Disorder of Liver, Pancreas, Gallbladder

• Bile production, storage, and secretion

  1. Produced by liver

  2. Stored in gallbladder

  3. Secreted into small intestine
• Liver's role

  • Detoxifying
  • Metabolizing
  • Filtration
• Nutrient metabolism


  Liver metabolizes drugs, filters blood, plays role in carbohydrate metabolism
• Bile synthesis


  Breaks down fat and transports waste back to liver
• Urea synthesis


  Liver converts ammonia to urea for extraction by kidneys
• Detoxification


  Liver detoxifies
• Pancreatitis


  Leads to elevated serum amylase and lipase levels
• Acute and chronic pancreatitis

  1. Acute pancreatitis leads to inflammation and autodigestion

  2. Chronic pancreatitis occurs from repeated attacks, leading to fibrosis and scarring, eventually causing diabetes
• Cholesterol stones


  • Asymptomatic "silent" stones that require no treatment
  • Weight loss can increase risk
  • More common in women
• Hepatocellular failure


  Leads to jaundice
• Liver disease diagnosis


  • Main tests: AST/ALT
  • Biochemical assays, needle biopsy, ultrasound, CT, ERCP
  • Conjugated/unconjugated bilirubin levels
  • Elevated AST/SGOT, ALT/SGPT
  • Coagulation factors, RBC breakdown leading to bilirubin
• Bilirubin types


  • Unconjugated: due to hemolysis and ineffective erythropoiesis
  • Conjugated: due to liver dysfunction or obstruction in bilirubin transport
• Etiologies for cirrhosis


  • Chronic alcohol use
  • Biliary obstruction
• Normal function of the liver, gallbladder, and pancreas

  • Liver:
  • Removes toxins/bilirubin

  Gallbladder:

  • Stores bile produced by the liver
  • Secretes bile into the small intestine

  Pancreas:

  • Plays a role in nutrient metabolism
  • Produces enzymes for digestion
• Bile production, storage, and secretion

  Produced: by liver

  Stored: in gallbladder

  Secreted: into the small intestine
• Liver's role


  • - Metabolizes drugs, filters blood, plays a role in carbohydrate metabolism
  • Breaks down fat and transports waste back to liver
  • Stores vitamins and minerals
  • Converts ammonia to urea for extraction by kidneys
  • Detoxification
• Pancreatitis


  • Leads to elevated serum amylase and lipase levels
  • Acute pancreatitis: inflammation of the pancreas leading to autodigestion
  • Chronic pancreatitis: repeated attacks leading to fibrosis and scarring of the pancreas, eventually causing diabetes
• Manifestations of pancreatitis


  • Acute:
  • Epigastric or LUQ pain
  • Nausea, abdominal distention, decreased bowel sounds
  • Tachycardia, hypertension, fever
  • Jaundice, weakness, pallor

  Chronic:

  • Eventually leads to diabetes
• Factors predisposing to cholesterol gallstone formation

  • Weight loss
  • Obesity
  • Oral contraceptives
  • Family history
  • Hyperlipidemia
• Clinical manifestations of cholecystitis

  • - Colicky pain in RUQ (can last for minutes or hours)
  • Meal intolerance to fat-containing foods
  • Clay-colored stool
• Alterations in liver function due to hepatocellular failure/jaundice


  • - Jaundice
  • Ascites, palmar erythema, gynecomastia, testicular atrophy, hair loss (men), central obesity with peripheral muscle wasting, dark urine
  • Altered protein metabolism
  • Ammonia buildup
• Alterations in liver function due to portal hypertension

  • - Anorexia
  • Ascites
  • Varices (including gastroesophageal varices leading to bleeding)
• Clinical manifestations of advanced liver disease

  • - Ascites (buildup of fluid and edema)
• Diagnostic tests for liver disease

  • - AST/ALT
  • Biochemical assays
  • Needle biopsy of the liver
  • Ultrasound
  • CT
  • ERCP
  • Conjugated/unconjugated bilirubin levels
  • Coagulation factors
• Etiologies of cirrhosis and liver dysfunction

  • - Chronic alcohol use (most common)
  • Biliary obstruction
• Chronic Pancreatitis


  Occurs from repeated acute attacks which lead to fibrosis and scarring of the pancreas
• Manifestations of Chronic Pancreatitis

  • Insidious onset of left upper abdominal pain radiating to the back
  • Nausea, vomiting, Weight loos (poor intake)
  • Flatulence, constipation, malaabsorption
  • Diabetes
• Acute Pancreatitis


  Inflammation of the pancreas that leads to autodigestion
• Acute Pancreatitis


  Leads to elevated serum amylase and lipase levels
• Manifestations of Acute Pancreatitis

  • Steady severe epigastric or LUQ pain that radiates to the back
  • Nausea
  • Abdominal distention
  • Decreased bowel sounds
  • Tachycardia
  • Hypotension
  • Fever
  • Jaundice
  • Weakness
  • Pallor
• Jaundice Manifestations


  • Ascites
  • Palmar erythema
  • Gynecomastia
  • Testicular atrophy
  • Hair loss (men)
  • Central obesity with peripheral muscle wasting
  • Dark urine
• Portal Hyppertension Manifestations


  • Anorexia
  • Varices
  • Ascites
• Gastroesophageal varices result from portal hypertension
• Ascites


  Pathologic accumulation of fluid within the peritoneal cavity that occurs in patients with advanced liver disease
• Ascites


  • Usually complicated by portal hypertension and hypoalbuminemia
  • Hypoalbuminemia leads to 3rd space edema due to inability to break protein
  • Abdominal distention results from the accumulation of sodium, water, and protein
• Hepatorenal failure


  • Due to impaired renal blood flow related to liver disease (impaired blood flow to the kidneys because of backup of the portal system)
  • Creatinine levels rise
  • Acute and progressive
• Prehepatic: d/t hemolysis and ineffective erythropoiesis (Unconjugated) 

  • Problems before it gets to the liver 
  • Large bruising, trauma, Ex: Rh incompatibility

  Hepatic: dysfunction of the liver 

  • Bilirubin is unconjugated if it cannot be broken down by the liver 

  Poshepatic: d/t issues with bilirubin transport  

  • Bilirubin is conjugated if it is/has been through the liver but cannot be turned into bile 
  • Obstruction of the bile ducts or gallstones common issue
• Etiologies of cirrhosis and liver disease:

  • Chronic alcohol use (most common)
  • Billary cirrhosis (obstruction in bile drainage)
  • Hepatitis

  1. Hep A (Fecal, Oral, Acute, Vaccine)
  2. Hep B (Blood, bodily fluid, chronic, vaccine)
  3. Hep C (Blood bodily fluid, NO vaccine)

  • Liver Cancer
  • Drug-Induced (Prescription, Illegal, OTC)
  • Nonalcoholic Fatty Liver Disease
  • Excessive storage of fat in the liver (Obesity, increased cholesterol, increased triglyceride)