Abdominal Disorders in Critically Ill Patients

Liver Disorders

Conditions affecting liver function and structure.

Cirrhosis

Chronic liver inflammation leading to structural changes.

Pancreatic Disorders

Conditions impacting pancreatic function.

Pancreatitis

Inflammation of the pancreas, causing abdominal pain.

HHS

Hyperglycemic Hyperosmolar State, severe diabetes complication.

Gastrointestinal Disorders

Conditions affecting the GI tract.

Right Upper Quadrant

Abdominal area where the liver is located.

Lobules

Functional units of the liver containing hepatocytes.

Hepatocytes

Liver cells responsible for metabolic functions.

Portal Triad

Structure including portal vein, hepatic artery, bile duct.

Kupffer Cells

Liver macrophages that phagocytize debris and bacteria.

Portal Vein

Carries venous blood from GI tract to liver.

Common Hepatic Artery

Supplies arterial blood to the liver.

Hepatic Vein

Drains blood from the liver to the vena cava.

Albumin

Plasma protein maintaining oncotic pressure.

Glycogenesis

Conversion of glucose to glycogen in liver.

Glycogenolysis

Breakdown of glycogen to glucose in liver.

Bilirubin

Byproduct of RBC degradation, elevated in liver dysfunction.

Ammonia

Toxin from protein metabolism, detoxified by liver.

Fat Metabolism

Liver processes fats, synthesizes cholesterol and phospholipids.

Fibrous Tissue

Irreversible scarring in cirrhosis affecting liver function.

Chronic Alcohol Abuse

Primary cause of cirrhosis and liver damage.

Liver Failure

Severe dysfunction leading to loss of liver function.

Portal Hypertension

Increased pressure in the portal venous system.

Intrahepatic Vascular Resistance

Resistance within liver vessels causing blood flow obstruction.

Fatty Deposits

Lipids obstructing veins, causing portal hypertension.

Venous Congestion

Back pressure leading to varicose veins formation.

Varices

Dilated veins in esophagus, stomach, or rectum.

Nutrient Shunting

Redirection of blood away from the liver.

Poor Metabolism

Inefficient processing of nutrients, drugs, toxins.

AST & ALT

Liver enzymes indicating liver dysfunction when elevated.

Unconjugated Bilirubin

Bilirubin not processed by the liver, causing jaundice.

Increased Ammonia

Result of poor protein breakdown, indicating liver failure.

Decreased Albumin

Low protein levels affecting osmotic pressure.

Increased PT/PTT

Prolonged clotting times indicating bleeding risk.

Edema

Swelling due to decreased colloid osmotic pressure.

Jaundice

Yellowing of skin due to high bilirubin levels.

Cognitive Changes

Altered mental state due to liver dysfunction.

Hepatic Encephalopathy

Neurological decline from toxin accumulation.

Asterixis

Hand flapping indicating early hepatic encephalopathy.

Fluid Overload Monitoring

Assessing for weight gain and hemodynamic stability.

Daily Weights

Tracking weight changes to monitor fluid retention.

Abdominal Girth Measurement

Assessing ascites by measuring waist circumference.

Fall Precautions

Safety measures to prevent patient falls.

Ascites

Fluid accumulation in the peritoneum causing abdominal swelling.

Colloid Osmotic Pressure

Pressure exerted by plasma proteins preventing fluid leakage.

Lactulose

Osmotic agent that clears ammonia from the gut.

Neomycin

Antibiotic used to reduce gut bacterial action.

Xifaxan

Antibiotic that targets gut bacteria, reducing ammonia.

Aldosterone

Hormone that promotes sodium and water retention.

ADH

Hormone that regulates water balance in the body.

Diuretics

Medications that promote fluid excretion from the body.

Spironolactone

Aldosterone antagonist used to treat ascites.

Furosemide

Loop diuretic often combined with spironolactone.

Paracentesis

Procedure to remove fluid from the peritoneal cavity.

LeVeen Shunt

Device to drain fluid from the peritoneal cavity.

TIPS

Procedure to decompress portal venous system.

Caput Medusae

Venous pattern indicating severe portal hypertension.

Fluid Wave

Physical exam sign indicating fluid presence in abdomen.

Electrolyte Loss

Depletion of essential minerals during diuretic therapy.

Sepsis

Systemic infection that can arise from paracentesis.

Peritonitis

Infection of the peritoneum, potential complication of paracentesis.

Esophagogastric Varices

Distended veins in esophagus due to portal hypertension.

Acute GI Hemorrhage

Life-threatening bleeding from ruptured varices.

Supportive Management

Primary care approach focusing on symptom relief.

Ethical Issues

Concerns about candidate selection in medical treatment.

Abstinence

Seeking help for self-induced alcoholism.

Liver Damage Severity

Assessment of liver health and function.

Medical Therapy Response

Stability of patient for treatment effectiveness.

Social Support Importance

Essential for successful recovery in patients.

Acute GI Bleeding

Potentially lethal medical emergency requiring immediate attention.

Peptic Ulcer Disease

Breakdown of gastro-mucosal lining causing bleeding.

Glycoprotein Mucus Barrier

Protective layer in gastric mucosa against damage.

Mucosal Blood Supply

Blood flow necessary for gastric mucosal health.

Tight Junctions

Connections between gastric cells preventing leakage.

H. Pylori Role

Bacteria that disrupts gastric mucosal protection.

NSAID Risks

Can erode stomach lining, leading to ulcers.

Stress-Related Erosive Syndrome

Increased gastric acid due to stress or trauma.

ICU Patient Risk

75-100% may develop stress ulcers within 24 hours.

Postural Hypotension

Drop in blood pressure upon standing.

Decreased H & H

Indicates potential blood loss; requires monitoring.

Tachycardia Signs

Increased heart rate indicating possible hypovolemic shock.

Coffee Ground Emesis

Vomiting resembling coffee grounds from gastric bleeding.

Hematochezia

Bright red blood per rectum indicating lower GI bleed.

Melena

Tarry stool indicating upper GI bleeding.

Physical Examination Signs

Assess for poor tissue perfusion and abdominal issues.

NG Tube Assessment

Evaluate bleeding extent; caution with esophageal varices.

H2 antagonists

Block acid secretion; used for stress ulcers.

Famotidine

An H2 antagonist; brand name Pepcid.

Ranitidine

An H2 antagonist; brand name Zantac.

Cimetidine

An H2 antagonist; brand name Tagamet.

Proton pump inhibitors

Block final stage of gastric acid production.

Omeprazole

A PPI; brand name Prilosec.

Lansoprazole

A PPI; brand name Prevacid.

Pantoprazole

A PPI; brand name Protonix.

Esomeprazole

A PPI; brand name Nexium.

Antacids

Neutralize stomach acid; bind phosphates.

Sucralfate

Forms protective covering over ulcer sites.

Hemodynamic stabilization

Replacement of blood products for GI bleeding.

Endoscopy

Procedure to visualize and repair GI structures.