Signs And Symptoms

Question 1

Diarrhea

Answer 1

Loose stools >3 times a day
Acute diarrhea <4weeks
D/t: viruses or toxins

Chronic diarrhea >4weeks
Organic or functional diarrhea

Organic:
Celiac disease
IBD: ulcerative colitis or crohns
Infections: bacterial or parasitic
Tumors
S/s: weeks
Often blood
No pattern
Fever, arthritis,skin lesions
Weight loss
Cramps

Functional:
IBS
Lactose intolerance
Food allergies
Alcohol/drug abuse

S/s: >6months
Blood never
Morning pattern, doesn’t wake patient at night.
No weight loss association

Small bowel:
Larger volume
Low frequency
Yellow/grey stool

Large bowel:
Smaller volume
High frequency
Blood or mucus stool

Question 2

Jaundice

Answer 2

Conjugated bilirubin= bilirubin +glucauronic acid

Unconjugated bilirubin=bilirubin + delta bilirubin

Causes:
1)Pre-hepatic- increased of unconjugated bilirubin
•hemolytic anemia
2)Hepatic jaundice
•hepatitis
•cirrhosis
•hepatic carcinoma
3)Post hepatic/Obstructive jaundice
•cholecystitis
•carcinoma of head of pancreas
•pancreatic edema

S/S:
Pale stools
Yellow skin, sclera

Question 3

Ascites

Answer 3

Abnormal build up of fluid in the peritoneal cavity
>25 ml of fluid, often more
Fluid contains: proteins(albumin), lipids, bile and WBC.
SAAG- serum ascites albumin gradient
S/S:
Visible distended peritoneum
Shifting dullness
Lab test:
Complete blood count test
Liver function test

High SAAG-> hydrostatic pressure imbalance.
Caused by portal hypertension:
-cirrhosis
-CHF
-portal vein thrombosis

Low SAAG-> oncotic pressure imbalance.
Caused by infections
-TB
-peritoneal malignancy
-pancreatitis
-nephrotic syndrome

Question 4

Syncope

Answer 4

-Reversible loss of consciousness, due to inadequate blood flow to the brain.
-Fast on set , short duration, spontaneous recovery!

Transient Loss of Consciousness:
(Non-traumatic and traumatic)
Non Traumatic
-syncope
-epileptic seizures
-psychogenic
-subclavian steal syndrome

Syncope types:

REFLEX/NEURAL MEDIATED
Vasovagal syncope;
-Fear, phobia, pain
Situational syncope ;
-swallowing, coughing
Carotid Sinus syndrome;
-tie is too tight around neck

ORTHOSTATIC HYPOTENSION
Volume depletion;
-hemorrhage, vomiting, diarrhea
Autonomic failure;
-diabetes, Parkinson’s
Drug induced;
- vasodilators, diuretics, anti depressants

CARDIAC CAUSES
Arrhythmia;
-tachycardia, bradycardia
Structural defect;
-aortic stenosis, MI
Great vessels;
-aortic dissection, pulmonary embolus

Question 5

Hypoalbuminemia

Answer 5

Albumin functions:
-Most abundant protein in the blood.
-Maintains oncotic pressure
-transports;hormones,fatty acids
-binds to calcium and drugs

Cause:
•Liver disease: cirrhosis, chronic hepatitis(d/t impaired synthesis and capillary leakage)
•Kidney disease: nephrotic syndrome d/t loss in protein
•Malnutrition/Malabsorption: ulcerative colitis, crohns, celiacs

S/S:
Weakness
Peripheral edema
Ascites
Thin hair
Jaundice if liver disease present:

Tests:
LFT
Urine sample
Stool

Question 6

Portal hypertension

Answer 6

-An elevated blood pressure in the portal system.
-Portal pressure >5mmHg

Main vessels:
-Superior mesenteric(small intestines
-Inferior mesenteric (large intestines)
- Splenic vein
-Left gastric vein
-Umbilical Vein(usually round ligament)

Causes: when blood flow from the portal system to the IVC meets.

Prehepatic- before it goes into liver d/t portal vein thrombosis, splenomegaly, splenic thrombus

Intrahepatic- within the liver. D/t cirrhosis

Posthepatic- after liver d/t IVC obstruction, right sided heart failure.

S/S:
Fatigue
Pruritis
Jaundice
Edema may be peripheral
Ascites
Gynecomastia
Palmar erythema
Spider naevi
Caput medusae
Hepatosplenomegaly

Examination:
Ascites
HepatoSplenomegaly
Varicose veins