Digestive System Disorders and Complications

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Questions and Answers

What is the characteristic feature of liver cirrhosis?

Necrosis with loss of liver function

Fibrosis with normal liver architecture

Inflammation with normal liver function

Fibrosis with the transformation of normal liver architecture into regenerative parenchymal nodules (correct)

Which of the following is NOT a complication of liver dysfunction?

Gastritis (correct)

Ascites

Portal hypertension

Hepatic encephalopathy

What is the term for the final common morphologic change for a wide variety of chronic liver diseases?

Chronic liver disease

Liver cirrhosis (correct)

Hepatorenal syndrome

Hepatic fibrosis

What is the term for the severe and sudden onset of hepatitis?

Fulminant hepatitis Signup and view all the answers

What is the term for the presence of gallstones in the gallbladder?

Cholelithiasis Signup and view all the answers

What is the term for the inflammation of the gallbladder?

Cholecystitis Signup and view all the answers

What is the primary consequence of the activation of hepatic stellate cells in cirrhosis?

Induction of fibrosis Signup and view all the answers

Which of the following is a complication associated with cirrhosis?

Hepatopulmonary syndrome Signup and view all the answers

What is the normal range of portal pressure in mm Hg?

5 - 10 mm Hg Signup and view all the answers

Which of the following is a cause of cirrhosis?

Autoimmune disease Signup and view all the answers

What is the characteristic feature of regenerative nodules in cirrhosis?

Lack of normal liver architecture Signup and view all the answers

What is the most common cause of cirrhosis?

Alcoholic liver disease Signup and view all the answers

What is the primary factor responsible for the development of portal hypertension?

Vascular resistance and increase blood flow Signup and view all the answers

What is the major complication of esophageal varices?

Bleeding Signup and view all the answers

What is the primary cause of ascites in patients with cirrhosis?

Portal hypertension Signup and view all the answers

What is the definition of hepatic encephalopathy?

A spectrum of neuropsychiatric abnormalities in patients with liver dysfunction Signup and view all the answers

What is the significance of variceal size and location in patients with esophageal varices?

It determines the risk of bleeding Signup and view all the answers

What is the primary characteristic of a patient with acute liver failure?

A previously healthy individual with an illness of less than 6 months duration Signup and view all the answers

Which of the following is NOT a clinical feature of acute liver failure?

Hemolytic jaundice Signup and view all the answers

What is the primary cause of prehepatic jaundice?

Excessive hemolysis of red blood cells or absorption of a hematoma Signup and view all the answers

What is the normal INR value for a patient without coagulopathy?

1.0 Signup and view all the answers

Which of the following is a clinical feature of obstructive jaundice?

Asterixis Signup and view all the answers

What is the percentage of all deaths attributed to alcohol abuse in the age group 20-29 years?

25% Signup and view all the answers

What is the approximate number of deaths worldwide resulting from harmful use of alcohol every year?

3.3 million Signup and view all the answers

In the liver, which of the following enzyme systems does not use oxygen as an oxidizing agent?

Peroxisomal catalase Signup and view all the answers

What is the criteria for alcohol abuse in American adults?

4.65% and 3.81% of American adults meet the criteria for alcohol abuse and alcohol dependence respectively Signup and view all the answers

What is the product of all three reactions of alcohol metabolism in the liver?

Acetaldehyde Signup and view all the answers

What is the risk factor for ALD in terms of the amount of ethanol consumed per week?

Ingestion of >35 drinks per week Signup and view all the answers

What is the primary result of cirrhosis on liver tissue?

Replacement of liver tissue by fibrous and regenerative nodules Signup and view all the answers

What is the most common cause of cirrhosis in the United States?

Chronic hepatitis C and alcohol-induced liver disease Signup and view all the answers

What is the characteristic of liver function in early-stage cirrhosis?

Abnormal liver function with normal blood tests Signup and view all the answers

What is the result of long-standing severe right-sided heart failure on the liver?

Cardiac cirrhosis Signup and view all the answers

What is the common symptom of cirrhosis in the early stage?

Fatigue and enlarged liver Signup and view all the answers

What is the term for the final stage of liver disease?

End-stage liver disease Signup and view all the answers

Which of the following mechanisms is NOT responsible for the accumulation of serous fluid in peritoneal or abdominal cavity in patients with cirrhosis?

Increased hepatic venous pressure Signup and view all the answers

What is the primary goal of lactulose therapy in the treatment of hepatic encephalopathy?

To reduce ammonia formation in the gut Signup and view all the answers

What is the primary laboratory test used to assess liver fibrosis in patients with cirrhosis?

Ultrasound elastography (Fibroscan) Signup and view all the answers

What is the primary complication of esophageal varices that is life-threatening?

Bleeding Signup and view all the answers

What is the primary mechanism responsible for the development of peripheral edema in patients with cirrhosis?

All of the above Signup and view all the answers

What is the primary treatment goal for hepatic encephalopathy in patients with cirrhosis?

Reduce ammonia formation Signup and view all the answers

What is the primary reason for the development of jaundice in cirrhosis?

Decreased ability to conjugate and excrete bilirubin Signup and view all the answers

What is the underlying cause of skin lesions, such as spider angiomas, in cirrhosis?

Decreased metabolism of steroids in the liver Signup and view all the answers

What is the characteristic hematologic disorder in cirrhosis?

Thrombocytopenia Signup and view all the answers

What is the endocrine disorder that can occur in men with cirrhosis?

Gynecomastia Signup and view all the answers

What is the primary cause of peripheral neuropathy in cirrhosis?

Dietary deficiencies of thiamine, folic acid, and cobalamin Signup and view all the answers

What is the characteristic change in the liver in cirrhosis?

Liver becomes smaller and nodular Signup and view all the answers

What is the primary focus of nutritional therapy for patients with cirrhosis without complications?

High in calories and carbohydrates Signup and view all the answers

What is the primary goal of health promotion in nursing management for patients with cirrhosis?

Reduce or eliminate risk factors Signup and view all the answers

What is the purpose of assessing the color of urine and stools in patients with cirrhosis?

To monitor for jaundice Signup and view all the answers

What is the primary purpose of using cholestyramine or hydroxyzine in patients with cirrhosis?

To relieve pruritus Signup and view all the answers

What is the primary benefit of using a semi- or high Fowler's position in patients with cirrhosis?

Relief of dyspnea Signup and view all the answers

What is the primary purpose of measuring abdominal girth in patients with cirrhosis?

To monitor for ascites Signup and view all the answers

Study Notes

Cirrhosis of the Liver

Cirrhosis is a condition in which the liver is scarred and permanently damaged, resulting in the replacement of healthy liver tissue with scar tissue and preventing the liver from functioning normally.
It is the end-stage of liver disease, characterized by extensive degeneration and destruction of liver cells, replaced by fibrous and regenerative nodules of the liver.

Etiologies and Pathophysiology

The most common causes of cirrhosis in the United States are chronic hepatitis C and alcohol-induced liver disease.
Other causes include extreme dieting, malabsorption, obesity, environmental factors, and genetic predisposition.
Biliary cirrhosis can be caused by primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC).
Cardiac cirrhosis can result from long-standing severe right-sided heart failure.

Clinical Manifestations

Early-stage cirrhosis may have few symptoms, with fatigue and enlarged liver being possible early symptoms.
Blood tests may be normal, indicating compensated cirrhosis.
Late manifestations of cirrhosis include portal hypertension, esophageal and gastric varices, peripheral edema, ascites, and hepatic encephalopathy.

Complications

Portal hypertension can lead to splenomegaly, large collateral veins, ascites, and gastric and esophageal varices.
Esophageal varices are complex, tortuous, and enlarged veins at the lower end of the esophagus, which are very fragile and can bleed easily.
Peripheral edema can occur due to decreased colloidal oncotic pressure from impaired liver synthesis of albumin, increased portacaval pressure from portal hypertension, and occurs in the lower extremities and presacral area.
Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity, caused by portal hypertension, hypoalbuminemia, and hyperaldosteronism.

Diagnostic Studies

Liver enzyme tests, such as alkaline phosphatase, AST, ALT, and GGT, can be used to diagnose cirrhosis.
Total protein, albumin levels, serum bilirubin, globulin levels, cholesterol levels, and prothrombin time can also be used to diagnose cirrhosis.
Ultrasound elastography (Fibroscan) and liver biopsy can also be used to diagnose cirrhosis.

Interprofessional Care

Hepatic encephalopathy can be treated by reducing ammonia formation, trapping ammonia in the gut, and preventing constipation.
Drug therapy can be used to treat symptoms and complications of advanced liver disease.
Nutritional therapy involves a diet high in calories, carbohydrates, and moderate to low fat, with protein restriction rarely needed.

Nursing Management

Nursing assessment involves health promotion, reducing or eliminating risk factors, treating alcoholism, maintaining adequate nutrition, identifying and treating acute hepatitis, and bariatric surgery for morbidly obese patients.
Acute care involves rest needs, nutritional needs, oral hygiene, between-meal snacks, offering preferred foods, and explaining dietary restrictions.
Monitoring for jaundice, pruritus, and monitoring for signs of bleeding, such as espresso-colored stools and vomiting blood, are also important.

Alcoholic Liver Disease

Alcoholic liver disease is a major cause of cirrhosis, and is responsible for approximately 3.3 million deaths worldwide each year.
Risk factors for ALD include ingestion of more than 35 drinks per week, female gender, chronic hepatitis C infection, acetaminophen overdose, and hereditary hemochromatosis.
Not all individuals who consume alcohol will develop ALD and liver cirrhosis.

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Description

Test your knowledge of the pathophysiology, clinical manifestations, and treatment options for various digestive system disorders, including appendicitis, irritable bowel syndrome, liver dysfunction, viral hepatitis, and cirrhosis. This quiz covers the key concepts and complications related to the digestive system.