From Bullock & Henze Focus on
Pathophysiology 2000 Lipincott

Chapter 26

Chapter 26

Hepatobiliary and Pancreatic

Hepatobiliary and Pancreatic

Exocrine Function

Exocrine Function

Chapter 26

Chapter 26

Hepatobiliary and Pancreatic

Hepatobiliary and Pancreatic

Exocrine Function

Exocrine Function

A. The liver

A. The liver

A. The liver

A. The liver



1. Structure of the liver

1. Structure of the liver



a. Blood supply

a. Blood supply



2. Functions of the liver

2. Functions of the liver



a. Protein synthesis and metabolism

a. Protein synthesis and metabolism



b. Synthesis and metabolism of amino acids

b. Synthesis and metabolism of amino acids



d. Synthesis and metabolism of plasma proteins

d. Synthesis and metabolism of plasma proteins



e. Carbohydrate metabolism

e. Carbohydrate metabolism



f. Phagocytosis

f. Phagocytosis



g. Biotransformation of foreign substances

g. Biotransformation of foreign substances



h. Bile and bilirubin synthesis

h. Bile and bilirubin synthesis



1. Structure of the liver

1. Structure of the liver



a. Blood supply

a. Blood supply



2. Functions of the liver

2. Functions of the liver



a. Protein synthesis and metabolism

a. Protein synthesis and metabolism



b. Synthesis and metabolism of amino acids

b. Synthesis and metabolism of amino acids



d. Synthesis and metabolism of plasma proteins

d. Synthesis and metabolism of plasma proteins



e. Carbohydrate metabolism

e. Carbohydrate metabolism



f. Phagocytosis

f. Phagocytosis



g. Biotransformation of foreign substances

g. Biotransformation of foreign substances



h. Bile and bilirubin synthesis

h. Bile and bilirubin synthesis

Gallbladder and Pancreas

Gallbladder and Pancreas

Gallbladder and Pancreas

Gallbladder and Pancreas



B. The gallbladder

B. The gallbladder



C. The exocrine pancreas

C. The exocrine pancreas



1. Secretion

1. Secretion



a. Nervous and hormonal regulation

a. Nervous and hormonal regulation



2. Protein, fat and carbohydrate digestion

2. Protein, fat and carbohydrate digestion



B. The gallbladder

B. The gallbladder



C. The exocrine pancreas

C. The exocrine pancreas



1. Secretion

1. Secretion



a. Nervous and hormonal regulation

a. Nervous and hormonal regulation



2. Protein, fat and carbohydrate digestion

2. Protein, fat and carbohydrate digestion

Diagnostic Liver Tests

Diagnostic Liver Tests

Diagnostic Liver Tests

Diagnostic Liver Tests



Liver Structure

Liver Structure



CT

CT



Ultrasound

Ultrasound



Radionucliide scans

Radionucliide scans



Liver enzymes

Liver enzymes



AST

AST



ALT

ALT



GGTP

GGTP



Alk Phos

Alk Phos



LDH

LDH



Liver Structure

Liver Structure



CT

CT



Ultrasound

Ultrasound



Radionucliide scans

Radionucliide scans



Liver enzymes

Liver enzymes



AST

AST



ALT

ALT



GGTP

GGTP



Alk Phos

Alk Phos



LDH

LDH



Liver Function

Liver Function



albumin

albumin



cholesterol

cholesterol



bilirubin

bilirubin



prothrombin

prothrombin



proteins

proteins



(ammonia)

(ammonia)



Liver Function

Liver Function



albumin

albumin



cholesterol

cholesterol



bilirubin

bilirubin



prothrombin

prothrombin



proteins

proteins



(ammonia)

(ammonia)

Liver dysfunction

Liver dysfunction

Liver dysfunction

Liver dysfunction



1. Jaundice

1. Jaundice



a. Etiology and pathophysiology

a. Etiology and pathophysiology



3. Ascites

3. Ascites



4. Portal hypertension and varices

4. Portal hypertension and varices



5. Liver failure

5. Liver failure



6. Hepatic encephalopathy and coma

6. Hepatic encephalopathy and coma



7. Hepatorenal syndrome

7. Hepatorenal syndrome



8. Drug-related liver damage

8. Drug-related liver damage



9. Reye's syndrome

9. Reye's syndrome



1. Jaundice

1. Jaundice



a. Etiology and pathophysiology

a. Etiology and pathophysiology



3. Ascites

3. Ascites



4. Portal hypertension and varices

4. Portal hypertension and varices



5. Liver failure

5. Liver failure



6. Hepatic encephalopathy and coma

6. Hepatic encephalopathy and coma



7. Hepatorenal syndrome

7. Hepatorenal syndrome



8. Drug-related liver damage

8. Drug-related liver damage



9. Reye's syndrome

9. Reye's syndrome

Cirrhosis of the liver

Cirrhosis of the liver

Cirrhosis of the liver

Cirrhosis of the liver



a Biliary cirrhosis

a Biliary cirrhosis



b. Alcoholic (Laennec's)

b. Alcoholic (Laennec's)

cirrhosis

cirrhosis



alcoholic fatty infiltration

alcoholic fatty infiltration



alcoholic hepatitis

alcoholic hepatitis



alcoholic cirrhosis

alcoholic cirrhosis



portal hypertension

portal hypertension



loss of synthetic function

loss of synthetic function



loss of metabolic function

loss of metabolic function



a Biliary cirrhosis

a Biliary cirrhosis



b. Alcoholic (Laennec's)

b. Alcoholic (Laennec's)

cirrhosis

cirrhosis



alcoholic fatty infiltration

alcoholic fatty infiltration



alcoholic hepatitis

alcoholic hepatitis



alcoholic cirrhosis

alcoholic cirrhosis



portal hypertension

portal hypertension



loss of synthetic function

loss of synthetic function



loss of metabolic function

loss of metabolic function

Portal Circulation

Portal Circulation

Portal Circulation

Portal Circulation

Liver Masses

Liver Masses

Liver Masses

Liver Masses



a. Benign hepatic tumors

a. Benign hepatic tumors



b. Primary malignancies

b. Primary malignancies



c. Metastatic carcinoma

c. Metastatic carcinoma



d. Other space occupying lesions

d. Other space occupying lesions



cysts

cysts



abscesses

abscesses



granulomatous diseass

granulomatous diseass



a. Benign hepatic tumors

a. Benign hepatic tumors



b. Primary malignancies

b. Primary malignancies



c. Metastatic carcinoma

c. Metastatic carcinoma



d. Other space occupying lesions

d. Other space occupying lesions



cysts

cysts



abscesses

abscesses



granulomatous diseass

granulomatous diseass

Bilirubin Metabolism

Bilirubin Metabolism

& Jaundice

& Jaundice

Bilirubin Metabolism

Bilirubin Metabolism

& Jaundice

& Jaundice



Erythrocyte

Erythrocyte



erythropoiesis

erythropoiesis



hemolysis

hemolysis



Hepatic

Hepatic



uptake

uptake



conjugation

conjugation



secretion

secretion



Biliary

Biliary



obstruction

obstruction



Erythrocyte

Erythrocyte



erythropoiesis

erythropoiesis



hemolysis

hemolysis



Hepatic

Hepatic



uptake

uptake



conjugation

conjugation



secretion

secretion



Biliary

Biliary



obstruction

obstruction

Viral hepatitis

Viral hepatitis

Viral hepatitis

Viral hepatitis



Acute, fecal-oral, self-

Acute, fecal-oral, self-

limited (usually)

limited (usually)



Hepatitis A

Hepatitis A



Hepatitis E

Hepatitis E



Acute & chronic, blood &

Acute & chronic, blood &

body fluids, complicated

body fluids, complicated



Hepatitis B

Hepatitis B



Hepatitis delta

Hepatitis delta



Hepatitis C

Hepatitis C



Acute, fecal-oral, self-

Acute, fecal-oral, self-

limited (usually)

limited (usually)



Hepatitis A

Hepatitis A



Hepatitis E

Hepatitis E



Acute & chronic, blood &

Acute & chronic, blood &

body fluids, complicated

body fluids, complicated



Hepatitis B

Hepatitis B



Hepatitis delta

Hepatitis delta



Hepatitis C

Hepatitis C

Gallbladder dysfunction

Gallbladder dysfunction

Gallbladder dysfunction

Gallbladder dysfunction



1. Cholecystitis and

1. Cholecystitis and

cholelithiasis

cholelithiasis



biliary colic

biliary colic



cholelithiasis

cholelithiasis



cholecystitis

cholecystitis



empyema of the

empyema of the

gallbladder

gallbladder



2. Cancer of the

2. Cancer of the

gallbladder

gallbladder



1. Cholecystitis and

1. Cholecystitis and

cholelithiasis

cholelithiasis



biliary colic

biliary colic



cholelithiasis

cholelithiasis



cholecystitis

cholecystitis



empyema of the

empyema of the

gallbladder

gallbladder



2. Cancer of the

2. Cancer of the

gallbladder

gallbladder

http://www.wip.villa-bosch.de/

C. Exocrine pancreatic dysfunction

C. Exocrine pancreatic dysfunction

C. Exocrine pancreatic dysfunction

C. Exocrine pancreatic dysfunction



1. Acute pancreatitis

1. Acute pancreatitis



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



2. Chronic pancreatitis

2. Chronic pancreatitis



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



3. Cancer of the pancreas

3. Cancer of the pancreas



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



1. Acute pancreatitis

1. Acute pancreatitis



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



2. Chronic pancreatitis

2. Chronic pancreatitis



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



3. Cancer of the pancreas

3. Cancer of the pancreas



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations

Cystic fibrosis

Cystic fibrosis

Cystic fibrosis

Cystic fibrosis



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



sweat glands - excess salt losses

sweat glands - excess salt losses



pancreas - insufficiency

pancreas - insufficiency



lungs - bronchitis, COPD, cor pulmonale

lungs - bronchitis, COPD, cor pulmonale



reproduction - infertility

reproduction - infertility



liver - biliary obstruction, cirrhosis

liver - biliary obstruction, cirrhosis



intenstines - obstruction

intenstines - obstruction



a. Pathophysiology

a. Pathophysiology



b. Clinical manifestations

b. Clinical manifestations



sweat glands - excess salt losses

sweat glands - excess salt losses



pancreas - insufficiency

pancreas - insufficiency



lungs - bronchitis, COPD, cor pulmonale

lungs - bronchitis, COPD, cor pulmonale



reproduction - infertility

reproduction - infertility



liver - biliary obstruction, cirrhosis

liver - biliary obstruction, cirrhosis



intenstines - obstruction

intenstines - obstruction