Untitled Quiz
48 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary function of Kupffer cells in the liver?

  • To produce bile
  • To carry out phagocytic activity (correct)
  • To detoxify hemoglobin
  • To metabolize bilirubin
  • What is the role of the gallbladder in digestion?

  • To digest fats directly
  • To concentrate and store bile (correct)
  • To break down proteins
  • To produce bile
  • Which statement correctly describes unconjugated bilirubin?

  • It is bound to albumin for transport (correct)
  • It is produced from the breakdown of bile salts
  • It is soluble in water
  • It can be excreted directly in bile
  • What is one of the primary components of bile?

    <p>Cholesterol (D)</p> Signup and view all the answers

    Which statement is true about the upper gastrointestinal series?

    <p>It helps identify esophageal strictures and tumors (A)</p> Signup and view all the answers

    What type of cells in the pancreas secrete insulin?

    <p>β cells (A)</p> Signup and view all the answers

    What does stercobilinogen contribute to in the human body?

    <p>The brown color of stool (B)</p> Signup and view all the answers

    What is the primary purpose of a lower gastrointestinal series?

    <p>To observe the colon filling with contrast medium (D)</p> Signup and view all the answers

    What role does leptin play in appetite regulation?

    <p>Suppresses appetite (B)</p> Signup and view all the answers

    Which structure serves as a barrier preventing the reflux of gastric contents into the esophagus?

    <p>Lower esophageal sphincter (C)</p> Signup and view all the answers

    What is the purpose of the rugae in the stomach?

    <p>To increase surface area for secretion (B)</p> Signup and view all the answers

    Which glands produce saliva in the oral cavity?

    <p>Parotid, submaxillary, and sublingual glands (C)</p> Signup and view all the answers

    Which part of the stomach is involved in guarding the exit from the stomach?

    <p>Pylorus (C)</p> Signup and view all the answers

    What mechanical action is primarily involved in the swallowing process?

    <p>Deglutition (C)</p> Signup and view all the answers

    What is the primary function of the tongue in the oral cavity?

    <p>Chewing and moving food (C)</p> Signup and view all the answers

    What is contained in saliva that aids in digestion?

    <p>Water, protein, mucin, inorganic salts, and salivary amylase (A)</p> Signup and view all the answers

    What is a characteristic manifestation of hepatic encephalopathy?

    <p>Asterixis (flapping tremors) (D)</p> Signup and view all the answers

    What might precipitate hepatic encephalopathy in a patient?

    <p>Increase in blood ammonia levels (A)</p> Signup and view all the answers

    Which option best describes the behavior seen in patients with hepatic encephalopathy?

    <p>Inappropriate behavior and lethargy (C)</p> Signup and view all the answers

    What is a common sign of impaired motor function in hepatic encephalopathy?

    <p>Inability to write clearly (B)</p> Signup and view all the answers

    When should planning for transfer to a transplant center begin in patients with hepatic encephalopathy?

    <p>In patients with grade 1 or 2 encephalopathy (B)</p> Signup and view all the answers

    What is the musty, sweet odor of a patient's breath in hepatic encephalopathy commonly referred to as?

    <p>Fetor hepaticus (D)</p> Signup and view all the answers

    What should be avoided to protect renal function in patients with liver failure?

    <p>Nephrotoxic agents (B)</p> Signup and view all the answers

    What is the treatment of choice for patients with acute liver failure?

    <p>Liver transplantation (B)</p> Signup and view all the answers

    Which drug is NOT commonly associated with causing acute liver failure?

    <p>Ibuprofen (A)</p> Signup and view all the answers

    What is the primary clinical manifestation observed first in acute liver failure?

    <p>Changes in mentation (C)</p> Signup and view all the answers

    Which laboratory test is essential for diagnosing complications associated with acute liver failure?

    <p>Blood glucose levels (A)</p> Signup and view all the answers

    How does ammonia contribute to the neuropsychiatric manifestations of liver disease?

    <p>It causes astrocyte swelling and inflammatory cytokines. (B)</p> Signup and view all the answers

    Which type of hepatitis virus is the second most common cause of acute liver failure?

    <p>Hepatitis B (C)</p> Signup and view all the answers

    What imaging technique is used to assess liver size and the presence of ascites in acute liver failure?

    <p>CT scan or MRI (C)</p> Signup and view all the answers

    Which of the following conditions can result as a complication of acute liver failure?

    <p>Cerebral edema (D)</p> Signup and view all the answers

    Which of the following best describes the onset of acute liver failure?

    <p>Rapid onset in someone with no previous liver issues (A)</p> Signup and view all the answers

    What is the purpose of NG suction in the management of patients with acute pancreatitis?

    <p>To reduce vomiting and gastric distention (C)</p> Signup and view all the answers

    Which surgical procedure is typically performed urgently when acute pancreatitis is related to gallstones?

    <p>ERCP plus endoscopic sphincterotomy (A)</p> Signup and view all the answers

    What is a common cause of chronic pancreatitis?

    <p>Cholelithiasis and alcohol abuse (C)</p> Signup and view all the answers

    In chronic pancreatitis, which of the following changes occurs in the pancreas?

    <p>Progressive destruction replaced by fibrotic tissue (C)</p> Signup and view all the answers

    What is the most common cause of obstructive pancreatitis?

    <p>Inflammation of the sphincter of Oddi associated with cholelithiasis (D)</p> Signup and view all the answers

    What is often a significant risk factor in patients who develop chronic pancreatitis without an identifiable cause?

    <p>Idiopathic pancreatitis (C)</p> Signup and view all the answers

    Which condition is often associated with chronic pancreatitis due to inflammation?

    <p>Obstruction from gallstones (C)</p> Signup and view all the answers

    What clinical manifestation is common in both acute and chronic pancreatitis?

    <p>Abdominal pain (D)</p> Signup and view all the answers

    What is the primary purpose of the adjustable gastric band (AGB)?

    <p>To inflate or deflate the band and change stoma size (A)</p> Signup and view all the answers

    Which of the following statements about Vertical Sleeve Gastrectomy is true?

    <p>About 85% of the stomach is removed. (C)</p> Signup and view all the answers

    What characteristic of Roux-en-Y Gastric Bypass makes it a combination of restrictive and malabsorptive surgery?

    <p>It creates a pouch and bypasses a significant part of the digestive tract. (C)</p> Signup and view all the answers

    What is a potential complication that should be monitored post-surgery in bariatric patients?

    <p>Nutritional deficiencies from malabsorption (A)</p> Signup and view all the answers

    What nursing action is crucial to prevent pulmonary complications after bariatric surgery?

    <p>Assisting with ambulation and encouraging deep breathing (D)</p> Signup and view all the answers

    Which surgical approach is recommended for patients who are at surgical risks?

    <p>Laparoscopic Adjustable Gastric Banding (B)</p> Signup and view all the answers

    What should a patient expect regarding postoperative equipment after bariatric surgery?

    <p>They may return with an IV catheter and compression stockings. (C)</p> Signup and view all the answers

    How does the adjustable gastric band provide long-term weight management?

    <p>By delaying stomach emptying and creating a sense of fullness (C)</p> Signup and view all the answers

    Flashcards

    Hepatocytes

    Cells in the liver that produce bile and process nutrients.

    Kupffer cells

    Liver cells that filter and remove toxins and bacteria from the blood.

    Bile

    Fluid produced by the liver that aids in fat digestion.

    Bile salts

    Components of bile that help emulsify fats for digestion.

    Signup and view all the flashcards

    Gallbladder

    Organ that stores and concentrates bile.

    Signup and view all the flashcards

    Bilirubin

    Waste product from hemoglobin breakdown.

    Signup and view all the flashcards

    Unconjugated Bilirubin

    Bilirubin not yet processed by the liver.

    Signup and view all the flashcards

    Conjugated Bilirubin

    Bilirubin processed by the liver, soluble for easier excretion.

    Signup and view all the flashcards

    Upper GI series

    X-ray procedure that visualizes the esophagus, stomach, and small intestine.

    Signup and view all the flashcards

    Lower GI series

    X-ray procedure that visualizes the colon.

    Signup and view all the flashcards

    Pancreas

    Organ with exocrine and endocrine functions, producing digestive enzymes and hormones.

    Signup and view all the flashcards

    Leptin's role in appetite

    Leptin is a hormone that helps regulate appetite by suppressing hunger.

    Signup and view all the flashcards

    Stimuli for appetite

    The sight, smell, and taste of food trigger the desire to eat.

    Signup and view all the flashcards

    Deglutition

    Deglutition is the physical process of swallowing food.

    Signup and view all the flashcards

    Organs in Deglutition

    The mouth, pharynx, and esophagus are involved in the process of swallowing food.

    Signup and view all the flashcards

    Mouth's role in chewing

    Teeth in the oral cavity are used for chewing (mastication).

    Signup and view all the flashcards

    Tongue's role

    The tongue assists in chewing, moving food, and swallowing.

    Signup and view all the flashcards

    Salivary Glands

    Parotid, submaxillary, and sublingual glands produce saliva.

    Signup and view all the flashcards

    Epiglottis' function

    The epiglottis is a flap that covers the larynx during swallowing to prevent food from entering the airway.

    Signup and view all the flashcards

    Oropharynx function

    The oropharynx allows food to pass from the mouth to the esophagus during ingestion.

    Signup and view all the flashcards

    Esophagus Peristalsis

    Muscles in the esophagus contract in waves (peristalsis) to push food to the stomach.

    Signup and view all the flashcards

    Esophageal Sphincters

    The upper esophageal sphincter (UES) and lower esophageal sphincter (LES) control movement in the esophagus.

    Signup and view all the flashcards

    LES function

    The lower esophageal sphincter prevents stomach acid from flowing back into the esophagus (reflux).

    Signup and view all the flashcards

    Stomach Functions

    The stomach stores, mixes, and sends food to the small intestine in small portions.

    Signup and view all the flashcards

    Stomach Absorption

    The stomach primarily absorbs small amounts of water, alcohol, electrolytes, and some drugs.

    Signup and view all the flashcards

    Layers of the stomach

    The stomach has serous, muscular, and mucosal layers responsible for its structure and function.

    Signup and view all the flashcards

    Stomach's Rugae

    Rugae are folds in the stomach lining that increase surface area for digestion.

    Signup and view all the flashcards

    Pylorus and Sphincters

    Pylorus is a part of the stomach proximal to the pyloric sphincter, controlling exit to the small intestine along with the LES.

    Signup and view all the flashcards

    Acetaminophen Liver Toxicity

    Alcohol abusers are particularly vulnerable to liver damage from acetaminophen.

    Signup and view all the flashcards

    Acute Liver Failure Causes

    Several drugs (isoniazid, halothane, sulfa drugs, NSAIDs) and viral hepatitis (HBV) can lead to rapid liver dysfunction.

    Signup and view all the flashcards

    Drug-Induced Liver Failure Mechanism

    Drugs disrupt internal processes or create toxic metabolic buildup in liver cells, leading to their dysfunction.

    Signup and view all the flashcards

    Viral Hepatitis (HBV)

    Viral hepatitis, especially hepatitis B, is a significant cause of acute liver failure.

    Signup and view all the flashcards

    Acute Liver Failure Symptoms

    Acute liver failure shows rapid onset of severe liver problems; common symptoms include jaundice, blood clotting issues, and mental changes.

    Signup and view all the flashcards

    Liver Function Tests

    Various blood tests (bilirubin, prothrombin time, liver enzymes, etc.) are used to assess liver function and possible causes of damage.

    Signup and view all the flashcards

    Hepatic Encephalopathy

    A neuropsychiatric condition related to liver disease, often caused by increased ammonia levels.

    Signup and view all the flashcards

    Ammonia's Role in Encephalopathy

    High ammonia levels in the blood lead to various brain problems. The liver normally processes ammonia to urea for removal.

    Signup and view all the flashcards

    Liver Bypasses and Ammonia

    Blood flow bypassing the liver and the liver's inability to process ammonia cause dangerous ammonia buildup.

    Signup and view all the flashcards

    Clinical Manifestations

    The recognizable signs and indicators of acute liver failure.

    Signup and view all the flashcards

    Diagnostic Imaging (CT/MRI)

    Imaging techniques that help assess liver size, structure, and the presence of complications like ascites.

    Signup and view all the flashcards

    Hepatic Encephalopathy

    A neurological disorder caused by liver failure. It affects mental and neurological function.

    Signup and view all the flashcards

    Ammonia & Hepatic Encephalopathy

    High blood ammonia levels can trigger hepatic encephalopathy because the liver can't process it, leading to brain issues.

    Signup and view all the flashcards

    Asterixis

    A characteristic sign of hepatic encephalopathy, a flapping tremor in hands.

    Signup and view all the flashcards

    Clinical Manifestations of Hepatic Encephalopathy

    Changes in neurological and mental responsiveness, impacting consciousness (from sleepiness to coma) and behavior.

    Signup and view all the flashcards

    Fetor Hepaticus

    A musty, sweet odor in a patient's breath from undigested liver byproducts.

    Signup and view all the flashcards

    Acute Liver Failure

    Rapid worsening of liver function, where consciousness changes rapidly.

    Signup and view all the flashcards

    Liver Transplant

    The preferred treatment for acute liver failure that improves survival.

    Signup and view all the flashcards

    Renal Failure in Liver Failure

    Kidney problems frequently occurring with liver failure due to dehydration, liver-related kidney issues or direct kidney damage (especially from toxic substances).

    Signup and view all the flashcards

    Grading System for Hepatic Encephalopathy

    A system to categorize the stages of hepatic encephalopathy, based on symptoms (from mild to deep coma).

    Signup and view all the flashcards

    Adjustable Gastric Banding (AGB)

    A restrictive bariatric surgery where a band is placed around the stomach to reduce its capacity.

    Signup and view all the flashcards

    Vertical Sleeve Gastrectomy

    A bariatric surgery removing about 85% of the stomach, creating a sleeve-shaped stomach.

    Signup and view all the flashcards

    Roux-en-Y Gastric Bypass

    A bariatric surgery combining restriction and malabsorption, by creating a small stomach pouch connected to the small intestine.

    Signup and view all the flashcards

    Bariatric Surgery Complications

    Potential post-operative issues, including urinary catheter, IV catheter, compression stockings, and/or nasogastric tube.

    Signup and view all the flashcards

    Peri-operative Care

    Care given to a bariatric patient before, during, or after surgery including vital sign monitoring and patient education.

    Signup and view all the flashcards

    Pre-op Bariatric Patient Education

    The patient should understand the surgical procedure and potential complications including the use of medical devices like IV catheters or catheters.

    Signup and view all the flashcards

    Post-op Bariatric Patient Ambulation

    The patient will be assisted with movement after the surgery to prevent complications and encourage lung function.

    Signup and view all the flashcards

    Post-Op Monitoring

    Frequent vital sign and general assessment will be performed.

    Signup and view all the flashcards

    Acute Pancreatitis

    Inflammation of the pancreas, often severe and potentially life-threatening.

    Signup and view all the flashcards

    NPO

    Nothing by mouth; a patient is not allowed to eat or drink.

    Signup and view all the flashcards

    NG Suction

    A tube inserted through the nose into the stomach to remove stomach contents.

    Signup and view all the flashcards

    Acute Necrotizing Pancreatitis

    Severe acute pancreatitis with tissue death and potential infection.

    Signup and view all the flashcards

    Infection (Pancreatitis)

    A significant complication of acute pancreatitis, a major cause of illness and death.

    Signup and view all the flashcards

    ERCP

    Endoscopic retrograde cholangiopancreatography; a procedure to view the bile ducts and pancreatic ducts.

    Signup and view all the flashcards

    Endoscopic Sphincterotomy

    Severing of muscle layers in the sphincter of Oddi, during ERCP.

    Signup and view all the flashcards

    Chronic Pancreatitis

    Ongoing inflammation and scarring of the pancreas.

    Signup and view all the flashcards

    Cholelithiasis

    Gallstones; hard deposits in the gallbladder.

    Signup and view all the flashcards

    Obstructive Pancreatitis

    Pancreatitis caused by blockage in the pancreatic or bile duct.

    Signup and view all the flashcards

    Nonobstructive Pancreatitis

    Pancreatitis caused by factors other than blockages.

    Signup and view all the flashcards

    Study Notes

    Gastrointestinal (GI) System

    • Also called the digestive system
    • Consists of the GI tract and its associated organs and glands
    • Includes the mouth, esophagus, stomach, small intestine, large intestine, rectum, and anus

    Structures and Functions of the Gastrointestinal System

    • The GI tract extends approximately 30 feet (9 meters) from the mouth to the anus
    • Composed of four common layers: mucosa, submucosa, muscle, and serosa
    • The muscular coat consists of two layers: the circular (inner) layer and the longitudinal (outer) layer
    • Innervated by the parasympathetic and sympathetic branches of the autonomic nervous system
    • Parasympathetic (cholinergic) system is mainly excitatory
    • Sympathetic (adrenergic) system is mainly inhibitory

    Location of Organs of the Gastrointestinal System

    • Diagram of the GI system with labeled organs (e.g., stomach, small intestine, colon)
    • Diagram illustrating the different parts of the stomach (e.g., fundus, body, antrum)

    Peritoneum

    • Abdominal organs are almost completely covered by the peritoneum
    • Two layers of the peritoneum: parietal layer (lines the abdominal cavity wall), and visceral layer (covers the abdominal organs)
    • Two folds of the peritoneum are the mesentery and the omentum
    • Mesentery attaches the small and part of the large intestine to the posterior abdominal wall
    • Contains blood and lymph vessels
    • Omentum hangs like an apron from the stomach to the intestines
    • Contains fat and lymph nodes

    Function of the GI System

    • The main function is to supply nutrients to body cells.
    • This is accomplished through the processes of ingestion (taking in food), digestion (breaking down food), and absorption (transferring food products into circulation).
    • Elimination is the process of excreting waste products.

    Ingestion

    • Ingestion is the intake of food
    • Appetite center is located in the hypothalamus
    • Hypoglycemia, an empty stomach, a decrease in body temperature, and input from higher brain centers stimulate the appetite center
    • The hormone ghrelin, released from the stomach mucosa, plays a role in appetite stimulation
    • Another hormone, leptin, is involved in appetite suppression
    • The sight, smell, and taste of food frequently stimulate appetite
    • Deglutition (swallowing) is the mechanical component of ingestion
    • Organs involved: mouth, pharynx, and esophagus
    • Mouth: oral cavity contains teeth (mastication) and the tongue
    • Pharynx: epiglottis closing over the larynx during swallowing
    • Oropharynx: provides a route for food from the mouth to the esophagus
    • Esophagus: Muscular layers contract (peristalsis) and propel food to the stomach. Upper esophageal sphincter (UES) at the proximal end, and the lower esophageal sphincter (LES) at the distal end. The LES remains contracted except during swallowing, belching, or vomiting

    Digestion and Absorption

    • Stomach: stores food, mixes food with gastric secretions, empties contents in small boluses into the small intestines.
    • The stomach absorbs only small amounts of water, alcohol, electrolytes, and certain drugs.
    • Stomach always contains gastric fluid and mucus.
    • Fundus (cardia), body, and antrum are three main parts of the stomach
    • Pylorus: small portion of the antrum proximal to the pyloric sphincter
    • Sphincter muscles (the LES and the pyloric sphincter) guard the entrance to and exit from the stomach.
    • The serous (outer) layer of the stomach is formed by the peritoneum.
    • Muscular layer of stomach: longitudinal (outer), circular (middle), and oblique (inner) layers.
    • Mucosal layer forms folds called rugae that contain chief cells (secrete pepsinogen) and parietal cells (secrete hydrochloric acid (HCl), water, and intrinsic factor).
    • HCl acid makes gastric juice acidic to protect against ingested organisms.
    • Intrinsic factor promotes cobalamin (vitamin B12) absorption in the small intestine
    • Small Intestine: two primary functions - digestion and absorption (uptake of nutrients from the gut lumen to the bloodstream)
    • Extends from the pylorus to the ileocecal valve
    • Composed of the duodenum, jejunum, and ileum
    • Ileum: prevents reflux from the large intestine
    • Digestive enzymes on the brush border of microvilli chemically break down nutrients
    • Villi surrounded by crypts of Lieberkühn (multipotent stem cells for other cell types)
    • Brunner's glands in the duodenum submucosa secrete bicarbonate.
    • Intestinal goblet cells secrete mucus to protect the mucosa
    • Table of Gastrointestinal secretions and their actions (e.g., salivary amylase, pepsinogen, HCI acid, lipase, intrinsic factor, enzymes from the small intestine, and liver/gallbladder bile).

    Elimination

    • Large Intestine: most important function is absorption of water and electrolytes. Forms feces, serves as a reservoir for fecal mass, and enables defecation.
    • Microorganisms in the colon break down proteins not digested or absorbed in the small intestine
    • Deaminate amino acids, producing ammonia, converted to urea by liver, and excreted by the kidneys.
    • Synthesize vitamin K and some B vitamins.
    • Contribute to flatus production.
    • The defecation reflex is initiated when feces enter the rectum. Sensory nerve ending produce the desire to defecate.
    • The reflex center for defecation is located in the sacral portion of the spinal cord.

    Liver

    • Functional units of the liver are lobules
    • Lobules consist of rows of hepatic cells (hepatocytes) arranged around a central vein
    • Capillaries (sinusoids) located between the rows of hepatocytes and lined with Kupffer cells.
    • Kupffer cells carry out phagocytic activity (removing toxins and bacteria from blood).
    • Table listing the functions of the liver (e.g., glycogenesis, glycogenolysis, gluconeogenesis, synthesis of plasma proteins, formation of urea, fat metabolism, detoxification, steroid metabolism)
    • Bile production, excretion, and storage (bile salts, pigments like bilirubin, and cholesterol)
    • Breakdown of old red blood cells (RBCs) into bilirubin and biliverdin. Albumin and other proteins formation

    Biliary Tract

    • System consisting of the gallbladder and duct system. The gallbladder is a pear-shaped sac located below the liver.
    • Concentrates and stores bile created by the liver.
    • Bilirubin is reduced to stercobilinogen and urobilinogen. Bilirubin is reduced to a water-soluble form by the liver.
    • Stercobilinogen is the main component of stool color.
    • Bilirubin metabolism, a breakdown of hemoglobin, is continuously produced. It is insoluble in water and must be bound to albumin for transport to the liver, where it is conjugated with glucuronic acid. This conjugated bilirubin is soluble and is excreted in bile.

    Pancreas

    • has both exocrine (producing and releasing enzymes) and endocrine functions. Endocrine functions occur in the islets of Langerhans (beta cells secrete insulin and amylin, alpha cells secrete glucagon, delta cells secrete somatostatin, and F cells secrete pancreatic polypeptide).

    Diagnostic Tests

    • Radiologic studies
    • Upper gastrointestinal series: fluoroscopy, barium solution to visualize esophagus, stomach, and small intestine (useful for esophageal strictures, polyps, tumors, hiatal hernias, foreign bodies, and peptic ulcers)
    • Lower gastrointestinal series (barium enema): visualization of colon using fluoroscopy and X-rays, identifying polyps, tumors, and lesions.
    • Virtual colonoscopy: CT or MRI scanning with computer software to produce images of the colon and rectum, identifying polyps and the necessity of a conventional colonoscopy for biopsy/removal
    • Endoscopy: direct visualization of body structures through a lighted fiberoptic instrument (e.g., esophagus, stomach, duodenum, colon, pancreatic, hepatic, and common bile ducts - endoscopic retrograde cholangiopancreatography (ERCP).
    • Liver biopsy: obtaining hepatic tissue to establish diagnoses or assess fibrosis or following liver disease progress (e.g., chronic hepatitis).
    • Serum tests (e.g., bilirubin, protein, and specific liver enzyme tests)

    Intraabdominal Hypertension and Abdominal Compartment Syndrome

    • Intraabdominal Hypertension (IAH): a steady-state pressure concealed within the abdominal cavity
    • IAH is diagnosed when three documented Intra-abdominal Pressure (IAP) measurements are 12-20 mm Hg, four to six hours apart
    • Without treatment, it can progress to Abdominal Compartment Syndrome.
    • Normal IAP: 5 mmHg
    • Critically ill patients: 5-7 mmHg
    • Obese patients: 15 mmHg
    • Complication of emergency repairs of abdominal aortic aneurysms
    • Persistent IAH reduces blood flow to viscera

    Acute Liver Failure

    • Fulminant hepatic failure is a clinical syndrome characterized by severe impairment of liver function
    • Associated with hepatic encephalopathy
    • Most common cause: drugs (e.g., acetaminophen, in combination with alcohol)
    • People with alcohol abuse are particularly susceptible to the detrimental effects of acetaminophen on the liver
    • Other drugs: isoniazid, halothane, sulfa-containing drugs, and NSAIDs
    • Viral hepatitis (Hepatitis B virus [HBV]) as the second most frequent cause of acute liver failure (Hepatitis A is less common)
    • Symptoms of jaundice, coagulation abnormalities, and encephalopathy. Changes in mentation are the first clinical sign
    • Complications include cerebral edema, renal failure, hypoglycemia, metabolic acidosis, sepsis, and multiorgan failure
    • Additional studies: Serum bilirubin is elevated and prothrombin time is prolonged
    • Liver enzyme levels (AST, ALT) usually markedly elevated, blood chemistries, complete blood counts (CBCs), acetaminophen level, viral hepatitis serologies, serum levels (a1-antitrypsin, iron levels, and autoantibodies), and CT or MRI for assessment of liver size and contours

    Acute Pancreatitis

    • Acute inflammation of the pancreas
    • Mild edema to severe hemorrhagic necrosis variations in inflammation
    • Risk factors: gallbladder disease, chronic alcohol illness, smoking (independent risk factor for other conditions)
    • Biliary sludge (cholesterol and calcium salt crystals)
    • Other causes: trauma, viral infections (mumps, coxsackievirus B, HIV), penetrating duodenal ulcer, cysts, abscesses, cystic fibrosis, Kaposi sarcoma, certain drugs (corticosteroids, thiazide diuretics, oral contraceptives), metabolic disorders (hyperparathyroidism), renal failure, and vascular diseases
    • Most common pathogenic mechanism: pancreatic autodigestion
    • Trypsinogen activated to trypsin by enterokinase. Trypsin is an inactive proteolytic enzyme.
    • In pancreatitis, activated trypsin digests the pancreas and produces bleeding.
    • Mechanisms of chronic alcohol intake in pancreatitis unknown (increases digestive enzymes production)
    • Pathophysiology involvement is classified as mild (edematous or interstitial pancreatitis) or severe (necrotizing pancreatitis)
    • Clinical Manifestations: abdominal pain, peritoneal irritation, and biliary tract obstruction
    • Back pain radiating to mid-epigastrium
    • Other symptoms: abdominal tenderness, decreased or absent bowel sounds, paralytic ileus, lung involvement (crackles), skin discoloration (Grey Turner's spots or Cullen's sign)
    • Complications: varying severity depending on pancreatic destruction (complete recovery, recurring attacks, chronic pancreatitis), potentially life-threatening
    • Pancreatic pseudocyst: accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall
    • Pancreatic abscess: collection of pus, extensive necrosis, and infection
    • Systemic complications: pulmonary (pleural effusion, atelectasis, pneumonia, ARDS), cardiovascular (hypotension) complications, tetany (hypocalcemia).
    • Complications can be linked to the passage of exudates from the peritoneal cavity through transdiaphragmatic lymph channels and enzyme-induced inflammation of the diaphragm.
    • Diagnostic studies: serum amylase/lipase usually elevated for 24–72 hours, abdominal ultrasound, x-ray; contrast-enhanced CT scan, ERCP(can cause acute pancreatitis), magnetic resonance cholangiopancreatography (MRCP), angiography, and chest X-rays
    • Collaborative care: relief of pain, preventing shock, reducing pancreatic secretions, correcting fluid/electrolyte imbalances, preventing infections, and removing precipitating causes
    • Treatment methods: aggressive hydration, pain management, minimizing pancreatic stimulation, and using IV morphine and pain medications together with an antispasmodic agent (atropine and anticholinergics avoided in paralytic ileus), blood volume replacements, and electrolyte solutions.

    Chronic Pancreatitis

    • Continuous, prolonged, inflammatory, and fibrosing process of the pancreas
    • Progressive destruction as replaced by fibrotic tissue
    • Risk factors: alcohol abuse, obstruction, cholelithiasis, tumors, trauma, systemic diseases (e.g., systemic lupus erythematosus), autoimmune pancreatitis, and cystic fibrosis
    • Etiology/causes: inflammation of the sphincter of Oddi (associated with cholelithiasis, cancer), and nonobstructive pancreatitis
    • Clinical manifestations: abdominal pain, often chronic, recurrent attacks, may become almost constant, location similar to acute pancreatitis, described as heavy, gnawing, burning, cramplike, not relieved by food
    • Other symptoms: pancreatic insufficiency (weight loss, constipation, mild jaundice, dark urine, steatorrhea, diabetes mellitus), fatty stools
    • Diagnostic studies: serum amylase and lipase, mild leukocytosis, elevated sedimentation rate
    • Stool samples for fat content, deficiencies, glucose intolerance
    • Collaborative care: analgesics, pancreatic enzyme replacement, controlled diabetes, low-fat diet, avoidance of alcohol and caffeinated beverages
    • Treatment: endoscopic therapy or surgery (choledochojejunostomy, Roux-en-Y pancreatojejunostomy), which involves diverting bile flow, relieves ductal obstruction
    • Drugs: acid-neutralizing drugs (e.g., antacids), inhibitors (e.g., H2-receptor blockers or proton pump inhibitors)

    Bariatric Surgery

    • Surgery is the only treatment for sustained weight loss
    • Criteria: BMI of 40 kg/m2 or BMI of 35 kg/m2 with complications (e.g., hypertension, type 2 diabetes mellitus, heart failure, sleep apnea)
    • Contraindications: untreated depression, binge eating disorders, drug abuse, cancer, end-stage kidney, liver, or cardiopulmonary disease, severe coagulopathy, or inability to comply with nutritional recommendations.

    Categories of Bariatric Surgeries

    • Restrictive surgeries, reducing stomach size (adjustable gastric banding, vertical sleeve gastrectomy), these surgeries do not alter digestion
    • Malabsorptive surgeries (biliopancreatic diversion with or without duodenal switch), which significantly reduce the bowel length to reduce absorption of nutrients

    Diabetes Mellitus

    • Group of metabolic diseases characterized by increased blood glucose levels
    • Defectives in insulin secretion, insulin action or both
    • Types:
      • Type 1: destruction of pancreatic beta cells, absolute insulin deficiency, prone to ketoacidosis
      • Type 2: relative lack of insulin receptors or resistance to insulin action, commonly occurs in people over age 30, prone to hyperosmolar, hyperglycemic syndrome
      • Gestational: any degree of glucose intolerance during pregnancy, caused by placental hormones
    • Predisposing factors: genetic predisposition, viruses, pancreatitis, pancreatic tumors, autoimmune diseases, and obesity
    • Risk factors: ethnicity, age ≥45, previous impaired fasting glucose/impaired glucose tolerance, hypertension, low HDL, high triglycerides, history of gestational diabetes
    • Manifestations: polyuria, polydipsia, weight loss, blurred vision, recurrent infections, weakness, paresthesia, nausea, vomiting, abdominal pain

    Diagnostic Tests

    • Fasting plasma glucose • Random plasma glucose • 2-hour postload glucose • Oral glucose tolerance test (OGTT) • Glycosylated hemoglobin A1c (HbA1c)

    Diabetes Management

    • Components: education, nutritional management, exercise, pharmacologic therapy, and monitoring.
    • Diet: individualized meal plan, balanced diabetic diet (50% carbohydrates, 30% fats, 20% protein)
    • Exercise: regular patterns, assess blood glucose before, during and after (15g carbohydrate snack)
    • Medications: oral hypoglycemic agents (first and second generation sulfonylureas,) biguanides, alpha-glucosidase inhibitors, non-sulfonylurea insulin secretagogues, thiazolidinediones, insulin,

    Insulin Therapy

    • Methods: traditional subcutaneous injections, insulin pens, jet injectors, insulin pumps.
    • Injection sites: abdomen, arms, thighs, buttocks.
    • Mixing insulin: introduce air into the vial of intermediate-acting insulin, then draw up regular insulin, then draw up the intermediate-acting insulin

    Complications of Insulin Therapy

    • Local/systemic reactions (e.g., edema, desensitization)
    • Lipodystrophy (lipoatrophy, lipohypertrophy)
    • Resistance to insulin
    • Dawn phenomenon
    • Somogyi effect
    • Insulin waning

    Hypoglycemia

    • Occurs when blood glucose falls to less than 70 mg/dL
    • Causes: overdose of insulin or oral hypoglycemic agents, omission of meals, strenuous exercise, gastrointestinal upset
    • Manifestations: sweating, tremor, pallor, tachycardia, headache, light-headedness, and confusion, numbness/tingle of lips/tongue, slurred speech, drowsiness, seizures, coma
    • Management: simple sugar orally if conscious, Glucagon (SQ or IM) if unconscious, carbohydrates, glucose IV

    Diabetic Ketoacidosis (DKA)

    • Absence or markedly inadequate amount of insulin
    • Life-threatening complication of type 1 diabetes
    • Clinical features: hyperglycemia, dehydration, electrolyte loss, acidosis
    • Pathophysiology: increased protein catabolism, increased gluconeogenesis, inefficient glucose utilization, increased ketone bodies production, osmotic diuresis, dehydration, electrolyte imbalances, shock, and tissue hypoxia
    • Manifestations: polyuria, thirst, nausea, vomiting, abdominal pain, weakness, headache, fatigue, dim vision, dehydration, hypovolemic shock, hyperpnea, acetone breath, lethargy, coma, blood glucose >300-800 mg/dL
    • Interventions: regular insulin IV push, IV fluids (0.9% NaCl 1 L first hour, 2-8 L over 24 hrs), sodium bicarbonate (correct acidosis), monitor electrolytes, especially serum potassium(K+), replace potassium, hourly monitoring of urine output (30 mL/hr)

    Hyperosmolar Hyperglycemic Syndrome (HHS)

    • Metabolic disorder of type 2 diabetes
    • Resulting from relative insulin deficiency
    • Without ketosis and acidosis
    • Precipitating factors: infection, renal failure, myocardial infarction, cerebrovascular accident, gastrointestinal hemorrhage, pancreatitis, congestive heart failure, total parenteral nutrition, and steroid use.
    • Pathophysiology: insulin deficiency, increased glucose production, impaired glucose utilization, osmotic diuresis, dehydration, hypovolemia, tissue hypoxia, lactic acidosis

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    More Like This

    Untitled Quiz
    55 questions

    Untitled Quiz

    StatuesquePrimrose avatar
    StatuesquePrimrose
    Untitled Quiz
    18 questions

    Untitled Quiz

    RighteousIguana avatar
    RighteousIguana
    Untitled Quiz
    50 questions

    Untitled Quiz

    JoyousSulfur avatar
    JoyousSulfur
    Untitled Quiz
    48 questions

    Untitled Quiz

    StraightforwardStatueOfLiberty avatar
    StraightforwardStatueOfLiberty
    Use Quizgecko on...
    Browser
    Browser