GI Flashcards
(141 cards)
1
Q
Abscess
A
A localized pocket of infection or purulent exudate surrounded by inflammation
2
Q
Adhesion
A
A band of fibrous scar tissue forming an abnormal connection between two surfaces or structures (binding two loops of intestine together)
3
Q
Autodigestion
A
Abnormal destruction of tissues by activated digestive enzymes
4
Q
Bolus
A
A round mass of food ready to be swallowed; a dose of concentrated drug administered intravenously all at once
5
Q
Calculi
A
A stone developing in the body (kidney or bile)
6
Q
Cholestasis
A
Obstructed flow of bile in the liver or biliary tract
7
Q
Chyme
A
Thick, semifluid mixture of partially digested food passing out of the stomach into the duodenum
8
Q
Colostomy
A
Surgical creation of an artificial opening from the colon onto the abdominal surface
9
Q
Exocrine
A
a
10
Q
Fecalith
A
a hard mass of feces, often impacted, in the intestine
11
Q
Gastrectomy
A
A surgical procedure where all, or a portion of the stomach is removed
12
Q
Gluconeogenesis
A
The production of glucose from protein or fat
13
Q
Glycogen
A
A polysaccharide, made up of glucose molecules, stored in skeletal muscle or the liver
14
Q
Hematemesis
A
Vomiting blood; may be called “coffee-grounds” vomitus because it appears brown and granular
15
Q
Hepatocytes
A
Epithelial cell of liver
16
Q
Hepatotoxins
A
A substance that damages the liver
17
Q
Hyperbilirubinemia
A
a
18
Q
Icterus
A
Jaundice
19
Q
Ileostomy
A
A surgical procedure where the ileum (small intestine) is attached to the abdominal wall to a bag outside the body
20
Q
Impaction
A
An immovable packing such as food or feces in the intestines
21
Q
Mastication
A
The process of chewing food in preparation for swallowing and digesting
22
Q
Melena
A
Black, tarry stool caused by bleeding in the digestive tract
23
Q
Mesentery
A
A double layer or peritoneum that supports the intestines and conveys blood vessels and nerves to supply the wall of the intestine
24
Q
Multiparity
A
a
25
Occult
Hidden, difficult to detect
26
Pruritus
Itching sensation
27
Retroperitoneal
Behind the peritoneal membrane against the abdominal wall
28
Rugae
Characteristic folds of the gastric mucosa, especially evident when the stomach is contracted
29
Sinusoids
a
30
Splenomegaly
Enlarged spleen
31
Steatorrhea
Fatty, bulky stool resulting from malabsorption
32
Stricture
Abnormal narrowing of a duct or tube
33
Tenesmus
Spams or straining associated with forced or painful elimination of urine or stool
34
Ulcerogenic
Producing or aggravating ulcers
35
Gastroenteritis
Inflammatory process caused by infection or allergic reactions
36
Intestinal obstruction
Refers to a lack of movement of the intestinal contents through the intestine
37
Small intestine
20 feet long, 1 inch in diameter
Hangs in coils
Digests food
Has 3 regions (duodenum, jejunum, ileum)
38
Large Intestine
Begins at ileocecal valve, terminates at the anus
5 ft long
Nutrients absorbed and indigestible materials eliminated
Parts: Cecum, ascending, transverse, descending (sigmoid colon, rectum)
39
Simple Obstruction
Intussusception - telescoping of a section of bowel inside an adjacent section
Volvulus - twisting of section of intestine
Adhesions of tumours
Gradual obstructions from chronic inflammatory conditions
40
Intestinal Obstruction: Signs and Symptoms Simple Obstruction; Small Intestine
Vomiting and abdominal distention occur quickly
No stool or gas is passed
Restlessness and diaphoresis (septic; early sign of shock)
Tachycardia (early sign of shock)
Severe colicky abd. pain
Abdominal distention
Vomiting
Borborygmi - hyperactive rumbling by movement of gas in intestine
Intestinal rushes - intestinal muscle contracts
41
Intestinal Obstruction: Signs and Symptoms Simple Obstruction; Large Intestine
Obstructions develop slowly and with mild signs
Constipation and mild lower abd. pain
Abd. distention, anorexia and eventually vomiting with severe pain
42
Functional obstruction or paralytic ileus
Peristalsis ceases due to neurologic impairment (spinal cord injury)
Distention of intestine occurs as fluids and electrolytes accumulate
Reflex spasms of the intestinal muscle do not occur
Remainder of process similar to mechanical
43
Etiology: Functional Obstruction
Inflammation related to severe schema
Pancreatitis, peritonitis, or infection in abd.
Hypokalemia, mesenteric thrombosis or toxemia
44
Signs and Symptoms: Functional Obstruction
Bowel sounds decrease or are absent
| Pain is steady
45
Diagnostic Tests
Abdominal x-rays (presence of gas and fluid in intestine)
Barium enema - locating obstructions (allows us to visualize what is happening; not used if perforation is suspected)
If location unknown - lower GI tract study first then upper GI
Sigmoidoscopy or colonoscopy
CBC (infection, "cold sepsis", clotting factors)
Electrolytes (K+, Na+)
Stool OB (3 tests over 3 days)
46
Colorectal Cancer: Pathophysiology
Begin as benign polyps
Grows undetected in the colon or rectum
Occurs in lower intestine
50+, sedentary lifestyles
47
Colorectal Cancer: Risk Factors
Familial risk
Long-term ulcerative colitis
Genetic factors
Environmental factors
48
Colon Cancer: Pathophysiology
Direct extension into the bowel wall
Spread to neighbouring organs
Seed other organs
Metastasis
49
Colon Cancer: Manifestations
Bleeding with BM (rectal cancers)
Change in bowel habits
Pain (goes away when peristalsis stops), anorexia, weight loss (feel full; not eating)
Prognosis depends on extent of the disease
50
Colon Cancer: Complications
```
Bowel obstruction (presenting symptom)
Perforation into neighbouring organs (stomach/bladder; will have darker, cloudy, foul, purulent, severe UTI
```
51
Colon Cancer; differences
```
Transverse colon (15%); pain, obstruction, change in bowel habits, anemia
Descending colon (15%); pain, change in bowel habits, bright red blood in stool (no time for it to absorb before it leaves the body)
Rectum (45%); blood in stool, change in bowel habits (may have to go more frequently), rectal discomfort (severe, spasmodic)
Ascending colon (25%); pain, mass change in bowel habits, anemia (blood is not obvious, will see occult)
```
52
Crohn's Disease
Inflammatory disorder
Genetic factor
Many similarities to other IBD (irritable bowel disease)
53
Crohn's Pahophysiology
```
Inflammatory lesions of bowel mucosa, ulcers and deep fissures develop (corrosion into the bowel)
Fistula formation
Skip lesions (definitive sign of crown's)
```
54
Crohn's Manifestations
Diarrhea (perfuse, watery)
Abdominal pain, palpable mass
Lesions of the rectum, anus
Exacerbations and remissions (can be very controlled or very uncontrolled)
55
Crohn's Complications
```
Intestinal obstruction
Increased risk of cancer in the small intestine or colon
Adhesions (huge risk; lead to obstruction)
Abscess
Fistula formation (common in bladder)
```
56
Ulcerative Colitis
Inflammation fo rectum and progresses through colon (only regulated to lower GI)
Mucosa and submucosa inflamed
Tissue edematous and bleeds
Ulcerations develop
Bowel wall thicken and shorter (exacerbation and remission)
Attempts to heal - granulation tissue forms but is vascular and fragile; bleeds easily (anemic)
57
UC: Manifestations
Intermittent rectal bleeding and mucous
Urgency & cramping pain LLQ relieved by defecation
Anorexia, weight loss, anemia, fatigue associated with malabsorption and malnutrition - VB12, bile salts
Children - delayed growth and sexual maturation
Tenesmus - straining, persistent ineffective spasms rectum
58
UC: Complications
```
Perforated colon ( ^ risk)
Toxic megacolon (only treatment is to remove)
High risk for colon cancer
Anklosing spondylitis
Arthritis
Nephrolithiasis
```
59
Crohn's & UC: Diagnostics
Stool specimen - blood and mucus
Hematology
Chemistry - Albumin, Vitamins - nutritional status
Upper GI with small bowel follow through
Barium enema
Sigmoidoscopy or colonoscopy - visualize and biopsy
60
Malabsorption: Pathophysiology
Celiac disease (can't break down wheat; blood test to see if they lack the enzyme)
Lactose intolerance (can't break down sugar)
Bowel resection
Short Bowel syndrome
61
Malabsorption: Manifestations
Depends on the cause
62
Celiac Disease: Diagnostic Tools
Stool samples
Blood tests
Intestinal biospy (confirms)
63
Celiac Disease: Pathophysiology
Glutenteropathy
Malabsorption syndrome
Genetic defect in intestinal enzymes that prevent digestion of gliadin and breakdown gluten
Occurs in childhood and middle age
64
Celiac Disease: Manifestations
```
Infant 4-6 months
Streatorrhea (a condition that is characterized by chronic fatty diarrhea)
Muscle wasting
Failure to gain weight
Irratibility and malaise
Skin rash
```
65
Dental Disorders
Caries (cavities)
Periodontal disease (general term)
Gingivitis (inflammation of gums)
Peridontitis (permanent loss)
66
Dysphagia
Neurological deficit
Mechanical deficit
Muscular disorder
Mechanical obstruction
67
Hiatal Hernia
Is a herniation of the stomach into the esophagus through an opening in the diaphragm
68
Hiatal Hernia: Sliding
Stomach slides into thoracic cavity when supine and goes back when upright
69
Hiatal Hernia: Paresophageal or rolling
Fundus and greater curvature causes stomach to roll up through the diaphragm
70
Hiatal Hernia: Etiology and Pathophysiology
Multiple factors cause:
Weakening of the muscles in the diaphragm
Increased intra-abdominal pressure (pregnancy, obesity, ascites, poor nutrition, pts that are supine)
71
Hiatal Hernia: Manifestations
Similar symptoms to GERD
Heartburn, especially after a meal (fat triggers acid reflux)
Dysphagia
Reflux and discomfort are associated with position
72
Hiatal Hernia: Complications
GERD
Hemorrhage from erosion
Stenosis of the esophagus (^ risk for esophageal cancer)
Ulcerations of the herniated portion of the stomach
Strangulation of the hernia (Ischemia can occur if stomach is pushed up enough)
Regurgitation with tracheal aspiration
73
Hiatal Hernia: Diagnostic
Barium swallow
| Endoscopic examination
74
Peptic Ulcer Disease
Condition characterized by erosion of GI mucosa resulting from digestive action of HCl and pepsin
Can be superficial or deep
75
Peptic Ulcer Development
Lower esophagus
Stomach
Duodenum
10% of the population of Western countries suffers a duodenal or gastric ulcer during their lifetime
76
Duodenum Ulcers
Occur at any age and in anyone
Increase risk between ages of 35-45
Account for 80% of all peptic ulcers
Associated with ^ HCl acid secretion
77
Psychological Stress Ulcers
Acute ulcers that develop following a major physiological insult, such as trauma or surgery
A form of erosive gastritis
78
Psychological Stress Ulcers: Complications
Hemorrhage
Perforation
Gastric outlet obstruction (an emergency, requires surgery)
79
Appendicitis
Inflammation and infection of vermiform appendix
Most common reason for abdominal surgery
Most often seen in adolescents and young adults
Slightly higher incidence in males
80
Appendicitis: Causes
Obstruction from fecalith (feces), gallstone, or foreign material
Obstruction due to twisting and kinking
81
Stage 1: Simple Appendicitis
```
Appendix is inflamed but intact
Manifestations
Generalized periumbilical pain
N&V
Low grade fever
```
82
Stage 2: Gangrenous Appendicitis
```
Tissue is necrotic and has microscopic perforations
Manifestations
Pain becomes more localized in RLQ
Rebound tenderness in McBurney's point
Positive Rosving's sign
```
83
Stage 3: Perforated Appendix
Appendix ruptures and contens contaminate peritoneal cavity
| Can occur within 24 hours
84
Stage 3: Manifestations
```
Pain briefly subsides with rupture then becomes more severe across abdomen as peritonitis (medical emergency) develops:
Abdomen is rigid
HR increases
Rapid, shallow breathing
Increased temp
Bowel sounds decrease
N&V
```
85
Appendicitis: Diagnostic Tests
Diagnosis based on complete physical exam and CBC
WBC will be elevated
Ultrasound may be done to confirm diagnosis
86
Peritonitis
Inflammation of peritoneal membranes
Result of chemical irritation or bacterial invasion
Chemical if not removed quickly, ultimately leads to bacterial peritonitis
87
Peritonitis: Pathophysiology
Initially: Local inflammation of peritoneum and momentum produce thick sticky exudate
Temporarily seals the area
Occasionally inflammation subsides and abscess forms
Peristalsis may reduce in this area
If cause not removed inflammation/infection will spread
88
Peritonitis
```
Hypovolemic shock due to third-spacing
Fluid becomes purulent
Complications:
Obstruction - paralytic ileus
Septicemia - circulating toxins
```
89
Peritonitis: Etiology
Abd. surgery - if foreign material remains or infection develops
Pelvic inflammatory disease - infection ascends uterus and fallopian tubes to peritoneal cavity
90
Peritonitis: S&S
Sudden, severe, generalized abd. pain. Pain increases with movement
Localized pain at area of problem
Breathing restricted
V
Signs of dehydration and hypovolemia - dec. turgor, dry mucous membranes, pallor, low BP
Fever and leukocytosis - inflammation & infection
Abd. distention - rigid abd. signals involvement of parietal peritoneum
Dec. bowel sounds - paralytic ileum and secondary obstruction
91
Peritonitis: Diagnostic Tests
Abd. x-ray - edematous and gaseous distention
Chest x-ray - elevated diaphragm
CBC - increase WBC
Paracentesis reveals bacteria, exudate, blood, pus or urine in abd.
92
Jaundice
Also known as icterus
Hyperbilirubinemia
Refers to yellowish colour of skin and other tissues
93
Jaundice
Disorders that cause jaundice are classified in 3 groups:
- Prehepatic (before liver)
- Intrahepatic (inside/ from the liver)
- Posthepatic (outside the liver)
94
Jaundice: Prehepatic
Results from excessive destruction of RBC
Characteristic of hemolytic anemias or transfusion reactions
Liver function normal but unable to handle the additional bilirubin
Physiologic jaundice of newborns - inc. hemolysis of RBC combined with immature liver
95
Jaundice: Intrahepatic
Occurs in individuals with liver disease
Hepatitis or cirrhosis
Impaired uptake of bilirubin from blood and dec. conjugation of bilirubin by hepatocytes
96
Jaundice: Posthepatic
```
Caused by obstruction of bile flow into gallbladder or duodenum and backup in blood
Congenital atresia (absence of opening) of bile-ducts, obstruction caused by cholelithiasis, inflammation of liver or tumours
```
97
Jaundice: Manifestations
Yellow sclera and skin
Changes in stool
Urine colour
98
Jaundice: Diagnostic tests
Prehepatic - serum levels unconjugated bilirubin (indirect-acting) elevated
Posthepatic - results from inc. of conjugated bilirubin (direct)
99
Hepatitis
Viral - A, B, C, D, E
Toxic or nonviral
Chronic noninfectious
100
Hepatitis: May result from
Local infection (viral hepatitis)
Infection elsewhere in body (infectious, mononucleosis or amebiasis)
Chemical or drug toxicity
101
Viral Hepatitis
Results from infection by a group of viruses that specifically target the hepatocytes
- Hep. A Virus (HAV); common in foods
- Hep. B Virus (HBV); blood born
- Hep. C Virus (HCV); blood transfusion
- Hep. D Virus (HDV); southeastern countries: water/food
- Hep. E Virus (HEV); Southeastern countries: water/food
102
Viral Hepatitis: Pathophysiology
Liver cells are damaged in two ways; direct action of virus or cell-mediated immune responses
Cell injury results in inflammation and necrosis in the liver
Hepatocytes and liver appear swollen and diffuse necrosis may be present
103
Viral Hepatitis: Manifestations
```
Range from mild or asymptomatic to severe
Course of hepatitis has 3 stages:
-Preicteric
-Icteric
-Posticteric
```
104
Viral Hepatitis: Preicteric Stage
Onset may be insidious, with fatigue, malaise, anorexia, nausea and general muscle aching (feels like they have the flu; contagious)
Sometimes fever, headache, distaste for cigarettes, mild RUQ discomfort
Serum AST or ALT are elevated
105
Viral Hepatitis: Icteric Stage
Onset of jaundice as serum bilirubin rises
As biliary obstruction increases stools lighten (clay-coloured), urine darkens (yellow/orange) and skin becomes pruritus
Liver tender and enlarged (hepatomegaly; able to palpate) and mild aching pain (more consistent)
Severe cases blood clotting factors impaired
106
Viral Hepatitis: Posticteric Stage
Marked by reduction in signs, may extend over some weeks
Acute stage of hepatitis A lasts 8-10 weeks
Hepatitis B prolonged to 16 weeks (will be left a carrier for Hep. B
107
Toxic or Nonviral Hepatitis
Hepatotoxins, such as chemicals or drugs, may cause inflammation and necrosis in the liver
May be due to direct effects of toxins or an immune response (hypersensitivity)
Toxic effects may be from sudden exposure or longterm (depending on severity, may require transplant)
108
Hepatitis: Diagnostic Tests
Antibodies and antigens by serology
HbsAg- active or chronic carrier (infectious)
Anti HCV & HBV DNA (hep C infectious)
Prothrombin time - prolonged (liver plays key role in clotting)
WBC elevated
Liver biopsy if chronic hepatitis is suspected
109
Gallbladder Disorders
Cholelithiasis: formation of gallstones which are masses of solid material or calculi that form in the bile
Cholecystitis: inflammation of gallbladder and cystic duct
Cholangitis: inflammation usually r/t infection of bile ducts
Choledocholithiasis: pertains to obstruction caused by gallstones of biliary tract
110
Cholelithiasis: Gallstones
10% of population have them
Vary in size and shape
Increased risk after 40 years old, female, obese
111
Cholelithiasis: Etiology
Small stones can pass silently
Lrg stones can obstruct flow of bile in cystic or common bile ducts
Can cause irritation and inflammation in gallbladder wall (cholecystitis) and tissue can then become infected
Gallstones from when bile contains inc. level of cholesterol or a deficit of bile salts
112
Cholelithiasis: Etiology
Cholesterol gallstones occurs twice as often in women
High cholesterol levels in bile
Factors: obesity; high cholesterol intake; multiparty; medications
113
Cholelithiasis: Etiology
Bile gallstones:
- hemolytic anemia
- Alcoholic cirrhosis
- Biliary tract infection
114
Cholelithiasis: Complications
Liver damage d/t back flow of bile
Pancreatitis d/t obstruction of common bile duct
Cholecystitis= inc. pressure = necrosis = inc. risk for perforation = peritonitis
115
Cholelithiasis: Diagnostic Tests
Abd. U/S of RUQ
Oral cholecytogram
Gallbladder scan
Blod work (WBC, serum bilirubin, alkaline phosphate, ALT, AST)
ERCP - endoscopic retrograde cholangiopancreatography (can be diagnostic or treatment)
116
Pancreatitis: Pathophysiology
Inflammation of pancreas resulting from auto digestion of the tissues
Autodigestion follows premature activation of pancreatic proenzymes within the pancreas (trypsin)
Digest the pancreatic tissue and cause massive inflammation, bleeding and necrosis
117
Pancreatitis
Lipase causes fat necrosis
Blood vessels eroded by elastase (a protease) leading to hemorrhage
Cytokines and prostaglandins released and lead to widespread inflammation of peritoneal membrane (chemical peritonitis)
Increased capillary permeability - hpovolemia
118
Pancreatitis: S&S
Sudden onset of acute pancreatitis may follow large meal or large amount of alcohol
Primary symptom: Severe epigastric pain or abd. pain radiating to back
Signs of shock: dec. BP, pallor, sweating and rapid weak pulse d/t inflammation, hemorrhage and therefore can lead to hypovolemia
119
Pancreatitis: S&S
Low-grade fever until infection develops
Abd. distention, dec. bowel sounds, dec. peristalsis and paralytic ileum
Ecchymosis - flank (Turner's sign) or umbilicus (Cullen's sign) indicates severe hemorrhagic pancreatitis
Jaundice
N&V
Mental confusion/ agitation (hypoxic; respiratory distress)
Possible hyperglycemia
120
Pancreatitis: Diagnostic Tests
Serum amylase inc. 12-24 hrs and dec. after 48
Serum lipase elevated and remain for weeks
Hypocalcemia (tetany) calcium binds to fatty acids in areas of necrosis
Urinary amylase - 24 hour urine collection can last up to 2 weeks
121
Pancreatitis: Diagnostic Tests
CT scan
Endoscopic retrograde cholangiopancreatography (ERCP)
Ultrasonography/ x-ray
122
Cirrhosis: Pathophysiology
Progressive disorder - liver failure
Extensive diffuse fibrosis and loss of lobular organization of the liver
Nodules of regenerated hepatocytes may form but are nonfunctional
Impaired blood flow thru liver increases pressure in portal venous system
123
Cirrhosis: Causes
```
Congenital (Cystic Fibrosis)
Inherited metabolic disorders
Long-term exposure to toxins
Chronic alcoholics
Hepatitis positive
```
124
Cirrhosis: Classified by structural changes
Alcoholic liver disease (portal cirrhosis)
Biliary cirrhosis
Postnecrotic cirrhosis
125
Cirrhosis: Alcoholic liver disease
```
Several stages of development
Alcohol metabolites
Malnutrition
Initial - Accumulation fat in liver cells
- Enlargement of liver (hepatomegaly)
- Reversible if alcohol intake reduced
```
126
Cirrhosis: Second and Third Stage
```
Second Stage:
Alcoholic hepatitis
Inflammation and cell necrosis
Fibrous tissue forms - irreversible
Third Stage:
End-stage cirrhosis (complete and irreversible liver failure)
Fibrotic tissue replaces normal tissue
Significant altering liver structure
```
127
Cirrhosis: Biliary cirrhosis
Immune disorder
Obstruction of bile flow due to stones or mucous plugs
Inflammation, necrosis and fibrosis
128
Cirrhosis: Posstnecrotic cirrhosis
Linked chronic hepatitis
Exposure to toxic materials
(Tylenol, Wilson's disease, neoplasms (cancer))
129
Cirrhosis: Effects of
Effects of cirrhosis evolve from two factors:
Loss of liver cell function
Interference with blood and bile flow in liver
130
Cirrhosis: Major functional losses
Dec. removal and conjugation of bilirubin
Dec. production of bile
Impaired digestion and absorption of nutrients
Dec. production blood-clotting factors (VK+ is essential)
Impaired glucose and glycogen metabolism
131
Cirrhosis: Obstruction of blood and bile
```
Dec. amount of bile entering intestines
Impaired digestion and absorption
Backup bile in liver - jaundice
Blockage of blood flow - portal hypertension
Congestion in spleen - splenomegaly
```
132
Cirrhosis: Manifestations
```
Fatigue, anorexia, indigestion, wt loss
Dull aching pain RUQ
Ascites (fluid in stomach)
General edema
Esophageal varices
Splenomegaly
Anemia
```
133
Complications of Cirrhosis
```
Portal hypertension
Ascites
Bleeding esophageal varices
Coagulation defects
Jaundice
Hepatic encephalopathy with hepatic coma
Hepatorenal syndrome
```
134
Port Hypertension
Sluggish blood flow resulting in increased pressure in portal circulation
Congested venous drainage of the GI tract
135
Portal Hypertension: Manifestations
Anorexia
Varices (esophageal, gastric, hemorrhoidal) can rupture; cause uncontrolled bleeding
Ascites
136
Esophageal Varices
```
Results from portal hypertension
Alcoholic or posthepatic cirrhosis
Infection from liver flukes
Vasoactive hormones
Increased splanchnic blood flow
Increased vascular resistance in the liver
```
137
Esophageal Varices: Manifestations
```
Hematemesis (vomiting blood)
Melena (passage of dark, pitchy, and grumous stools stained with blood pigments)
Bright red rectal bleeding
Anemia
Shock
```
138
Hepatic Encephalopathy
Complex neuropsychiatric syndrome from too much ammonia
| Associated with hepatic failure or severe chronic liver disease
139
Hepatic Encephalopathy: Manifestations
```
Psychotic symptoms
Spastic myelopathy
Cerebellar/ extrapyramidal signs
Asterixis "liver flap" (classic sign)
- Spastic jerking of hands held in forced extension
Dementia
```
140
Hepatorenal Syndrome
Acute and progressive disease
Normal kidney with disturbed infrarenal blood flow
- Related to imbalance between vasoconstriction and vasodilating mechanisms
Rising serum creatinine levels and oliguria
141
Cirrhosis: Diagnostic Tests
Liver biopsy; determine cause and extent of damage
Chemistry; CBC, electrolytes, amino acids, ammonia, LFT's
Coagulation studies; risk of bleeding
Abdominal ultrasounds; liver size, nodules, ascites
Upper endoscopy; esophageal varices
