liver, pancreas, peritonitis - Sheet1

Question 1

What is hepatic failure?

Answer 1

Acute liver failure (fulminant) occurs in patients with no prior history. End-stage liver disease (ESLD) is the progression from compensated to decompensated liver state.

Question 2

What is the mechanism of hepatic failure?

Answer 2

Results from intrahepatic necrosis or decreased blood supply to the liver, leading to impaired metabolic processes, such as altered carb, protein, and fat metabolism, and decreased detoxification and storage functions.

Question 3

What are the manifestations of hepatic failure?

Answer 3

Asymptomatic initially. Prodromal stage includes anorexia, N/V, abdominal pain, fatigue. Fulminant hepatic failure can cause hyperexcitability, irritability, jaundice, fever, coma, and convulsions.

Question 4

How is hepatic failure diagnosed?

Answer 4

H&P, labs, abdominal CT/ultrasound, antibody testing for hepatitis types.

Question 5

What are the complications of hepatic failure?

Answer 5

Includes unstable glucose levels, hypoglycemia, malnutrition, ascites, edema, bleeding, infection, DVTs/PEs, hepatic encephalopathy, portal hypertension, and variceal bleeding.

Question 6

What is hepatitis?

Answer 6

Inflammation of the liver caused by viruses (e.g., hepatitis A, B, C, D, E; CMV; Epstein-Barr), alcohol, medications, chemicals, autoimmune diseases, or metabolic abnormalities.

Question 7

How is hepatitis transmitted?

Answer 7

Via blood, blood products, saliva, semen, vaginal fluids, mucous membranes, or contact with infected fluids or objects.

Question 8

What is cirrhosis?

Answer 8

End stage of liver disease after years of chronic liver disease. Characterized by fibrotic scar tissue and regenerative nodules in the liver.

Question 9

What causes cirrhosis?

Answer 9

Alcohol, Hepatitis C, hepatosteatosis, other hepatitis viruses, autoimmune diseases.

Question 10

What are the manifestations of cirrhosis?

Answer 10

Early: Fatigue, hepatomegaly, normal LFTs (compensated). Late: Jaundice, scleral icterus, peripheral edema, ascites, anemia, thrombocytopenia, hypoglycemia, and abnormal LFTs (decompensated).

Question 11

How is cirrhosis diagnosed?

Answer 11

H&P, labs, abdominal CT/ultrasound, antibody testing for hepatitis types.

Question 12

What is hepatic encephalopathy?

Answer 12

Neuropsychiatric manifestation of liver disease, primarily due to elevated ammonia levels.

Question 13

What are the manifestations of hepatic encephalopathy?

Answer 13

Asterixis (early sign), altered LOC, confusion, impulsive behavior, impaired judgment, motor deficits, and coma.

Question 14

How is hepatic encephalopathy diagnosed?

Answer 14

H&P, serum ammonia levels.

Question 15

What is portal hypertension?

Answer 15

Abnormally high blood pressure in the portal system caused by resistance to blood flow. Normal: 3 mmHg; Portal HTN: >10 mmHg.

Question 16

What causes portal hypertension?

Answer 16

Cirrhosis, which leads to structural changes in the liver and obstructed blood flow, increasing pressure in liver vasculature.

Question 17

What are the manifestations and complications of portal hypertension?

Answer 17

Abdominal distention, increased girth, weight gain, dyspnea, edema. Complications include varices, ascites, and splenomegaly.

Question 18

What is liver cancer?

Answer 18

Includes hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma. HCC accounts for 75% of cases. 5th most common cancer globally, but 2nd leading cause of cancer death.

Question 19

Where does liver cancer commonly metastasize?

Answer 19

To the lungs.

Question 20

What are the manifestations of liver cancer?

Answer 20

Symptoms of cirrhosis plus unexplained weight loss, palpable mass, RUQ pain.

Question 21

How is liver cancer diagnosed?

Answer 21

Ultrasound, CT, MRI, and biopsy if needed.

Question 22

What is acute pancreatitis?

Answer 22

Acute inflammatory process of the pancreas caused by spillage of pancreatic enzymes into surrounding tissue, leading to autodigestion and severe pain.

Question 23

What are common etiologies of acute pancreatitis?

Answer 23

Gallstones (women), chronic alcohol intake (men), smoking, biliary sludge, hypertriglyceridemia, and ERCP.

Question 24

What are less common etiologies of acute pancreatitis?

Answer 24

Trauma, viral infections, penetrating duodenal ulcers, cysts, and abscesses.

Question 25

What is the mechanism of acute pancreatitis?

Answer 25

Pancreatic enzymes spill into surrounding pancreatic tissue, causing autodigestion, inflammation, and severe pain.

Question 26

What are the manifestations of acute pancreatitis?

Answer 26

Epigastric pain (mild to severe) with possible radiation to the back, fever, leukocytosis, abdominal distention, and hemodynamic instability related to inflammation.

Question 27

How is acute pancreatitis diagnosed?

Answer 27

H&P, serum pancreatic enzyme levels, abdominal X-ray, CT, or ultrasound.

Question 28

What is peritonitis?

Answer 28

Localized or generalized inflammation of the peritoneal lining.

Question 29

What are the etiologies of primary peritonitis?

Answer 29

Bacterial peritonitis caused by blood-borne infections, GU organisms, or cirrhosis with ascites.

Question 30

What are the etiologies of secondary peritonitis?

Answer 30

Ruptured appendicitis, blunt/penetrating trauma, perforated bowel, and postoperative incision leakage.

Question 31

What are complications of peritonitis?

Answer 31

Hypovolemic shock, sepsis, abscess formation, paralytic ileus, ARDS, and abdominal compartment syndrome.

Question 32

What are the classic manifestations of peritonitis?

Answer 32

Hard, distended abdomen, rebound tenderness, guarding and splinting of abdominal wall due to pain.

Question 33

What other manifestations are seen in peritonitis?

Answer 33

N/V, decreased or absent bowel sounds, hypovolemic shock, Cullen’s sign (ecchymosis around umbilicus), and Grey Turner’s sign (ecchymosis around the flank, indicating retroperitoneal bleed).

Question 34

How is peritonitis diagnosed?

Answer 34

H&P, WBC with differential, abdominal X-ray, CT, ultrasound, and diagnostic paracentesis.