Metabolic and Hepatic Disorders: Diabetes, Hepatitis, and Cirrhosis

Comprehensive vocabulary review flashcards covering metabolic conditions, diabetes mellitus, viral and toxic hepatitis, cirrhosis, portal hypertension, and their clinical management.

Type 1 Diabetes

An autoimmune metabolic disease characterized by destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, fasting hyperglycemia, and a propensity toward ketosis; it accounts for $5\%$ of adult diabetes cases.

Type 2 Diabetes

A progressive metabolic disorder caused by cellular insulin resistance, impaired beta-cell responsiveness to hyperglycemia, and abnormal receptor function; it accounts for $95\%$ of adult diabetes cases.

Gestational Diabetes

Glucose intolerance that first develops during pregnancy in individuals without prior diabetes, conferring elevated fetal risks such as neonatal hypoglycemia and shoulder dystocia, as well as an increased maternal risk for developing type 2 diabetes later in life.

Prediabetes

A state in which blood glucose values exceed normal physiological levels but remain below the diagnostic threshold for diabetes, marked by a fasting plasma glucose between $100\text{ to }125\,mg/dL$ ($5.6\text{ to }6.9\,mmol/L$).

Prediabetes and Diabetes Diagnostic Thresholds

Established diagnostic cutoffs indicating prediabetes ($A1C\text{ }5.7\%\text{ to }6.4\%$, fasting glucose $100\text{ to }125\,mg/dL$, or $2\text{-hour }OGTT\text{ }140\text{ to }199\,mg/dL$) versus diabetes ($A1C \ge 6.5\%$, fasting glucose $\ge 126\,mg/dL$, or $OGTT \ge 200\,mg/dL$).

Three Ps of Diabetes

The triad of classic symptoms characteristic of hyperglycemia and diabetes: polyuria (increased urination), polydipsia (increased thirst), and polyphagia (increased hunger).

Diabetic Exchange List

A nutritional planning framework in which foods with similar macronutrient and carbohydrate content per serving size are categorized together so they can be interchanged to maintain stable blood glucose control.

Rule of 15

A protocol for treating hypoglycemia by administering $15\,g$ of fast-acting carbohydrate (such as $3\text{ to }4$ glucose tablets or $4\text{ to }6\,oz$ of fruit juice), re-evaluating blood glucose in $15\,minutes$, and retreating if blood glucose remains below $70\,mg/dL$.

Diabetic Ketoacidosis (DKA)

An acute, life-threatening complication predominantly seen in type 1 diabetes, precipitated by severe insulin deficiency and characterized by rapid-onset hyperglycemia ($> 250\,mg/dL\text{ to }1000\,mg/dL$), metabolic acidosis ($\text{pH} < 7.30$, low serum bicarbonate), ketonuria, and ketonemia.

Kussmaul Breathing

A deep, rapid, and labored respiration pattern that develops in severe metabolic acidosis, such as diabetic ketoacidosis, functioning as a compensatory mechanism to eliminate carbon dioxide.

Hyperglycemic Hyperosmolar Syndrome (HHS)

A severe acute metabolic complication typically occurring in older adults with type 2 diabetes, distinguished by profound hyperglycemia ($\ge 600\,mg/dL$), hyperosmolality ($\ge 320\,mOsm/kg$), severe dehydration (averaging $9\,L$ of fluid loss), and neurological deficits in the absence of significant ketoacidosis ($\text{pH} > 7.30$).

Hepatic Portal System

A specialized vascular circuit through which the liver receives nutrient-rich deoxygenated blood from the gastrointestinal tract via the hepatic portal vein and oxygen-rich blood via the hepatic artery before draining into the hepatic vein.

Kupffer Cells

Specialized resident hepatic macrophages located within the liver sinusoids responsible for phagocytosing foreign pathogens and breaking down aged, worn-out red blood cells.

Scleral Icterus

The yellow discoloration of the sclera caused by abnormally elevated bilirubin levels in the bloodstream, often representing an early clinical manifestation of jaundice in hepatic or biliary dysfunction.

Hepatitis A Virus (HAV)

A viral infection of the liver transmitted primarily through the fecal-oral route via contaminated food or water, having an incubation period of approximately $28\,days$ and confirmed diagnostically by positive serum immunoglobulin M (IgM) anti-HAV.

Hepatitis B Virus (HBV)

A bloodborne and sexually transmitted viral pathogen with an incubation period averaging $90\,days$ that can lead to chronic infection in $25\%$ of cases and is a major worldwide cause of cirrhosis and hepatocellular carcinoma.

Hepatitis C Virus (HCV)

The most common bloodborne infection, spread via parenteral exposure such as injection drug use and pre-1992 transfusions, which progresses to chronic hepatitis in $50\%$ of cases and serves as the leading indication for liver transplantation.

Hepatitis D Virus (HDV)

A defective RNA virus that requires the presence of Hepatitis B surface antigen for replication and survival, presenting an elevated risk of rapidly progressing to fulminant liver failure and cirrhosis.

Hepatitis E Virus (HEV)

A self-limiting enterically transmitted viral hepatitis spread primarily through contaminated drinking water, carrying a high mortality rate of approximately $20\%$ in infected pregnant women during their third trimester.

Toxic Hepatitis

Nonviral inflammation and necrosis of liver parenchyma caused by exposure to hepatotoxins, industrial chemicals, or medications such as acetaminophen overdoses, statins, and certain antibiotics.

Fulminant Hepatic Failure

The rapid and severe impairment of liver function defined by the clinical onset of encephalopathy within $8\,weeks$ of initial symptom appearance in a patient with no pre-existing liver disease.

Cirrhosis

A late stage of chronic, progressive hepatic fibrosis characterized by widespread scarring, destruction of parenchymal architecture, and the formation of regenerative nodules that impede vascular and biliary flow.

Portal Hypertension

Abnormally elevated hydrostatic pressure within the portal venous system resulting from increased resistance to blood flow through a scarred, fibrotic liver, leading to splenomegaly, ascites, and collateral variceal vessels.

Decompensated Cirrhosis

Advanced liver disease manifested by prominent clinical signs of liver failure and severe portal hypertension, including jaundice, caput medusae, ascites, umbilical hernia, gynecomastia, asterixis, and peripheral edema.

Ascites

The pathological accumulation of protein-rich fluid within the peritoneal cavity resulting from portal hypertension, systemic arterial vasodilation, and decreased serum albumin causing reduced intravascular oncotic pressure.

Esophageal Varices

Fragile, tortuous, distended collateral veins located in the submucosa of the lower esophagus caused by elevated portal pressure, which carry a significant risk of rupture and massive gastrointestinal hemorrhage.

Sengstaken-Blakemore Tube

A multi-lumen nasogastric balloon tamponade tube equipped with gastric and esophageal balloons utilized as an emergency, temporary intervention to mechanically compress bleeding esophageal and gastric varices.

Endoscopic Variceal Ligation (EVL)

An endoscopic therapeutic procedure (esophageal banding) in which elastic bands are applied over bleeding or high-risk varices using a suction applicator to induce local thrombosis, vessel sloughing, and mucosal sclerosis.

Portosystemic Shunts

Surgical or radiologic vascular bypass pathways (such as end-to-side portacaval, splenorenal, and H-graft mesocaval shunts) designed to divert blood from the high-pressure portal system directly into the inferior vena cava, mitigating portal hypertension.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

An interventional radiological procedure in which an expendable stent is positioned to create a low-resistance tract between the portal vein and hepatic vein within the liver, decompressing portal venous pressure to manage refractory ascites and variceal bleeding.

Hepatic Encephalopathy

A reversible neuropsychiatric syndrome resulting from acute or chronic hepatic insufficiency and portosystemic shunting, permitting un-metabolized intestinal neurotoxins (principally ammonia) to cross the blood-brain barrier and cause cognitive deterioration.

Asterixis

A coarse, flapping motor tremor of the hands elicited upon forced wrist dorsiflexion with outstretched arms, serving as a classic clinical indicator of worsening hepatic encephalopathy and hyperammonemia.

Fetor Hepaticus

A distinctive sweet, musty breath odor present in severe chronic liver failure, caused by the pulmonary excretion of volatile metabolic byproducts that bypass hepatic clearance due to portosystemic shunting.

Hepatorenal Syndrome (HRS)

A form of functional, progressive renal failure occurring in advanced cirrhosis caused by severe splanchnic arterial vasodilation that triggers intense compensatory sympathetic and renal vasoconstriction, marked by oliguria and sodium retention.

CHEAP Mnemonic

A clinical memory aid summarizing major life-threatening complications of cirrhosis: C (Clotting disorders), H (Hepatorenal syndrome), E (Encephalopathy and Esophageal varices), A (Ascites), and P (Portal hypertension).

Metformin

A first-line oral antidiabetic medication belonging to the biguanide class that lowers blood glucose by decreasing hepatic glucose production and increasing peripheral insulin sensitivity.

Rapid-Acting Insulins

A class of mealtime insulins—including lispro, aspart, and glulisine—characterized by a rapid onset of action ($10\text{ to }15\,\text{minutes}$), a peak effect at $30\text{ to }90\,\text{minutes}$, and a duration of $3\text{ to }5\,\text{hours}$, administered immediately before eating to control postprandial blood glucose spikes.

Long-Acting Insulins

A class of basal insulins—such as glargine, detemir, and degludec—characterized by a slow, continuous release with no pronounced peak, an onset of approximately $1\text{ to }2\,\text{hours}$, and an extended duration of action ($24\,\text{hours}$ or longer) to maintain steady baseline glucose control throughout the day and night.