flow and perfusion of areas of the liver - Considered absolutely irreversible Cirrhosis - Fibrosis - Parenchymal injury Jaundice and Cholestasis - Jaundice--retention of bilirubin levels above 2.0 mg/dl - Yellow sclera and skin - Cholestasis--retention of bilirubin and bile salts and cholesterol - Symptoms: inadequate absorption of fat soluble vitamins Bilirubin and Bile Acids - Takes 2 weeks to mature function of conjugating and excreting bilirubin - Nearly every infant has some symptoms Hepatic failure - Early sign--jaundice - Musty body odor--action of GI bacteria on methionine (contains sulfur) - Patients susceptible to MODS (multiple organ failure) - Coagulopathy--decreased blood clotting factors Hepatic Encephalopathy

- Metabolic disorder of the CNS and neuromuscular system - Minor changes in the brain lead to edema (brain) - Severe loss of hepatic function - Shunting of blood around liver instead to through - Exposure of brain to toxins Hepatorenal Syndrome - Renal failure 2nd to liver failure - Kidney function improves if liver function improves - Hyperosmolar urine lacking proteins and sediments, low in sodium Cirrhosis--Fibrosis with parenchymal injury (60% ETOH related) - Portal hypertension - Ascites - Varices - Spider angiomas - Splenomegaly Hepatitis A - Was called infectious hepatitis - Rarely causes liver failure - benign , self-limited - Incubation 15-45 days - Fever, malaise, anorexia, jaundice Hepatitis - Acute or chronic inflammatory process of the cells of the liver Chronic Hep. B--5-10% of chronic liver disease - Was called serum hepatitis - Vaccination--effective if given within 7 days of exposure - Oral or sexual exposure possible in addition to blood-born - Cirrhosis, massive hepatic necrosis (fulminate type, bleeding) Chronic Hep. c--75-80% of chronic liver disease - Used to be called nonA-nonB - 6 specific genotypes with over 50 subtypes - Often subclinical--no symptoms - Fatigue, anorexia, weight loss Chronic Hep. D--disease process depends if concurrent infection with B - If without B can often be acute - Increases the severity of B because of a fulminating property Autoimmune - 10% of chronic hepatitis - Genetic predisposition - Antibodies directed at liver cells - Symptoms range from none to liver failure Biliary Atresia - Plugging of the intrahepatic or extrahepatic ducts Inborn Errors of metabolism and Pediatric liver disease - Hemochromatosis--autosomal recessive - Excess accumulation of iron in liver and pancreas - Leads to necrosis and pancreatic fibrosis - Wilson’s Disease--accumulation of toxic levels of copper--toxic levels to brain

- Copper chelation therapy--need transplant Alpha-antitrypsin Deficiencies--cholestasis---liver transplant Neonatal Hepatitis--jaundice, dark urine, hepatomegaly - Caused by biliary atresia - Lack of canal can be surgically corrected - Reye’s Syndrome - Faty changes in liver - Encephalopathy - 3-4 days following viral illness in children Intrahepatic Biliary Tract Diseases - Bile duct obstruction - Malformation of duct Circulatory Disorders - Impaired blood flow into the liver - Impaired blood flow through the liver - Hepatic venous outflow obstruction Tumors and tumor-like conditions - Benign tumors - Liver cell adenoma - Primary carcinoma of the liver Biliary tract - Disorders of the gallbladder - Cholelithiasis (gallstones) - Cholecystitis--inflammation of the gallbladder Disorders of Extrahepatic Bile Ducts - Choledoccholithiasis and ascending cholangitis - Persistent stones - Paired with inflammation of the bile ducts - Obstruction of duct, pancreatitis, liver abscess - Extrahepatic Biliary Atresia - Complete obstruction of the bile duct - Liver transplant Tumors - Carcinoma of gallbladder - Carcinoma of the Extrahepatic Bile Ducts, including Ampulla of Vater Exocrine Pancreas - Enzymes - Lipase - Amylase - Trypsin Pancreatitis - Acute pancreatitis - Activation of protease enzymes within the pancreas - Breakdown of tissue and cell membranes leading to inflammatory response -

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- Midabdominal pain radiating to the back - Bowel hypermobility Chronic Pancreatitis - Increases risk for pancreatic cancer - Chronic release of inflammatory mediators...