Patho Week 6, Gi, Endocrine, Diabetes

Front 1

cirrhosis is characterized by...

Back 1

by diffuse fibrosis and conversion of normal liver architecture into structurally abnormal nodules.

Front 2

What happens when these nodules increase, such as in advanced cirrhosis?

Back 2

• Portal hypertension and its complications
• Obstruction of biliary channels
• Exposure to the destructive effects of bile stasis

Front 3

Causes of cirrhosis?

Back 3

• usually is associated with alcoholism
• viral hepatitis
• toxic reactions to drugs and chemicals
• biliary obstruction
• heart failure.
• Also accompanies metabolic disorders that cause the deposition of minerals in the liver.
o Two of these disorders are hemochromatosis (i.e., iron deposition) and Wilson disease (i.e., copper deposition).

Front 4

Early manifestations of cirrhosis

Back 4

• Often no symptoms until the disease is far advanced.
• weight loss (sometimes masked by ascites)
• weakness
• anorexia
• Jaundice, usually not an early sign, is mild at first but increases in severity during the later stages of the disease.
• Diarrhea frequently is present, although some persons may complain of constipation.
• Abdominal pain because of liver enlargement or stretching of Glisson capsule. This pain is located in the epigastric area or in the upper right quadrant and is described as dull, aching, and causing a sensation of fullness

Front 5

Late manifestations of cirrhosis

Back 5

• Splenomegaly
• Ascites
• portosystemic shunts (i.e., esophageal varices, anorectal varices, and caput medusae) result from portal hypertension.
• bleeding due to decreased clotting factors
• thrombocytopenia due to splenomegaly
• gynecomastia and a feminizing pattern of pubic hair distribution in men because of testicular atrophy
• spider angiomas
• palmar erythema
• encephalopathy with asterixis and neurologic signs.

Front 6

ASCITES:

Back 6

Occurs when the amount of fluid in peritoneal cavity is increased
Occurs with late stage cirrhosis (sometimes up to 15L of fluid) and portal hypertension

Front 7

Etiology of splenomegaly?

Back 7

Portosystemic shunts often lead to esophageal varices.

Front 8

Liver failure can cause:

Back 8

• Anemia
o blood loss
o red blood cell destruction
o impaired formation of red blood cells
o folic acid deficiency
• Thrombocytopenia
o occurs as the result of splenomegaly
• coagulation defects
o clotting factors, prothrombin, and fibrinogen are synthesized by the liver, their decline in liver disease contributes to bleeding disorders
o Malabsorption of vit. K impairs synthesis of clotting factors
• leukopenia
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o
Endocrine Disorders:
• The liver metabolizes the steroid hormones; therefore, these hormones are often elevated in persons with liver failure
• This messes with all kinds of hormonal stuff:

Women
o menstrual irregularities (usually amenorrhea), loss of libido, and sterility
Men
o testicular atrophy, loss of libido, impotence, and development of gynecomastia
o
Skin Disorders
• Liver failure brings on numerous skin disorders
o vascular spiders
o telangiectases
o spider angiomas
o spider nevi
• They consist of a central pulsating arteriole from which smaller vessels radiate
• Palmar erythema is redness of the palms, probably caused by increased blood flow from higher cardiac output
• Clubbing of the fingers may be seen in persons with cirrhosis
• Jaundice usually is a late manifestation.

Hepatorenal Syndrome
• refers to a functional renal failure sometimes seen during the terminal stages of liver failure with ascites

o characterized by progressive azotemia, increased serum creatinine levels, and oliguria
o a decrease in renal blood flow is believed to play a part

• when renal failure is superimposed on liver failure, azotemia and elevated levels of blood ammonia occur
o this condition is thought to contribute to hepatic encephalopathy and coma

Hepatic Encephalopathy
• refers to the totality of central nervous system (CNS) manifestations of liver failure
o characterized by neural disturbances ranging from:
 lack of mental alertness to confusion
 coma
 convulsions
o early sign is a flapping tremor called asterixis
o Various degrees of memory loss may occur
o personality changes such as euphoria, irritability, anxiety
o lack of concern about personal appearance and self
o Speech may be impaired
o may be unable to perform certain purposeful movements
o The encephalopathy may progress to decerebrate rigidity, then to a terminal deep coma

Front 9

Explain the development of gallstones and their consequences

Back 9

Cholelithiasis or gallstones is caused by precipitation of substances contained in bile, mainly cholesterol and billirubin

Three factors contribute to the formation of gallstones:
1. abnormalities in the composition of bile
2. stasis of bile
3. inflammation of the gallbladder.

• associated with obesity and occurs more frequently in women
• Gallstones cause symptoms when they obstruct bile flow
• Small stones (e.g., <8 mm in diameter) pass into the common duct, producing symptoms of indigestion and biliary colic
• Larger stones are more likely to obstruct flow and cause jaundice
• The pain of biliary colic usually is abrupt in onset and increases steadily in intensity until it reaches a climax in 30 to 60 minutes

Front 10

4. Compare cholelithiasis and cholecystitis in the areas of etiology, risk factors, pathophysiology, clinical picture

Back 10

Cholecystitis refers to inflammation of the gallbladder

Acute cholecystitis almost always is associated with complete or partial obstruction of the cystic or common bile ducts

Chronic cholecystitis results from repeated episodes of acute cholecystitis or chronic irritation of the gallbladder by stones

Cholelithiasis refers to gallstones
Both acute and chronic cholecystitis are associated with GALLSTONES

Acute cholecystitis may be superimposed on chronic cholecystitis.

Front 11

Acute pancreatitis

Back 11

• severe, life-threatening disorder
• assoc with the escape of pancreatic enzymes into the pancreas and tissues
• enzymes cause fat necrosis, or autodigestion, of the pancreas
o produce fatty deposits in the abdominal cavity with hemorrhage
• Most cases result from
o gallstones (stones in the common duct)
o alcohol abuse
• associated with:
o hyperlipidemia
o hyperparathyroidism
o infections (particularly viral)
o abdominal and surgical trauma
o drugs such as steroids and thiazide diuretics

Front 12

S/S Acute pancreatitis

Back 12

• Onset usually is abrupt & dramatic may follow a heavy meal or alcoholic binge
• most common initial symptom is severe epigastric and abdominal pain that radiates to the back
• pain is aggravated when the person is lying supine
• pain is less severe when the person is sitting and leaning forward
• Abdominal distention accompanied by hypoactive bowel sounds is common
• loss of a large volume of fluid into the retroperitoneal and peripancreatic spaces and the abdominal cavity
• Tachycardia, hypotension, cool and clammy skin, and fever often are evident
• Complications include acute respiratory distress syndrome and acute tubular necrosis

Front 13

2 types chronic pancreatitis

Back 13

1. Chronic calcifying pancreatitis
• calcified protein plugs (i.e., calculi) form in the pancreatic ducts
• most often in alcoholics

2. Chronic obstructive pancreatitis
• Stenosis of the sphincter of the pancreatic duct
• Caused by cholelithiasis and sometimes is relieved by removal of the stones
• Manifested in episodes that are similar, but less severe than acute pancreatiti
• Persistent, recurring episodes of epigastric and upper left quadrant pain
• Attacks often are precipitated by alcohol abuse or overeating
• Disease progresses to the extent that endocrine and exocrine pancreatic functions become deficient. At this point, signs of diabetes mellitus and the malabsorption syndrome (e.g., weight loss, fatty stools [steatorrhea]) become apparent.

Front 14

Common S/S Chronic obstructive pancreatitis

Back 14

• Anorexia
• Nausea
• Vomiting
• Constipation
• flatulence

Front 15

What is its ascites cause?

Back 15

• an increase in capillary pressure due to portal hypertension and obstruction of venous flow through the liver, and salt and water retention by the kidney.
• Disturbances include: failure of the liver to metabolize aldosterone, causing an increase in salt and water retention by the kidney.

Front 16

• Hepatic encephalopathy refers to

Back 16

the totality of central nervous system (CNS) manifestations of liver failure

Front 17

o early sign of hepatic encephalopathy is

Back 17

a flapping tremor called asterixis

Front 18

Causes of Hypopituitarism

Back 18

• Tumors and mass lesions—pituitary adenomas, cysts, metastatic cancer, and other lesions
• Pituitary surgery or radiation
• Infiltrative lesions and infections—hemochromatosis, lymphocytic hypophysitis
• Pituitary infarction—infarction of the pituitary gland after substantial blood loss during childbirth (Sheehan syndrome)
• Pituitary apoplexy—sudden hemorrhage into the pituitary gland
• Genetic diseases—rare congenital defects of one or more pituitary hormones
• Empty sella syndrome—an enlarged sella turcica that is not entirely filled with pituitary tissue
• Hypothalamic disorders—tumors and mass lesions (e.g., craniopharyngiomas and metastatic malignancies), hypothalamic radiation, infiltrative lesions (e.g., sarcoidosis), trauma, infections

Front 19

3 reasons for growth hormone:

Back 19

• bone and cartilage growth
• body organs
• muscle

Front 20

. In children GH deficiency interferes with linear bone growth resulting in

Back 20

short stature

Front 21

GH excess in children results in

Back 21

dwarfism

Front 22

In adults GH excess results in

Back 22

overgrowth of cartilaginous parts of the skeleton, enlargement of the heart or other organs, metabolic disturbances. Most people with this condition have a(n) somatotropic adenoma as the cause.

Front 23

Thyroid hormone has two major functions, list them.

Back 23

• increases protein synthesis and metabolism
• necessary for growth and development and sexual maturity

Front 24

Describe the actions of thyroid hormone on the metabolic rate

Back 24

Metabolic Rate
• Thyroid hormone increases metabolic rate in all body tissues except the retina, spleen, testes, and lungs
• As a result of this higher metabolism, the rate of glucose, fat, and protein use increases.
• Lipids are mobilized from fat, and the catabolism of cholesterol by the liver is increased.
• Muscle proteins are broken down and used as fuel, probably accounting for some of the muscle fatigue that occurs with hyperthyroidism.
• The absorption of glucose from the gastrointestinal tract is increased.
• An increase in metabolic rate “speeds up” the use of vitamins and tends to cause vitamin deficiency.

Front 25

Describe the actions of thyroid hormone on the Cardiovascular Function

Back 25

• With an increase in metabolism, there is a rise in oxygen consumption and production of metabolic end products, with an accompanying increase in vasodilatation.
• Blood flow to the skin, in particular, is augmented as a means of dissipating the body heat that results from the higher metabolism.
• Blood volume, cardiac output, and ventilation all are increased as a means of maintaining blood flow and oxygen delivery to body tissues.
• Heart rate and cardiac contractility are enhanced to maintain the needed cardiac output.
• Blood pressure is likely to change little because the increase in vasodilatation tends to offset the increase in cardiac output.

Front 26

Describe the actions of thyroid hormone on the Gastrointestinal Function

Back 26

• Thyroid hormone enhances gastrointestinal function, causing an increase in motility and production of GI secretions that often results in diarrhea.
• An increase in appetite & food intake accompanies the higher metabolic rate
• At the same time, weight loss occurs because of the increased use of calories.

Front 27

Describe the actions of thyroid hormone on the Neuromuscular Effects

Back 27

• Marked effects on neural control of muscle function and tone.
• Slight elevations in hormone levels cause skeletal muscles to react more vigorously, and a drop in hormone levels causes muscles to react more sluggishly.
• In hyperthyroid, a fine muscle tremor is present.
• In the infant, thyroid hormone is necessary for brain development. In the hyperthyroid state, it causes extreme nervousness, anxiety, and difficulty in sleeping.
• Strong interaction between thyroid hormone & the sympathetic nervous system.
• S/S of hyperthyroidism suggest overactivity of the sympathetic division of the ANS, such as tachycardia, palpitations, and sweating. Tremor, restlessness, anxiety, and diarrhea also may reflect ANS imbalances.

Front 28

ACTH deficiency (secondary adrenal failure) is the most serious endocrine deficiency, leading to:

Back 28

weakness
nausea and anorexia
fever
postural hypotension.

Front 29

S/S Hyperpituiarism:

Back 29

• nervousness, irritability, and fatigability
• Weight loss is common despite a large appetite
• Tachycardia and palpitations
• shortness of breath
• excessive sweating
• muscle cramps
• heat intolerance.
• person appears restless and has a fine muscle tremor.
• In persons without exophthalmos (i.e., bulging of the eyeballs seen in ophthalmopathy), there is an abnormal retraction of the eyelids and infrequent blinking such that they appear to be staring. The hair and skin usually are thin and have a silky appearance.

Front 30

The Adrenal Cortex produces three types of steroid hormones. List them and describe their functions and their effects on metabolism, psychology, immune system.

Back 30

• mineralocorticoids (principally aldosterone), which function in sodium, potassium, and water balance
• the glucocorticoids (principally cortisol), which aid in regulating the metabolic functions of the body and in controlling the inflammatory response, and are essential for survival in stress situations
• Adrenal sex hormones (principally androgens), which serve mainly as a source of androgens for women.

Front 31

The manifestations of adrenal cortical insufficiency are related mainly to ...

Back 31

mineralocorticoid deficiency and glucocorticoid deficiency.

Front 32

Describe what happens when pharmaceutical preparations of adrenal cortical hormones are withdrawn from a patient.

Back 32

• acute adrenal insufficiency

Front 33

Addison’s Disease is caused by destroys adrenal gland. Describe its manifestations.

Back 33

• orthostatic hypotension
• weakness
• fatigue
• if loss of sodium is extreme, cardiologic collapse can occur
• hyperpigmenttation
• limited ability to respond to infections, trauma, and stress
• gums may become bluish black

Front 34

________ is the most common cause of Addison disease in the United States.

Back 34

autoimmune destruction

Front 35

Cushing’s syndrome refers to manifestations of hypercortisolism. Describe its manifestations

Back 35

• round moon shape face
• buffalo hump
• increased facial hair
• thinning of the scalp
• protruding abdomen
• legs and arms look puny
• purpura
• amenorrhea
• skin ulcers (poor skin healing)