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37 Cards in this Set
- Front
- Back
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Jaundice |
Yellow staining of the skin sclera and mucus membran caused by the accumulation of bilirubin |
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Prehepatic jaundice |
Results from the overproduction of bilirubin due to hemolysis Excess RBC lysis Hemolytic disease of newborn Sickle Cell disease High unconjugated bilirubin |
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Intrahepatic jaundice |
Impaired uptake, conjugation or secreation of bilirubin Liver dysfunction |
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Posthepatic jaundice |
Caused by obstruction of the biliary tree Accumulation of conjugated bilirubin Pale stole(absence of bilirubin) Dark urine(increase conjugated bilirubin) |
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Neonatal jaundice |
Transient (resolves in the first 10 days) Common in premature infants Due to immaturity of the enzymes use in bilirubin conjugation Unconjugated bilirubin are toxic to newborn due to its hydrophobic qualities it can cross the blood-brain barrier and cause a mental illness called kernicterus Phototherapy with UV light is used to convert it to water soluble non-toxic form Exchange blood transfusion is used to remove excess bilirubin Phenobarbital crosses the placenta and induces the synthesis of UDP glucuronyl trsnsferase |
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Laboratory tests for prehepatic jaundice |
Increase unconjugated bilirubin Unconjugated bilirubin is toxic in water so the jaundice is acholuric (urine not bile stained) |
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Laboratory tests for hepatic jaundice |
Increase conjugated bilirubin and unconjugated bilirubin |
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Laboratory tests for posthepatic jaundice |
Increase conjugated bilirubin Urine dark Stool pale Normal aminotansaminase Increase GGT ALP & 5'nucleotide |
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Investigation of jaundice |
Ultrasonography Endoscopic retrograde cholangiopancreatography (ERCP) transhepatic cholongiogram Liver biopsy |
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Peritoneal respond to infection |
Bacteria rapidly removed Peritoneal macrophages release pro-inflammatory mediators WBC migrate to peritoneum Degranulation of mast cells: vasodilation Opsonization of bacteria by protein:phagocytosis Bacteria sequestered:abscess, limitation of spread |
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Parietal peritoneal inflammation |
Tenderness Guarding Rebound Rigidity |
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Pain of the perietal peritoneum |
Sharp well localized Coverage Nerve-T5-L2 Diaphragm-C3-C5 Sensitive to- mechanical Thermal Chemical |
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Pain of the visceral peritoneum |
Deep poorly localized Nerve-T6-L2 Sensitive to- distension Ischemia Traction |
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Mechanisms of pain |
Perforation Obstruction Inflammation |
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Investigation of peritoneum |
Blood test Urine test Radiology Endoscopy Peritoneal |
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Dysphagia |
Difficulty in swallowing Food sticks in upper or lower chest Food/liquid come back up No smell Discomfort is common |
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Patterns of dysphagia |
Dysphagia for solid Dysphagia for liquid Progressive dysphagia Total dysphagia |
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Dysphagia for solids |
Implies fixed inelastic obstruction |
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Mechanism of dysphagia for solid |
Rigid obstruction Solids cannot induce receptive relaxation due to fibrous tissue or tumour tissue Liquids can seep past the obstruction |
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Dysphagia for liquid |
Due to neurological disorders of the esophagus Chagas disease (parasitic) Myaesthenia gravis |
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Mechanism of achalagia for liquids> solid |
Loss of neurons in myenteric plexus results in LOSS OF RELAXATION of the denervated segment of the gullet Solids can FORCE RELAXATION via gravitational effects while liquids are less efficient at doing so hence dysphagia for liquids before solids |
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Investigation for dysphagia |
Shouldering Irregular mucosa Fissuring Proximally not dilated Apple core deformity Fistula upper and middle 1/3 |
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Ba swallowing- achalasia |
Smooth mucosa Narrow segment Dilated proximally Rat tall/bird beak deformity |
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Oesophageal manometery |
Pass down esophagus and inflated Response measured hypertonic lower GES diagnostic of achalasia Gold standard for testing achalasia |
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Treatment for achalasia |
Muscle relaxant Dilation BoTox injection Surgery Hellers cardiomyotomy Ca inhibition Nitrates |
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Achalasia symptoms |
Dysphagia liquids before solids Repetitive vomiting Wheezing Usually in young individuals |
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Aim of surgical nutrition |
Maintain or attain ideal body weight before elective surgery Correct electrolyte/metabolic imbalance Limit the post stress catabolism in emergency surgery and other stress |
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Weight less than ideal |
Assessment Feed patient Review progress |
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Obesity |
Increase physical activity Reduce intake Voluntary Surgical |
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Advantages of enteral alimentation |
Trophic effects on mucosa Gut function maintained Decrease translocation of bacteria Cheaper Personal Equipment |
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Parenteral nutrition |
GI tract unavailable Short bowel impaired motility of GIT High output fistula Inflamed bowel Sever pancreatitis Expensive |
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Barium |
Double contrast effect Done with fluoroscopy unit |
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Pathological entities |
Filling defects- mass Area of narrowing- strictures Outpouching- ulcer-irregular, wide neck Diverticulum-smooth, narrow neck |
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Function of peritoneum |
Control fluid within peritoneal cavity Remove bacteria Facilitate entry of inflammatory cells |
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Desphagea achalahia |
Solid Liquid |
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Stomach enteral alimenation |
Must have a intact gag reflex prevent aspiration |
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Small bowel alimentation |
Less aspiration Better for comatose pts Continuous feeding required |
