DIGESTIVE FUNCTION EXAM 4 PATHO PT3

What is appendicitis?

Inflammation of the vermiform appendix

What is the most common age range for appendicitis?

Typically between 10 and 19 years of age

Is the exact mechanism of appendicitis well understood?

No, the exact mechanism is not well understood

What are possible causes of appendicitis?

Obstruction, foreign bodies, infection

What type of pain is associated with appendicitis?

Epigastric or periumbilical pain

What physical exam finding is associated with appendicitis?

Rebound tenderness to the right lower quadrant (RLQ)

What laboratory findings are often seen in appendicitis?

Elevated temperature and white blood cell count (WBC)

What are the most serious complications of appendicitis?

Perforation, peritonitis, and abscess formation

What is the treatment for appendicitis?

Antibiotics and appendectomy

What is portal hypertension?

Abnormally high blood pressure in the portal venous system caused by resistance to blood flow.

What causes portal hypertension?

Disorders that obstruct or impede blood flow through any component of the portal venous system or vena cava.

What is the most common cause of portal hypertension?

Fibrosis and obstruction caused by cirrhosis of the liver.

What are the long-term effects of portal hypertension?

Varices, splenomegaly, ascites, hepatic encephalopathy, and hepatopulmonary syndrome.

What are varices?

Distended, tortuous collateral veins particularly in the lower esophagus and stomach, but also over the abdominal wall.

What can rupture of varices cause?

Life-threatening hemorrhage.

How is portal hypertension often diagnosed?

At the time of variceal bleeding and confirmed by upper GI endoscopy.

What history is relevant for diagnosing portal hypertension?

History of jaundice, hepatitis, alcoholism, or cirrhosis.

What type of medication is used to prevent variceal bleeding?

Nonselective beta-blocking drugs.

What are some emergency management techniques for bleeding varices?

Vasopressors, compression of the varices with an inflatable tube or balloon, sclerotherapy, variceal ligation, or portacaval shunt.

What surgical procedures can decompress varices?

Transjugular intrahepatic portosystemic shunts (TIPS) and anastomosis of the portal vein to the inferior vena cava.

What is ascites?

Accumulation of fluid in the peritoneal cavity.

What is the most common cause of ascites?

Cirrhosis.

What is the mortality rate within 1 year for patients with ascites associated with cirrhosis?

25%.

What are the symptoms of ascites?

Abdominal distention, increased abdominal girth, and weight gain.

What is paracentesis?

A procedure to remove fluid from the peritoneal cavity.

What are contributing factors to the development of ascites?

Portal hypertension, decreased synthesis of albumin by the liver, splanchnic arterial vasodilation, and renal sodium and water retention.

How does portal hypertension contribute to ascites?

It causes capillary hydrostatic pressure to exceed capillary osmotic pressure, pushing water into the peritoneal cavity.

What effect does portal hypertension have on hepatic lymph production?

It increases the production of hepatic lymph, which can weep into the peritoneal cavity.

How does sodium and water retention affect ascites formation?

It expands plasma volume, accelerating portal hypertension and ascites formation.

What is Hepatic Encephalopathy?

A neurologic syndrome of impaired behavioral, cognitive, and motor function.

How does Hepatic Encephalopathy develop?

It develops rapidly during fulminant hepatitis or slowly during the course of liver disease.

Why are cells in the nervous system vulnerable in Hepatic Encephalopathy?

They are vulnerable to neurotoxins absorbed from the GI tract that circulate to the brain due to liver dysfunction.

What are early symptoms of Hepatic Encephalopathy?

Subtle changes in personality, memory loss, irritability, disinhibition, lethargy, and sleep disturbances.

What are later symptoms of Hepatic Encephalopathy?

Confusion, disorientation to time and space, flapping tremor of the hands (asterixis), slow speech, bradykinesia, stupor, convulsions, and coma.

How is Hepatic Encephalopathy diagnosed?

Diagnosis is based on a history of liver disease, clinical manifestations, psychometric tests, and exclusion of other causes of brain dysfunction.

What does tracking serum ammonia levels assess in Hepatic Encephalopathy?

It assesses treatment effectiveness and liver function.

What are the first steps in treating Hepatic Encephalopathy?

Correction of fluid and electrolyte imbalances and withdrawal of depressant drugs metabolized by the liver.

How is dietary protein managed in Hepatic Encephalopathy?

Dietary protein is maintained to prevent malnutrition but at levels that reduce blood ammonia levels.

What role does Lactulose play in treating Hepatic Encephalopathy?

Lactulose prevents ammonia absorption in the colon.

What is the function of Neomycin in Hepatic Encephalopathy treatment?

Neomycin eliminates ammonia-producing intestinal bacteria but can be nephrotoxic.

What do Glutamase inhibitors do in the context of Hepatic Encephalopathy?

They reduce gut ammonia.

What is Rifaximin used for in Hepatic Encephalopathy?

Rifaximin decreases intestinal production of ammonia and is used for lactulose nonresponders.

What is jaundice also called?

Icterus

What causes jaundice?

Hyperbilirubinemia

What are plasma bilirubin concentrations greater than for jaundice to occur?

2.5 to 3 mg/dl

What can cause hyperbilirubinemia and jaundice?

Extrahepatic obstruction to bile flow

What is another cause of hyperbilirubinemia and jaundice?

Intrahepatic obstruction

What is a prehepatic cause of jaundice?

Excessive production of unconjugated bilirubin (i.e., excessive hemolysis of red blood cells)

What is a clinical manifestation of jaundice related to urine color?

Dark urine due to bilirubin

What stool color indicates complete obstruction of bile flow?

Light-colored stools

What happens to stool color with partial obstruction of bile flow?

Stool is normal in color and bilirubin is present in the urine

What symptoms may accompany jaundice due to liver inflammation?

Fever, chills, and pain

Where does yellow discoloration from jaundice first occur?

In the sclera (white area) of the eye

What skin symptom is associated with bilirubin accumulation?

Pruritus

What is monitored to evaluate jaundice?

Plasma bilirubin levels

What is important in the history and physical examination for jaundice?

Identifying underlying disorders, such as cirrhosis or exposure to hepatitis virus

What does treatment for jaundice consist of?

Correcting the cause

What is hemolytic jaundice?

Destruction of erythrocytes leading to increased bilirubin production.

What are the causes of hemolytic jaundice?

Hemolytic anemia, severe infection, toxic substances in circulation, transfusion of incompatible blood.

What are disorders of bilirubin metabolism?

Decreased bilirubin uptake and decreased bilirubin conjugation.

What are the causes of disorders of bilirubin metabolism?

Drug induced and hereditary disorder.

What is obstructive jaundice?

Obstruction of the passage of conjugated bilirubin from the liver to the intestine.

What are the causes of obstructive jaundice?

Obstruction of bile duct by gallstones or tumor, obstruction of bile flow through liver, drugs.

What is hepatocellular jaundice?

Failure of liver cells to conjugate bilirubin and for bilirubin to pass from liver to intestine.

What are the causes of hepatocellular jaundice?

Genetic deficit of hepatocytes, severe infections, alcoholic liver disease, or biliary cirrhosis.

What is acute liver failure?

A rare clinical syndrome resulting in severe impairment or necrosis of liver cells without preexisting liver disease or cirrhosis.

What is the leading cause of acute liver failure in the United States?

Acetaminophen overdose.

What is the recommended treatment for acetaminophen overdose?

N-acetyl cysteine, which should be given as soon as possible - within 16 hours after the overdose.

What conditions can lead to acute liver failure?

Liver disease, including complications of viral hepatitis (particularly hepatitis B virus infection) and metabolic liver disorders.

What are the histological features of acute liver failure?

Edematous hepatocytes, patchy areas of necrosis, and inflammatory cell infiltrates disrupt liver tissue.

What can cause the death of hepatocytes in acute liver failure?

Viral or toxic injury, or immunologic and inflammatory damage.

When does acute liver failure usually develop after the initial symptoms of viral hepatitis?

6 to 8 weeks after the initial symptoms.

What is the time frame for acute liver failure to develop after acetaminophen overdose?

Within 5 days to 8 weeks.

What are the initial signs of acute liver failure?

Anorexia, vomiting, abdominal pain, and progressive jaundice, followed by ascites and GI bleeding.