Appendicitis and Digestive Disorders

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Questions and Answers

What is the most common area affected by Crohn's disease?

Sigmoid colon

Rectum

Cecum

Ascending & transverse colon (correct)

What type of ulcers are typically observed in Crohn's disease?

Linear ulcers

Fissured ulcers with a cobblestone pattern (correct)

Superficial ulcers

Hemorrhagic ulcers

What symptom is less common in Crohn's disease compared to ulcerative colitis?

Weight loss

Bloody diarrhea (correct)

Diarrhea

Abdominal tenderness

Which of the following is a characteristic of diverticulitis?

Inflammation of diverticula Signup and view all the answers

What is a possible cause of diverticular disease that remains uncertain?

Decreased fiber intake Signup and view all the answers

What is the most common age range for the occurrence of appendicitis?

20 to 30 years Signup and view all the answers

What is the common theory behind the cause of appendicitis?

Obstruction of the lumen by stool, tumors, or foreign bodies Signup and view all the answers

Which symptom is NOT typically associated with appendicitis?

Cold extremities Signup and view all the answers

What condition is described by abnormally high blood pressure in the portal venous system?

Portal Hypertension Signup and view all the answers

Which of the following is a progressive complication of acute or chronic liver disease?

Systemic complications Signup and view all the answers

Which of the following organs is NOT classified as an accessory organ of digestion?

Large intestine Signup and view all the answers

What is a potential sign of diverticula that cause abscesses?

Localized tenderness in the left lower quadrant Signup and view all the answers

Which statement is false regarding the clinical manifestations of liver disorders?

Acute liver disease does not cause significant symptoms. Signup and view all the answers

What primarily causes hemolytic jaundice?

Excessive lysis of RBCs or large hematoma absorption Signup and view all the answers

Which substance is primarily elevated in hemolytic jaundice?

Unconjugated bilirubin Signup and view all the answers

What is a common symptom of viral hepatitis?

Clay-colored stools Signup and view all the answers

Which of the following is NOT a cause of hepatitis?

Genetic mutations affecting liver function Signup and view all the answers

What characterizes the cell changes during the acute phase of viral hepatitis?

Varying degrees of hepatic cell injury and tissue necrosis Signup and view all the answers

Which symptom is NOT commonly associated with ascites caused by cirrhosis?

Fever Signup and view all the answers

What is the function of hepatocytes concerning bilirubin?

Conjugate unconjugated bilirubin Signup and view all the answers

What mechanism leads to increased lymph production in the liver?

Increased pressure in the liver Signup and view all the answers

What results in the yellowish pigmentation of the skin known as jaundice?

Elevated plasma bilirubin levels Signup and view all the answers

Which statement about bilirubin metabolism is correct?

Bilirubin binds to albumin in the plasma. Signup and view all the answers

What constitutes the primary cause of obstructive jaundice?

Obstructions in the bile ducts Signup and view all the answers

What phase in bilirubin metabolism occurs after hemoglobin breakdown?

Conjugation of bilirubin in the liver Signup and view all the answers

Which of the following statements about unconjugated bilirubin is false?

It is water soluble. Signup and view all the answers

What is the primary reason for the development of cardiac cirrhosis?

Prolonged venous congestion from right-sided heart failure Signup and view all the answers

What is a common symptom of both cirrhosis and cholecystitis?

Vomiting Signup and view all the answers

Which type of gallstone is the most prevalent?

Cholesterol Stones Signup and view all the answers

What is a key risk factor for developing cholelithiasis?

Rapid weight loss Signup and view all the answers

What kind of pain is typically associated with cholelithiasis?

Colicky pain Signup and view all the answers

Cholecystitis is primarily caused by what?

Obstruction from a gallstone Signup and view all the answers

Which of the following is NOT a common symptom of cirrhosis?

Severe chest pain Signup and view all the answers

In cholelithiasis, what causes the precipitation of stone formation?

Supersaturation of bile with cholesterol Signup and view all the answers

Study Notes

Appendicitis

Inflammation of the vermiform appendix
Most common surgical emergency of the abdomen
Usually occurs between 20 and 30 years of age
The exact cause is unknown; a common theory is that the lumen becomes obstructed with stool, tumors, or foreign bodies, resulting in pressure, ischemia, infection, and inflammation
Symptoms include vague epigastric or periumbilical pain that worsens over 3-4 hours. Pain may come and go, then shift to the right lower quadrant. Nausea, vomiting, anorexia, and fever may develop. WBC may be elevated, and rebound tenderness may be present

Disorders of the Accessory Organs of Digestion

Accessory organs of digestion secrete substances needed for digestion and metabolic functioning
These organs include the liver, gallbladder, and pancreas

Clinical Manifestations of Liver Disorders

Of all the accessory organ disorders, acute or chronic liver disease leads to the most systemic and life-threatening complications

Portal Hypertension

Abnormally high blood pressure in the portal venous system

Crohn's Disease

Inflammatory disorder affecting all of the gastrointestinal tract; the ascending and transverse colon are most commonly affected
Risk factors and causes are relatively the same as ulcerative colitis
Affects all layers of the colon: Inflammation begins in the intestinal submucosa and spreads into the mucosa and serosa. Neutrophils and macrophages cause tissue injury
Ulcerations may be "skip lesions" and appear as fissured ulcers ("cobblestone pattern"). Perianal fistulas may develop
Increased risk for colon cancer

Diverticular Disease

Disease characterized by "pouchings" of the mucosa through the muscle layers of the colon wall, most commonly in the sigmoid area
Diverticulosis is an asymptomatic disease
Diverticulitis is an inflammatory condition
Most common in people over 60
The cause is unknown - possibly due to low fiber intake

Clinical Manifestations of Liver Disorders: Portal Hypertension

Symptoms include weight gain, abdominal distention, increased abdominal girth, "shiny" tight appearance of the skin over the abdomen, dyspnea, increased respiratory rate with possible orthopnea, and peripheral edema

Mechanisms of Ascites Caused by Cirrhosis

Ascites is an accumulation of fluid in the peritoneal cavity
There are three major mechanisms of ascites caused by cirrhosis:
- Decreased Oncotic Pressure: This is due to hypoalbuminemia, which is a result of impaired liver function. Albumin is responsible for maintaining oncotic pressure, which draws fluid into the vascular space.
- Increased Hepatic Lymph Production: Increased pressure in the liver leads to increased lymph production, which can contribute to ascites.
- Portal Hypertension: This increased pressure in the portal venous system leads to increased capillary permeability and fluid leakage into the peritoneal cavity.

Jaundice

A yellowish pigmentation of the skin caused by hyperbilirubinemia (elevated plasma bilirubin)
Can result from obstructive disorders of the bile ducts or impaired liver cells

A&P: Bilirubin Review

Bilirubin is a byproduct of destroyed old red blood cells
The metabolism of bilirubin involves several steps:
- Old red blood cells are taken up and destroyed by macrophages. Lysis of red blood cells releases hemoglobin.
- Hemoglobin is then separated into its two component parts: heme and globin (globin turns into amino acids).
- Through enzymatic processes, heme is converted into bilirubin, which is then released into the plasma.
- In the plasma, bilirubin binds to albumin, forming unconjugated bilirubin. It is then transported to the liver.
- Liver hepatocytes then convert (conjugate) bilirubin.
- Conjugated bilirubin is excreted via bile to the intestines. Bacteria in the intestine break down bilirubin to urobilinogen for excretion in the feces (most) and urine (some).

Unconjugated (Indirect) Bilirubin vs Conjugated (Direct) Bilirubin

Unconjugated bilirubin is lipid-soluble and is not water-soluble
Conjugated bilirubin is water-soluble and is not lipid soluble

Clinical Manifestations of Liver Disorders: Jaundice (Icterus)

A yellowish pigmentation of the skin caused by hyperbilirubinemia (elevated plasma bilirubin)
Can result from:
- Obstructive disorders of the bile ducts or impaired liver cells
- Hemolytic Jaundice (vs. Physiological jaundice): prehepatic
  - Excessive lysis of red blood cells or absorption of a large hematoma: Excess of unconjugated bilirubin exceeds the hepatocytes' ability to conjugate it, leading to unconjugated hyperbilirubinemia
  - Causes may include: red blood cell membrane defects, immune reactions (e.g., lupus; transfusion of incompatible blood), severe infections, toxic substances in general circulation, Rh incompatibility.
- Hepatitis: Hepatocytes are infected, leading to reduced processing of bilirubin, contributing to unconjugated hyperbilirubinemia.

Disorders of the Liver: Hepatitis

Liver inflammation
Injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ
Acute or chronic forms
Hepatitis can lead to fulminant hepatitis
Many different causes of hepatitis, such as:
- Viruses/Infections
- Toxins
- Drugs (especially those that are hepatotoxic)
- Autoimmune processes/diseases
- Alcohol
- Hereditary causes

Disorders of the Liver: Viral Hepatitis

All types of viral hepatitis cause varying degrees of hepatic cell injury and tissue necrosis
Autolysis (self-destruction of cells)
These changes are completely reversible when the acute phase of the disease subsides
Symptoms include fatigue, anorexia, headache, joint and muscle pain, nausea and vomiting, fever, right upper quadrant pain, dark urine, clay-colored stools, and jaundice.

Disorders of the Liver: Cirrhosis

A late complication of chronic liver disease
Characterized by widespread fibrosis and nodular regeneration of the liver
Hepatocytes are replaced by fibrous tissue, disrupting liver function
Can lead to portal hypertension and ascites
Symptoms include anorexia, indigestion, nausea and vomiting, abdominal pain, bruising, easy bleeding, jaundice, pruritus, and lethargy
Cardiac cirrhosis is a prolonged venous congestion in the liver from right-sided heart failure

Disorders of the Gallbladder

The gallbladder stores and concentrates bile produced by the liver
The common bile duct conducts bile from the gallbladder to the duodenum

Cholelithiasis

Presence of gallstones in the gallbladder
The cause of gallstone formation is unknown
Develops when the balance of cholesterol, bile salts, and calcium is disrupted
Bile secreted by the liver is supersaturated with cholesterol, leading to precipitation and stone formation
Types of gallstones include cholesterol stones (most common), pigment stones (bilirubin), and mixed stones (bile salts, bilirubin, and calcium salts)

Disorders of the Gallbladder: Cholelithiasis

Risk factors include obesity, middle age, female, fertile (the "4Fs"), gallbladder or pancreatic disease, rapid weight loss/crash diets, and conditions that encourage stasis of or decreased bile flow (immobility, etc.)
Symptoms include:
- Cardinal: epigastric discomfort, fatty food intolerance
- Others: heartburn, flatulence, epigastric pain, pruritus, and jaundice. Pain is usually “colicky".

Cholecystitis

Inflammation of the gallbladder or cystic duct
Acute or chronic
Usually caused by lodging of a gallstone in the cystic duct
Obstruction leads to inflammation and distention of the gallbladder
Pressure against the distended gallbladder wall impairs blood flow, resulting in ischemia, necrosis, and potential perforations.

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Description

This quiz covers key topics related to appendicitis, including its causes, symptoms, and occurrence. Additionally, it explores disorders of the accessory organs of digestion such as the liver, gallbladder, and pancreas, focusing on liver disease and its systemic impacts.