GI Patho 3

Question 1

Alcohol Liver Disease:

1) What is the main metabolic enzyme?
2) What leads to lipid accumulation?
3) 3 diseases?
4) Diet & Alcohol effect on Fatty Liver Disease?

Answer 1

1) Alcohol Dehydrogenase
2) Reduced Fatty acid oxidation (NAD is used up which is required for breakdown of fat)
3) - Fatty liver disease
- Alcohol Hepatitis
- Cirrhosis
4) - Independent of dietary habit
- Reversible after quitting alcohol

Question 2

Alcohol Hepatitis:

1) Usually occurs in?
2) What is it?
3) Mortality in acute stage?
4) % of alcoholics develop cirrhosis?

Answer 2

1) Binge drinkers
2) Liver inflammation & Necrosis
3) 10-30%
4) 10-15%

Question 3

Liver Cirrhosis:

1) What is it?
2) What does it disrupt? (2)
3) Major cause?

Answer 3

1) Scar tissue Replaces Functional tissue
2) - Blood flow (Portal Hypertension)
- Bile flow (Bile stasis)
3) Alcohol abuse

Question 4

Liver Cirrhosis:

1) When do symptoms occur?
2) Early manifestations?
3) Late manifestations?

Answer 4

1) Late in the disease
2) - Hepatomegaly (Enlargement of liver)
- Anorexia
- Diarrhoea
- Weight loss
- Fatigue
- Jaundice
3) - Portal Hypertension
- Liver cell Failure

Question 5

Portal Hypertension:

1) Normal portal BP?
2) What results in ^ BP in Hepatic portal vein?
3) Causes of Portal Hypertension?

Answer 5

1) 5 - 10 mmHg
2) ^ Resistance to flow (in portal venous system)
& sustained Portain Vein Pressure > 22mmHg
3) Obstruction of blood flow anywhere in Portal Venous System or Inferior Vena Cava

Question 6

Portal Hypertension: Most common cause:

1) Prehepatic factors?
2) Intrahepatic factors?
3) Posthepatic factors?

Answer 6

1) - Portal vein thrombosis
- External compression (from cancer or enlarged lymph nodes)
2) Liver cirrhosis
3) - Hepatic vein thrombosis
- Severe right heart failure

Question 7

Portal Hypertension:

Effects? (4)

Answer 7

1) Varices (swollen blood vessels)
2) Ascites (accumulation of fluid in peritoneal cavity)
3) Hepatic Ecephalopathy (CNS disturbances due to liver failure)
4) Splenomegaly (enlargement of spleen)

Question 8

Portal Hypertension:
Effects:
1) A type of varicose vein (Due to ^BP in portal veins)
2) Where?
3) % develop oesophageal varices?
4) Varicose veins radiating from the umbilicus are called?

Answer 8

1) Varices (distended collateral blood vessels, shunt>200mmHg)

2) Oesophageal & Gastric varices
3) 65%
4) Caput medusae

Question 9

Portal Hypertension: Varices

1) Why is vomiting blood common?
2) Most common cause of death in alcoholics?

3)Treatment of Oesogphageal varices? (2)

Answer 9

1) Reduced clotting factors
2) Sudden Haemorrhage (massive & fatal)
(thin & weak walls of varices rupture)

3) NG tube to lavage (wash out with water) Gastric contents before endoscopy
* ** Endoscopic Sclerotherapy
* ** Endoscopic Ligation

Question 10

Varices: Emergency treatment:
1) Resuscitate?
2) Restore circulating blood volume?
(restore BP & adequate urine output)

Answer 10

1) Establish airway protection :
- not fully conscious pt
- massive bleeding
2) - Blood transfusion
- IV 5% Dextrose & Colloid solution (in treatment of shock to ^ volume & pressure)
- Correct clotting factor deficiencies:
* Fresh frozen plasma
* Fresh blood
* Vitamin K-1

Question 11

Portal Hypertension: Ascites:

1) What is ascites?
2) Portal BP?
3) How many litres of ascites?

Answer 11

1) accumulation of fluid in peritoneal cavity
2) > 300 mmHg
3) 15L+

Question 12

Portal Hypertension: Ascites:

1) Due to?
2) If severe, what can it cause?
3) Low KCl = ?

Answer 12

1) - ^ intestinal blood vessel pressure
- Na+ & Water retention by kidneys
- ˅ colloidal osmotic pressure (osmotic pressure exerted by plasma proteins)
***Due to impaired Liver synthesis of albumin Acute renal failure and/or Cardiac arrest
- ˅ Urine
- ˅ Na+, K+, Cl-
3) Metabolic Alkalosis
(H+ exchange with K+)

Question 13

Portal hypertension: Treatment:

1) Diet?
2) Other treatments? (5)

Answer 13

1) - High Energy
(NO Protein if ˅ Liver function OR Hepatic encephalopathy)
- Na+ & Water restriction
2) - Oral diuretics
- Laxatives
- IV albumin
- Remove ascetic fluids
- Surgery

Question 14

Liver Failure:
1) % hepatic functional capacity lost?
Manifestations:
2) Hematologic disorders?
3) Endocrine disorders?
4) Hepatorenal Syndrome?
5) Hepatic encephalopathy?

Answer 14

1) 80-90%
2) Anemia; Coagulation defects;
[Leukopenia (˅WBCs)]
3) Fluid retention; ^ estrogen ˅ testosterone;
[Red palms (palmar erythema); Spider angioma]
4) ^ plasma Creatinine & Urea; Oliguria (˅urine)
5) Confusion; Coma; Convulsions; Asterixis (abnormal tremor consisting of involuntary jerking movements, especially in the hands)

Question 15

Liver Failure: Treatment (towards symptoms):

1) Diet?
2) Others?

Answer 15

1) - Stop alcohol
- adequate Carbohydrates
- ˅ Protein (to ˅ ammonia prod.)
2) - Correct fluids & electrolytes
- Liver transplant

Question 16

Primary Biliary Cirrhosis:

1) What is it?
2) Symptoms?
3) Treatment?

Answer 16

1) Inflam & scaring in bile ducts;
Portal inflam;
--> scaring of liver
2) - Unexplained pruritus (itching)
-  Weight loss, Fatigue
-  dark Urine, pale Stool
-  jaundice, liver failure
3) Drugs NOT effective
- Liver Transplant

Question 17

Gallstones:

1) AKA?
2) Formation of gallstones? Due to?

Answer 17

1) Cholelithiasis
2) - Abnormal bile composition
- Stasis (stoppage of flow) of Bile:
* Pregnancy ; Starvation ; Rapid weight loss
- Inflam. of Gall Bladder
* Excessive water absorption

Question 18

1) 2 types of gallstones? & Risk factors?

2) Inflammation of gallbladder is called?

Answer 18

1) - CHOLESTEROL (most common)
* Obesity ; Middle age
- PIGMENTED
* ^ lvls of Bilirubin
* Cirrhosis ; Later life
2) Cholecystitis

Question 19

Cholecystitis:

1) Cause?
2) Symptoms?
3) What does Jaundice indicate?
4) Diagnosis?
5) Preferred Treatment?

Answer 19

1) Chronic irritation of gall bladder by Gall Stones
2) - Abdominal pain in Upper right/Epigastric area
- Stones lodge in Cystic/Common bile duct (>8mm)
- occurs after Fatty food
- Persist 2-8hrs
3) Stone is located in Common Bile Duct
4) - Murphy’s sign (physical exam)
- B Ultrasound
5) Laparoscopic cholecystectomy