Gastrointestinal Bleeding & Liver Disorders

Question 1

What are the main functions of the liver?

Answer 1

Bile production and exrcretion

Glucose metabolism

Protein metabolism

Lipid metabolism

Blood coagulation

Toxin removal

Immunity

Hormone metabolism

Question 2

What is hepatitis?

Answer 2

Inflammation of the liver causing liver cell damage

Question 3

What are common causes of hepatitis?

Answer 3

Viral infection, alcohol overuse, drugs, autoimmune disease

Question 4

Describe the pathophysiology of hepatitis

Answer 4

Liver swelling compresses bile ducts and vasculature. This impairs metabolism and ability to filter toxins.

Question 5

Why is there no vaccine for Hep C?

Answer 5

It mutates too fast

Question 6

What virus is Hep D always transmitted with?

Answer 6

Hep B

Question 7

What are the three phases of hepatitis?

Answer 7

Preicteric - up to 3 weeks post exposure. Malaise, headache, RUQ pain, fever

Icteric - 2-6 weeks long. Jaundice, clay colored stools, dark urine, GI symtptoms

Posticteric - lasts several months. Fatigue, malaise, anemia

Question 8

How is hepatitis diagnosed?

Answer 8

Liver biopsy used to identify type and severity of infection and progression

Elevated LFTs, incl. bilirubin.

Decreased albumin

Positive viral antigen test

Question 9

What is cirrhosis?

Answer 9

Chronic progressive liver disease characterized by degeneration and destruction of liver cells.

Question 10

What is the primary pathophysiologic feature of cirrhosis?

Answer 10

Fibrotic bands of connective tissue impair liver throughput

Question 11

What is the most common symptom in cirrhosis and hepatitis?

Answer 11

Pain in RUQ, then digestive issues

Question 12

What are some complications of cirrhosis?

Answer 12

Portal hypertension, esophageal varices, ascites, hepatic encephalopathy

Question 13

What are esophageal varices?

Answer 13

Collateral vessels in reaction to low portal vein flow

Question 14

What serum values are decreased in cirrhosis?

Answer 14

Total protein, RBC, HBG, HCT, WBC, cholesterol

Question 15

What is the treatment goal with cirrhosis?

Answer 15

Limit functional deterioration

Question 16

What is ascites?

Answer 16

Accumulation of fluid in the peritoneal space

Question 17

What is an important diet consideration in hepatic encephalopathy?

Answer 17

Low protein diet (keep ammonia low - lactulose)

Question 18

What are common causes of upper GI bleed?

Answer 18

Peptic ulcers, gastritis, esophageal varices, esophagitis, bleeding disorders

Question 19

What amount is considered a mild GI bleed?

Answer 19

500 mL or less per day

Question 20

What amount is considered a severe GI bleed?

Answer 20

1500 mL or more per day

Question 21

What does ocreotide do for GI bleeds?

Answer 21

Reduces blood flow to esophageal varices

Question 22

What two common classes of drugs are used to help upper GI bleeds?

Answer 22

PPIs and H2 blockers