DIGESTIVE FUNCTION EXAM 4 PATHO PT4

What is cirrhosis?

Cirrhosis is an irreversible inflammatory, fibrotic liver disease.

What happens to biliary channels in cirrhosis?

Biliary channels become obstructed and cause portal hypertension.

What factors influence the severity and progression of cirrhosis?

The severity and rate of progression depend on the cause.

Are there many causes of cirrhosis?

Yes, there are many causes of cirrhosis.

What does cellular injury in cirrhosis depend on?

Cellular injury depends on the cause of cirrhosis.

Are the pathologic mechanisms of cirrhosis clearly understood?

No, the pathologic mechanisms are not all clearly understood.

What structural changes occur in the liver due to cirrhosis?

Structural changes result from injury and fibrosis.

What can cause injury leading to cirrhosis?

Injury can be caused by viruses or toxicity from alcohol.

What is fibrosis a consequence of in cirrhosis?

Fibrosis is a consequence of infiltration of leukocytes, release of inflammatory mediators, and activation of fibrotic processes.

How may the liver appear in cirrhosis?

The liver may be larger or smaller than normal.

How does the liver feel when palpated in cirrhosis?

The liver may feel firm or hard when palpated.

What is Alcoholic Liver Disease related to?

Toxic effects of alcohol and coexisting liver disease

What is the most prevalent type of cirrhosis?

Alcoholic cirrhosis

What percentage of persons with alcoholism develop cirrhosis?

Approximately 25%

What are the components of the spectrum of alcoholic liver disease?

Alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis

What symptoms develop with advanced fatty infiltration or the onset of alcoholic hepatitis?

Anorexia, nausea, jaundice, and edema

What is Viral Hepatitis?

A systemic viral disease that primarily affects the liver.

What are the five types of Viral Hepatitis?

A, B, C, D, and E.

What type of illness can Viral Hepatitis cause?

Acute, icteric illness.

Which types of Viral Hepatitis are the most common causes?

B and C.

What is the spectrum of manifestations of Viral Hepatitis?

It ranges from absence of symptoms to fulminating hepatitis, with rapid onset of liver failure and coma.

What indicates acute viral hepatitis in liver function tests?

Abnormal liver function test results.

Which serum aminotransferase values are elevated in Viral Hepatitis?

Aspartate transaminase (AST) and alanine transaminase (ALT).

What are the phases of the clinical course of hepatitis?

The clinical course usually consists of three phases, preceded by an incubation phase.

What is Hepatitis A?

Often mild and resolves on its own, typically within six months. It is easily transmitted, especially to children, and is spread through contaminated food and water, as well as person-to-person contact.

What is Hepatitis B?

Can be acute or chronic, and in some cases, leads to long-term liver damage, liver cancer, and cirrhosis. It is transmitted through contact with infected blood, needles, or bodily fluids, and from mother to baby.

What is Hepatitis C?

Can lead to chronic infection and long-term liver damage, including liver cancer and cirrhosis. It is primarily spread through contact with infected blood or from mother to baby during childbirth.

What is Hepatitis D?

Only occurs in individuals who are already infected with Hepatitis B. It is transmitted through contact with infected blood, needles, or bodily fluids.

What is Hepatitis E?

Predominantly found in Africa, Asia, and South America. It is typically a mild and self-limiting infection but can be serious in some individuals, like those with a weakened immune system.

What are common symptoms of all types of viral hepatitis?

RUQ discomfort, anorexia, weight loss, fever, chills, jaundice, dark urine.

What is the general treatment for all types of viral hepatitis?

Rest, activity as tolerated, nutrition, hydration.

What are the three phases of viral hepatitis?

Prodromal phase, Icteric phase, Recovery phase

What characterizes the prodromal phase of viral hepatitis?

Begins about 2 weeks after exposure and ends with the appearance of jaundice; marked by fatigue, anorexia, malaise, nausea, vomiting, headache, hyperalgia, cough, and low-grade fever; highly transmissible.

What are the symptoms of the icteric phase of viral hepatitis?

Jaundice, dark urine, clay-colored stools, enlarged smooth and tender liver, pain on percussion or palpation, fatigue, and abdominal pain.

When does the recovery phase of viral hepatitis begin?

Begins with resolution of jaundice, about 6 to 8 weeks after exposure.

What happens to liver function during the recovery phase of viral hepatitis?

Liver function returns to normal 2 to 12 weeks after the onset of jaundice.

How is the diagnosis of HAV and HCV infections made?

Based on the presence of anti-HAV and anti-HCV antibodies.

What serologic analysis is used in the evaluation of viral hepatitis?

Serologic analysis for specific hepatitis virus antigens.

What dietary recommendations are beneficial if bile flow is obstructed in viral hepatitis?

A low-fat, high-carbohydrate diet.

What is the goal of treatment for chronic hepatitis?

To suppress viral replication before irreversible liver cell damage or hepatic carcinoma occurs.

What are the most common disorders of the gallbladder?

Obstruction and inflammation

What causes obstruction in the gallbladder?

Gallstones

What are gallstones composed of?

Aggregates of substances in the bile

Where can gallstones remain?

In the gallbladder or may be ejected into the cystic duct

What happens when gallstones lodge in the cystic duct?

They obstruct the flow of bile into and out of the gallbladder and cause inflammation

What is Cholelithiasis?

Gallstone formation

What is Cholecystitis?

Inflammation of the gallbladder or cystic duct

What is a risk factor for gallbladder disorders related to body weight?

Obesity

What age group is at higher risk for gallbladder disorders?

Middle age

Which gender is more likely to develop gallbladder disorders?

Female

What contraceptive method is a risk factor for gallbladder disorders?

Oral contraceptive use

What rapid change in body weight is a risk factor for gallbladder disorders?

Rapid weight loss

Which ethnic group has a higher risk for gallbladder disorders?

Native American ancestry

What type of predisposition can increase the risk of gallbladder disorders?

Genetic predisposition

What diseases can increase the risk of gallbladder disorders?

Gallbladder, pancreas, or ileal disease

What are gallstones formed from?

Impaired metabolism of cholesterol, bilirubin, and bile acids

What determines the type of gallstones?

Chemical composition

What are cholesterol gallstones formed from?

Bile that is supersaturated with cholesterol produced by the liver

What are pigmented brown gallstones formed from?

Calcium bilirubinate and fatty acid soaps that bind with calcium

What are black gallstones composed of?

Calcium bilirubinate with mucin glycoproteins

What conditions are black gallstones associated with?

Chronic liver disease and hemolytic disease

What are common symptoms of gallstones?

Often asymptomatic or vague, epigastric and right hypochondrium pain, intolerance to fatty foods

What can happen to gallstones in the gallbladder?

They may lie dormant or become lodged in the cystic or common duct, causing pain when the gallbladder contracts and cholecystitis

What can happen if gallstones accumulate?

They can fill the entire gallbladder

What is cholecystitis?

Inflammation of the gallbladder or cystic duct.

What is the most common cause of cholecystitis?

A gallstone lodged in the cystic duct.

What type of pain is associated with cholecystitis?

Pain similar to that caused by gallstones.

What are common findings in cholecystitis?

Fever, leukocytosis, rebound tenderness, and abdominal muscle guarding.

What is carcinoma of the esophagus?

A rare type of cancer with an estimated incidence of 17,650 new cases and 16,080 deaths in the United States in 2019.

What are some risk factors for esophageal cancer?

Age, tobacco use, alcohol, vitamin deficiency, malnutrition, GERD, obesity, Barrett's Esophagus.

What type of cancer is associated with smoking tobacco and chronic alcohol consumption?

Squamous cell carcinoma.

What type of cancer is associated with obesity, GERD, and smoking tobacco?

Adenocarcinoma.

What are some early symptoms of stomach cancer?

Loss of appetite, malaise, and indigestion.

What are some later symptoms of stomach cancer?

Unexplained weight loss, upper abdominal pain, vomiting, change in bowel habits, and anemia.

What is a common association with stomach cancer?

Atrophic gastritis and Helicobacter pylori.

What dietary factors are associated with most adenocarcinomas of the stomach?

Consumption of heavily salted and preserved foods, low intake of fruits and vegetables, and use of tobacco and alcohol.

What is cancer of the gastrointestinal tract commonly associated with?

Colon and rectum

What are the common causes of gastrointestinal tract cancer?

Multiple gene alterations and environmental interactions

What is familial adenomatous polyposis?

A hereditary condition that increases the risk of colorectal cancer

What is hereditary nonpolyposis colorectal cancer?

A genetic condition that increases the risk of colorectal cancer without the presence of polyps

What is an early sign of gastrointestinal tract cancer?

Occult blood in the stool

What symptoms are associated with cancer in the transverse colon?

Pain, obstruction, change in bowel habits, anemia

What symptoms are associated with cancer in the ascending colon?

Pain, mass, change in bowel habits, anemia

What symptoms are associated with cancer in the rectum?

Blood in stool, change in bowel habits, rectal discomfort

What symptoms are associated with cancer in the descending colon?

Pain, change in bowel habits, bright red blood in stool, obstruction

What factors influence the symptoms of gastrointestinal tract cancer?

Location, size, and shape of the lesion

What percentage of colorectal cancer cases are sporadic or associated with family history?

Most cases

What is the primary cause of liver cancer?

Usually caused by metastatic spread from a primary site elsewhere in the body

What is the most common type of liver cancer?

Hepatocellular carcinoma

Is liver cancer usually symptomatic or asymptomatic?

Usually asymptomatic

What is another type of liver cancer?

Cholangiocellular carcinoma

What are common symptoms of cholangiocellular carcinoma?

Pain, loss of appetite, weight loss, and gradual onset of jaundice

What is the primary cause of gallbladder cancer?

Usually caused by metastasis

What may chronic inflammation of the gallbladder trigger?

Dysplasia and progress to metaplasia

What are the symptoms in the early stages of gallbladder cancer?

Usually asymptomatic

When is gallbladder cancer usually diagnosed?

Usually caught in late stages

How is gallbladder cancer often discovered?

Often found incidentally

What diagnostic procedures are used for gallbladder cancer?

Ultrasonography and further imaging with suspicious findings

What is the only effective treatment for early stages of gallbladder cancer?

Complete surgical resection of the gallbladder

What is common after the complete surgical resection of the gallbladder?

Recurrence is common