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What is the most common area affected by Crohn's disease?
What type of ulcers are typically observed in Crohn's disease?
What symptom is less common in Crohn's disease compared to ulcerative colitis?
Which of the following is a characteristic of diverticulitis?
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What is a possible cause of diverticular disease that remains uncertain?
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What is the most common age range for the occurrence of appendicitis?
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What is the common theory behind the cause of appendicitis?
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Which symptom is NOT typically associated with appendicitis?
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What condition is described by abnormally high blood pressure in the portal venous system?
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Which of the following is a progressive complication of acute or chronic liver disease?
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Which of the following organs is NOT classified as an accessory organ of digestion?
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What is a potential sign of diverticula that cause abscesses?
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Which statement is false regarding the clinical manifestations of liver disorders?
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What primarily causes hemolytic jaundice?
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Which substance is primarily elevated in hemolytic jaundice?
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What is a common symptom of viral hepatitis?
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Which of the following is NOT a cause of hepatitis?
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What characterizes the cell changes during the acute phase of viral hepatitis?
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Which symptom is NOT commonly associated with ascites caused by cirrhosis?
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What is the function of hepatocytes concerning bilirubin?
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What mechanism leads to increased lymph production in the liver?
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What results in the yellowish pigmentation of the skin known as jaundice?
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Which statement about bilirubin metabolism is correct?
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What constitutes the primary cause of obstructive jaundice?
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What phase in bilirubin metabolism occurs after hemoglobin breakdown?
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Which of the following statements about unconjugated bilirubin is false?
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What is the primary reason for the development of cardiac cirrhosis?
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What is a common symptom of both cirrhosis and cholecystitis?
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Which type of gallstone is the most prevalent?
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What is a key risk factor for developing cholelithiasis?
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What kind of pain is typically associated with cholelithiasis?
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Cholecystitis is primarily caused by what?
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Which of the following is NOT a common symptom of cirrhosis?
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In cholelithiasis, what causes the precipitation of stone formation?
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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.
