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
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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