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51 Cards in this Set

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What is ascites?
increased fluid in peritoneal cavity
( a late stage manifestation of cirrhosis and portal HTN )
What are 3 contributing factors of ascites?
1. increased capillary pressure from portal htn and obstruction of flow thru liver

2. retention of Na and H2O by kidneys

3. decreased colloidal pressure (impaired albumin synthesis from failing liver)
3 types of tx for ascites?
1. dietary restriction of Na and H2O

2. diuretics

3. paracentesis
What is a complication of ascites?
spontaneous bacterial peritonitis
What is spontaneous bacterial peritonitis?
-a complication of ascites

1. seen in persons with both cirrhosis and ascites

2. peritoneal infected with bacteria from blood, lymph, or thru bowel wall

3. serious infection; high mortality even with antibiotics
What is splenomegaly?
the result of shunting of blood into splenic vein
What does splenomegaly cause?
sequestering of large #s of blood elements and development of hypersplenism

-decreased life span and #s of formed elements of blood such as thrombocytopenia, anemia, and leukopenia
What are collateral channels?
the development of large collateral channels for flow caused by increased pressure in portal vein
Where do collateral channels occur?
between portal and systemic veins supplying lower rectum and esophagus and the umbilical veins of falciform ligament
What are the results of collateral channels?
1. hemorrhoids

2. caput medusae

3. portopulmonary shunts (bypass pulmonary caps)
What is the clinically most important aspect of collateral channels?
connections to the esophagus cause esophageal varices
How are surgical shunts involved with collateral channels?
portosystemic (connections between portal and systemic venous systems) or TIPS (transjugular intrahepatic portosystemic shunt)
What are esophageal varices?
pressure in the portal vein due to obstruction, causing collateral channel development
What do esophageal varices cause?
reversal of flow (back-up) and formation of thin-walled varicosities in submucosa of esophagus
What are esophageal varices subject to?
rupture
Esophageal varices subject to rupture can result in massive what?
fatal hemorrhage
Esophageal varices subject to rupture are complicated by what 2 things?
1. liver dysfunction (failure to produce coagulation factors)

2. splenomegaly (thrombocytopenia)
Hepatic encephalopathy is seen in 50-70% of ? patients and 10% of patients with ??
cirrhosis....systemic shunts
What is hepatic encephalopathy?
failing liver is unable to metaboize neurotoxins (ammonia, particularly)....the totality of CNS manifestations of liver failure
What are some of the symptoms seen in hepatic encephalopathy?
ranges from a lack of mental alertness to confusion, coma, convulsions
What is the most severe clinical consequence of liver disease?
liver failure
In what 2 ways may liver failure occur?
1. acutely (fulminant hepatitis)

2. chronic, progressive damage (cirrhosis)
How much loss of hepatic function needs to occur for liver failure to occur?
80 - 90%
5 possible ways of tx liver failure?
1. eliminate alcohol intake

2. prevent infections

3. carbos and calories to prevent protein breakdown

4. correct fluid/electrolyte imbalances

5. decrease ammonia production
2 general manifestations/disorders of liver failure?
1. disorders of synthesis and storage function

2. disorders of metabolic and excretory function


(both reflect liver functions)
What 4 things are directly related to liver failure disorders of synthesis and storage function?
1. glucose

2. proteins

3. lipoprotein cholesterol

4. bile salts
In liver failure disorders of synthesis and storage function as it relates to glucose results in what?
hypoglycemic events
In liver failure disorders of synthesis and storage function as it relates to proteins results in what 2 things?
1. hypoalbuminemia leading to edema/ascites

2. Coagulation factors leading to bleeding
In liver failure disorders of synthesis and storage function as it relates to lipoprotein cholesterol results in what?
decreased cholesterol
In liver failure disorders of synthesis and storage function as it relates bile salts results in what?
Impaired fat absorption which leads to A) deficiency in fat soluble vitamins and B) fatty stools
Liver failure's cause of metabolic and excretory function as it relates to AAs can result in what?
conversion to ammonia which leads to encephalopathy
Liver failure's cause of metabolic and excretory function as it relates to steroid hormones can result in what?
1. increased aldosterone that leads to edema/ascites

2. increased androgens/estrogens that leads to A) gynecomastia and testicular atrophy and B) menstrual irreg.
Liver failure's cause of metabolic and excretory function as it relates to drugs can result in what?
drug interactions/tox.
Liver failure's cause of metabolic and excretory function as it relates to bilirubin can result in what?
hyperbilirubinemia that leads to jaundice
What is Cholelithiasis?
gallstones
What is the size of cholelithiasis (gallstones)?
range from grain of sand to 1 inch
What essentially is a gallstone?
precipitation of substances in bile (especially cholesterol and bilirubin)
What are 3 risk factors for cholelithiasis?
1. women

2. native americans

3. over the age of 40
3 contributing factors to cholelithiasis?
1. bile composition abnormalities

2. bile stasis

3. gallbladder inflammation
4 signs and symptoms of cholelithiasis (gallstones)?
1. many are asymptomatic

2. symptoms when bile flow obstructed

3. small stones (<8mm in diameter) pass into common duct which causes indigestion and biliary colic (pain in the upper right quadrant)
-stone may become lodged: acute cholecystitis (repeated episode: lead to chronic cholecystitis)

4. larger stones: more likely to obstruct flow...causes jaundice
The pancreatic enzymes trypsin and chymotrypsin acts on what substrate and produce what action?
substrate = proteins

action = proteins to peptides
The pancreatic enzyme carboxypeptidase acts on what substrate and produce what action?
substrate = proteins

action = removes last aa from carboxy end of peptide
The pancreatic enzyme lipase acts on what substrate and produce what action?
substrate = fat

action = converts triglycerides into fatty acids and monoglycerides
The pancreatic enzyme pancreatic amylase acts on what substrate and produce what action?
substrate = polysaccharide

action = converts polysaccharides into glucose and maltose
The pancreatic enzymes RNAase and DNAase acts on what substrate and produce what action?
substrate = nucleic acid

action = convert nucleic acids into nucleotides
What is acute pancreatitis? give an example.
activated pancreatic enzymes escape into pancreas and surrounding tissue (ex. autodigestion of pancreas)
What causes acute pancreatitis?
usually develops from gallstones in common duct or alcohol abuse
Describe the onset of acute pancreatitis?
abrupt...initial symptom is severe epigastric pain radiating to back
6 ways of diagnosing acute pancreatitis?
1. serum amylase (rise w/n first 24 hours, elevated for 72 hrs)

2. serum lipase (rise within first 24-48 hours, elevated for 5-14 days)

3. urine amylase (increased urinary clearance)

4. increased wbc

5. hyperglycemia

6. increased bilirubin
3 complications of acute pancreatitis?
1. acute respiratory distress syndrome

2. acute tubular necrosis

3. hypocalcemia
3 tx for acute pancreatitis?
1. prophylactic antibiotics

2. fluid replacement

3. pain relief/smooth muscle relaxation