ALU201_Ch2.pdf

Chapter 3: Four Cancers LIVER AND BILE DUCT DISORDERS Introduction The Egyptian Papyrus Ebers chapter is to help the underwriter determine the mortality implications associated with disorders Page 23 ALU 201: Intermediate Medical Life Insurance Writing contained in the liver. Arterial (oxygenated) b...

Chapter 3: Four Cancers LIVER AND BILE DUCT DISORDERS Introduction The Egyptian Papyrus Ebers chapter is to help the underwriter determine the mortality implications associated with disorders Page 23 ALU 201: Intermediate Medical Life Insurance Writing contained in the liver. Arterial (oxygenated) blood is supplied to the liver by the hepatic artery, while the portal vein brings to the liver all the blood that has previously passed through the small intestine and spleen. enter sinusoids lobule. The central veins coalesce into hepatic veins, which leave the liver and empty into the Biliary System Page 24 Chapter 2: Liver and Bile Duct Disorders Enzymes in the liver alter some toxins so they can be more easily excreted in urine. Metabolism substances needed by the body. 1. 2. 3. certain globulins that transport substances such as cholesterol and iron. Page 25 ALU 201: Intermediate Medical Life Insurance Writing Digestive Functions neutralize acid in the duodenum. in these red blood cells and is excreted into bile by hepatocytes. Jaundice results when bilirubin Storage and B12. Blood Tests 1. with other pathologic disorders. 2. 3. medications, sample collection technique, specimen transport/stability, and hemolysis. 4. 1. detect injury to hepatocytes (i.e., determine cellular integrity) 2. determine hepatic biosynthetic capacity (i.e., ability to synthesize proteins) 3. 4. 5. serve as tumor markers. Page 26 Chapter 2: Liver and Bile Duct Disorders duct epithelia, and kidney but is also present in smaller amounts in many other tissues, including the pancreas, heart, epididymis, small intestine, bone marrow, spleen, and brain. Since there is phosphatase. (Dilantin® ® injury, or bone growth. hepatic tumors, hepatic congestion, acute and chronic hepatitis, biliary obstruction, sclerosing Page 27 ALU 201: Intermediate Medical Life Insurance Writing Bilirubin the liver’s ability to take up, process, and secrete bilirubin into the bile. some is reabsorbed and goes through the liver again, and a small amount is excreted in the urine. added to the blood specimen. In the clinical setting, total bilirubin, direct bilirubin, and indirect 1. 2. 1. 2. atresia, sclerosing cholangitis. Alkaline Phosphatase liver, increased AP levels are stimulated by a rise in bile acids. A rise in bile acids is the earliest also be elevated Page 28 Chapter 2: Liver and Bile Duct Disorders 1. liver – biliary obstruction, cholestasis, cholecystitis, cholangitis, cirrhosis 2. 3. 4. 5. 6. 7. 8. malignant tumors renal disease (secondary hyperparathyroidism) primary hyperthyroidism polycythemia vera pregnancy normal bone growth in children and adolescents. Albumin Albumin, which is the most important plasma protein, is synthesized exclusively in the liver. With progressive hepatocellular injury, hepatic synthetic capacity decreases and albumin levels nephrotic syndrome, in which protein is lost through the urine. hepatitis. Most studies report that elevated AFP concentrations are present in approximately 70% the diagnosis. Prothrombin Time Page 29 ALU 201: Intermediate Medical Life Insurance Writing detect binge drinking. Computed Tomography liver or hemochromatosis. Page 30 Chapter 2: Liver and Bile Duct Disorders metastases. lesions, particularly hemangiomas. Despite all the other diagnostic testing available, liver biopsy remains the most accurate test to 1. 2. 3. 4. 5. 6. 7. 8. with liver biopsy. These include pain, hemorrhage, biliary peritonitis, and bacteremia. The major obtained. Surrogate Tests Although liver biopsy is the gold standard to evaluate liver pathology, it is an invasive procedure Page 31 ALU 201: Intermediate Medical Life Insurance Writing Serologic Tests Radiologic Tests measuring their speed through the liver using imaging. The imaging can be with ultrasound or Major Disorders 1. 2. 3. 4. 5. processes). Page 32 Chapter 2: Liver and Bile Duct Disorders F3 – numerous septa without cirrhosis F4 – cirrhosis Page 33 ALU 201: Intermediate Medical Life Insurance Writing >66%. 1. 2. 3. 4. 5. 6. 7. 8. older age DM heavy alcohol use elevated serum transaminases BMI >28 which may lead to hepatocellular carcinoma. likely to develop in someone with steatohepatitis than steatosis. Although alcohol is considered a Page 34 Chapter 2: Liver and Bile Duct Disorders 1. 2. 3. 4. 5. malnutrition 6. 7. liver. Cirrhosis 1. 2. 3. 4. 5. portal hypertension, esophageal varices, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, and coagulopathy. Jaundice Jaundice, or icterus Page 35 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. hepatic jaundice 3. extrahepatic jaundice (obstructive jaundice). Portal Hypertension blood (75%) supplied by the portal circulation in the liver. The portal vein receives venous blood circulation, bypassing the liver. hypersplenism, ascites, and acute and chronic hepatic encephalopathy. disease. Esophageal Varices secondary to hepatitis C, the risk is lower, in that 30% develop esophageal varices within six to 50% mortality rate associated with each bleeding episode. Page 36 Chapter 2: Liver and Bile Duct Disorders vessels is measured in millimeters while the esophageal varices can be 0.5 to 1.0 cm or larger in diameter. Ascites cirrhosis and less commonly in those with subacute liver disease. Those with ascites and cirrhosis Hepatorenal Syndrome 1. 2. marked abnormalities in systemic hemodynamics 3. splanchnic circulation, which Page 37 ALU 201: Intermediate Medical Life Insurance Writing Hepatic Encephalopathy and reversible or chronic and progressive. In severe cases, irreversible coma and death can occur. Coagulopathy there can be direct bone marrow suppression due to the alcohol. Diminished protein synthesis can hepatitis. hepatitis produce clinically similar illnesses. Page 38 Chapter 2: Liver and Bile Duct Disorders Hepatitis A chronic liver disease, and the immunosuppressed. A vaccine is available to prevent hepatitis A in Hepatitis B hepatocellular carcinoma worldwide. childbirth. 1. 2. 3. 4. months. Page 39 ALU 201: Intermediate Medical Life Insurance Writing 1. 2. severe acute viral hepatitis 3. 4. hepatitis. 1. a. b. c. d. a. b. c. d. a. b. c. 4. a. b. c. chronic carrier state d. 5. 6. a. measures the viral load b. treatment and to track response to treatment. Page 40 Chapter 2: Liver and Bile Duct Disorders Grade Descriptive necrosis 0 Portal 1 Minimal necrosis Minimal, patchy necrosis 2 3 Mild Moderate portal tracts Moderate damage hepatocellular change 4 Severe Severe damage Stage 0 1 2 3 4 Descriptive Criteria Fibrous portal expansion Cirrhosis obvious cirrhosis Cirrhosis Hepatitis C new viral particles each day, generating many mutant viruses. These represent minor molecular Page 41 ALU 201: Intermediate Medical Life Insurance Writing hepatocellular carcinoma. 1. (e.g., blood donors). 2. stage. 3. liver has occurred. 1. direct damage to hepatocytes 2. 3. another third progress to cirrhosis within 30 years. The remainder progress so slowly that they Page 42 Chapter 2: Liver and Bile Duct Disorders progression include age (increasing age is associated with more rapid progression), gender (males appropriate treatment. Hepatitis D Hepatitis E third trimester, is approximately 20%. Autoimmune Hepatitis Page 43 ALU 201: Intermediate Medical Life Insurance Writing Evidence suggests that the progressive liver injury in individuals with autoimmune hepatitis is Autoimmune hepatitis is initially treated with prednisone, with or without azathioprine (Imuran®). Drug-induced liver injury (DILI) complication. Page 44 Chapter 2: Liver and Bile Duct Disorders 1. 2. 3. recessive disorder with low penetrance, which means that not everyone with the gene mutation The excessive iron is deposited into several organs, including the heart, pancreas, skin, joints, heart, skin, joints, and endocrine organs. 1. hepatocellular carcinoma (30%) 2. esophageal varices 3. 4. 5. only 62%. Page 45 ALU 201: Intermediate Medical Life Insurance Writing 1. protein, can be associated with hemochromatosis but can also be elevated in the presence 2. is the protein that transports iron in the blood. 3. 4. 5. liver biopsy. lesions. The most common benign solid tumors are hepatocellular adenoma, hemangioma, and Hepatocellular Adenoma adenomas > 5 cm or who are experiencing symptoms should undergo surgical resection. Men have Hemangioma Page 46 Chapter 2: Liver and Bile Duct Disorders In most cases, hemangiomas are small and asymptomatic. When symptoms are present, right hemangioma is rare and is not related to the lesion size. Although hemangiomas can increase in there is no additional mortality risk associated with hemangiomas. Focal Nodular Hyperplasia be made, liver biopsy or surgical resection can be indicated to rule out hepatocellular carcinoma. require treatment. in individuals with cirrhosis. Page 47 ALU 201: Intermediate Medical Life Insurance Writing gastrointestinal, and genitourinary tracts. Portal Vein Thrombosis vein thrombosis include cirrhosis, malignancy, pancreatitis, hypercoagulable disorders, and sepsis. and increased pressure in the vascular bed. This leads to portal hypertension and its associated complications, including variceal bleeding, hepatic encephalopathy, and ascites. In cases where hypertension is variceal bleeding. Wilson’s Disease gastrointestinal absorption and biliary excretion. organs, primarily the brain. The primary complications associated with progressive disease include Page 48 Chapter 2: Liver and Bile Duct Disorders with neurologic or psychiatric symptoms. Early recognition is critically important since untreated and genetic mutation testing. Page 49 ALU 201: Intermediate Medical Life Insurance Writing Gilbert’s Syndrome phosphatase concentrations are normal. Cholangitis and extrahepatic bile ducts. Cholangitis can be acute or chronic. It can originate as a primary Acute Cholangitis most common cause. in the gallbladder, bile duct, ampulla, duodenum, or pancreas. Acute cholangitis can also be a to treatment. Page 50 Chapter 2: Liver and Bile Duct Disorders Primary Sclerosing Cholangitis the immune system are thought to cause the disease. An autoimmune response, causing damage to the intrahepatic and extrahepatic biliary tree. It is a progressive disease that results in irreversible Primary Biliary Cholangitis progressive liver disease. Primary biliary cholangitis is a chronic and progressive cholestatic liver disease that have been observed. smoking and certain genetic mutations. Page 51 ALU 201: Intermediate Medical Life Insurance Writing Hepatic Sarcoidosis The liver is involved in most people with sarcoidosis but is only symptomatic in 5 to 15% cholangitis and hepatic vein thrombosis. Gaucher’s Disease 1. 2. deterioration. 3. children. It progresses more slowly with survival into late adolescence and early adulthood. Page 52 Chapter 2: Liver and Bile Duct Disorders Reye’s Syndrome Early recognition and treatment are essential to prevent death and to minimize the risk although neurologic impairment is common in children. Page 53