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WEEK 6 Flashcards

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1
Q

INFECTIOUS DIARRHOEA

A
  • Disruption of the epithelium of the intestine due to pathogens is a common cause of diarrhoea
  • Blood in the lumen→ blood stool
  • Loss of the epithelial absorptive properties→ water retained in the lumen

Examples of pathogens frequently associated with infectious diarrhoea include:

  • Bacteria Salmonella, E. coli, Campylobacter
  • Viruses
  • Protozoa, including Cryptosporidium, Giardia
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2
Q

SECRETORY DIARRHOEA

A
  • Occurs when secretion of water into the intestinal lumen exceeds absorption
  • Does NOT stop after fasting
  • Often associated with cholera (Vibrio cholerae)
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3
Q

INFLAMMATORY BOWEL DISEASE: ULCERATIVE COLITIS

A
  • Chronic non-specific inflammatory condition
  • Ulceration of the colonic mucosa, usually in the sigmoid colon or the rectum
  • Pinpoint mucosal haemorrhages and pus → Stool contains blood and mucus
  • Inflammation makes the colon empty frequently causing diarrhoea
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4
Q

INFLAMMATORY BOWEL DISEASE: CROHN’S DISEASE

A
  • Chronic inflammatory condition involving entire intestinal wall
  • Most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum) but can occur in any part of the GIT
  • “Cobblestone” appearance
  • Nutritional deficiencies
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5
Q

INFLAMMATORY BOWEL DISEASE: SYMPTOMS (SIMILAR FOR BOTH)

A
  • Abdominal pain
  • Diarrhoea
  • Blood and mucus in stools
  • Dehydration
  • Fever
  • Weight loss
  • Periods of remission and exacerbation
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6
Q

IRRITABLE BOWEL SYNDROME (IBS) DESCRIPTION

A
  • Functional gastrointestinal disorders: dysregulation of intestinal motor and sensory functions moderated by the CNS due to stress
  • Women > men
  • Persistent of recurrent lower abdominal pain
  • Altered bowel function
  • Flatulent, bloating
  • Nausea, anorexia
  • Abdominal pain relieved by defecation and change in consistency/ frequency of stools
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7
Q

IRRITABLE BOWEL SYNDROME (IBS) DIAGNOSIS

A
  • Continuous or recurrent symptoms of at least 12 weeks duration of abdominal discomfort
  • Or pain in the preceding 12 months
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8
Q

IRRITABLE BOWEL SYNDROME (IBS) TREATMENT

A
  • Manage psychological and physiologic stress
  • Adequate fibre intake; avoid fat, gas-producing food, alcohol and caffeine
  • Antispasmodic and anticholinergic drugs
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9
Q

LIVER FUNCTION

A
  • Detoxification: bilirubin, ammonia, toxins
  • Metabolism: Glucose, lipid, protein
  • Synthesis: Bile, albumin, haemoglobin, precursors (steroid hormone, clotting factors)
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10
Q

JAUNDICE

A
  • Yellowing of the skin and sclera of the hyperbilirubinemia

Major causes

  • Prehepatic factors: Disorders causing excess haemolysis of red blood cells
  • Intrahepatic factors: Any condition which impairs hepatocyte function of
  • Conjugation of bilirubin
  • Bilirubin uptake. E.g. hepatitis, cirrhosis, liver cancer
  • Posthepatic factors: Primarily involve blockage of bile flow- e.g. from gallstones or tumours
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11
Q

LIVER DISORDERS

A
  • Hepatitis: Inflammation of the liver- acute or chronic

- Cirrhosis: Dead liver cells replaced irreversibly with non-functioning scar tissue

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12
Q

HEPATITIS

A
  • Non-infectious causes
  • Alcohol, Autoimmune disease, Drugs and toxins, Tumours
  • Infectious hepatitis caused by viruses
    Hep A, Hep B, Hep C, Hep D, Hep E
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13
Q

ALCOHOL LIVER DISEASE

A
  • Reduced fatty acid oxidation→ lipid accumulation
  • Usually occurs in binge drinkers; Reversible after quitting alcohol
  • Fatty liver disease: independent of dietary habit
  • Alcoholic Hepatitis→ Liver inflammation and necrosis
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14
Q

VIRAL HEPATITIS

A
  • Cell injury is due to
  • Direct cell damage by the virus
  • Indirect damage by the body’s immune responses against the viral antigens, which kill the virus but also damages cells
  • The clinical course of infections may be:
  • Asymptomatic (serologic evidence only) - a carrier state without clinical features (e.g. HBV)
  • Acute
  • Chronic with or without progression to cirrhosis
  • Fulminating disease with rapid onset of liver failure
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15
Q

ACUTE HEPATITIS (3 IDENTIFIABLE STAGES) PRODROMAL (ABRUPT OR INSIDIOUS)

A
  • Abdominal pain, usually mild on the right side
  • Fatigue
  • Severe anorexia
  • Nausea and vomiting, diarrhoea or constipation
  • Possibly a distaste for smoking in smokers
  • Muscle and Joint pain
  • Chills and fever may occur with abrupt onset
  • Increased AST, ALT
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16
Q

ACUTE HEPATITIS (3 IDENTIFIABLE STAGES) ICTERUS (5-10 DAYS)

A
  • Severe pruritus and liver tenderness common
  • Increased bilirubin and jaundice
  • Jaundice less likely in HCV infection
  • Dark urine- black tea colour
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17
Q

ACUTE HEPATITIS (3 IDENTIFIABLE STAGES) CONVALESCENT (2-3 WEEKS)

A
  • Increased sense of well-being
  • Decreased jaundice
  • Course: HAV- 9 weeks, uncomplicated HBV- 16 weeks
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18
Q

HEPATITIS A: Summary

A

Viral infection with hepatitis A virus (HAV) causing inflammation of the liver

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19
Q

HEPATITIS A: Transmission

A
  • Via the fecal- oral route and is highly infectious

- More common in countries with poor sanitation

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20
Q

HEPATITIS A: Clinical Features

A
  • Clinical features are acute or can be asymptomatic
  • Fever
  • Malaise
  • Anorexia
  • Abdominal discomfort
  • Dark urine
  • Jaundice
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21
Q

HEPATITIS A: Treatment

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A
  • Benign (uncomplicated)
  • Self-limited- recover after 2 weeks usually
  • Symptomatic support
22
Q

HEPATITIS A: Carrier State

23
Q

HEPATITIS A: Vaccine

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A

Yes, develop immunity through IgG antibodies

24
Q

HEPATITIS A: Incubation period

25
HEPATITIS A: Chronic Disease Development
Does not develop to a chronic state
26
HEPATITIS B: Summary
Viral infection with Hepatitis B Virus (HBV) causing inflammation of the liver
27
HEPATITIS B: Transmission
Transmitted by body fluids, vertical | Can also be transmitted by breast milk
28
HEPATITIS B: Clinical Features
``` Fever Malaise Anorexia Abdominal discomfort Dark urine Jaundice ```
29
HEPATITIS B: Treatment
- Some recover without meds in 16 weeks | - Antiviral medication
30
HEPATITIS B: Carrier State
Yes
31
HEPATITIS B: Vaccination
Yes
32
HEPATITIS B: Incubation Period
4-26 weeks
33
HEPATITIS B: Chronic Disease Development
May lead to chronic disease development
34
HEPATITIS C: Summary
- Viral infection with Hepatitis C Virus (HCV) | - Virus is genetically unstable and leads to liver inflammation
35
HEPATITIS C: Transmission
- Transmission via blood-blood contact - Drug infusions - Unprotected sex (uncommon) - Vertical (uncommon)
36
HEPATITIS C: Clinical Features
- Acute- mild symptoms/ asymptomatic | - Chronic disease can progress to cancer and cirrhosis
37
HEPATITIS C: Treatment
- Dual or triple antiviral therapy - Treat the symptoms and complications - Liver transplant in cirrhosis
38
HEPATITIS C: Carrier State
Yes
39
HEPATITIS C: Vaccination
No; multiple genotypes of virus
40
HEPATITIS C: Incubation Period
14-180 days (7 weeks average)
41
HEPATITIS C: Chronic Disease development
Yes→ common
42
CIRRHOSIS: SUMMARY
- Develops slowly over the years (25-30 years) - Scarring of the liver= reduced functional tissue - Functional tissue is replaced by scar tissue→ leads to cobbled appearance of the liver
43
CIRRHOSIS: CAUSES
Hepatitis C, Fatty Liver Disease, Alcohol Abuse
44
CIRRHOSIS: CLINICAL FEATURES
Early features - Weight loss, Anorexia, Fatigue, Hepatomegaly, Diarrhoea, Jaundice Late features - Features of portal hypertension- splenomegaly, variceal bleeding, hepatic encephalopathy (altered level of consciousness) - Bleeding tendency, Acites, Endocrine changes→ loss of libido, hair loss, Male changes→ Testicular atrophy, gynaecomastia, Female changes→ breast atrophy, irregular menses, amenorrhea
45
CIRRHOSIS: INVESTIGATIONS
Increased AST and ALT Increased bilirubin Decreased total protein and albumin Decreased clotting factors
46
CIRRHOSIS: TREATMENT
- Irreversible (incurable) - Treatment of underlying cause - Maintenance of nutrition - Treatment of complications, including ascites, hepatic encephalopathy, portal hypertension - Liver transplant and varices
47
AUTOIMMUNE HEPATITIS
- A chronic liver inflammation of unknown aetiology that is characterised by the presence of circulatory auto-antibodies and ongoing liver tissue damage - In a genetically predisposed individual - Certain agents such as drugs and viruses can trigger this process of self induced liver damage - Varicella- Zoster virus: vaccine available Varicella (chickenpox) Herpes Zoster (Shingles)
48
PORTAL HYPERTENSION: DESCRIPTION
- Increased BP in the hepatic portal vein - Normal 5-10 mmHg - Increased resistance to flow in the portal venous system and sustained portal vein pressure > 22 mmHg
49
PORTAL HYPERTENSION: EFFECTS
- Varices- distended collateral blood vessels, shunt > 200 mmHg - 65% develop esophageal varices - Walls of varices are thinner and weaker than usual- rupture - Vomiting blood is common: reduced clotting factors - Sudden haemorrhage: massive and fatal→ most common cause of death in alcoholics
50
PORTAL HYPERTENSION: ASCITES
- Accumulation of fluid in peritoneal cavity → - Portal BP > 300 mmHg - Ascites 15L + - Abdominal discomfort, limits lung expansion→ dyspnoea, insomnia, difficulties of walking Due to - Increased pressure in intestinal blood vessels - Decreased colloid osmotic pressure due to impaired liver synthesis of albumin < 30g/L - Salt and water retention by the kidney - If severe can cause hypovolemia and shock, decreased BP, leading to cardiac arrest and/or acute renal failure - Metabolic alkalosis: due to low KCI H+ enters the cells to exchange for K+
51
PORTAL HYPERTENSION: EMERGENCY TREATMENT
- Promptly resuscitate and restore the circulating blood volume - Establish intravenous access for blood transfusion - Start rapid transfusion of 5% dextrose and colloid solution - Establish airway protection - Patients with massive bleeding, especially if the patient is not fully conscious - Correct clotting factor deficiencies - Fresh frozen plasma, fresh blood and vitamin K1 - Nasogastric tube - Endoscopic sclerotherapy, Endoscopic ligation
52
PORTAL HYPERTENSION: TREATMENT
- Resting - Diet: High energy with good nutrition, no protein if liver function is severely reduced or with hepatic encephalopathy - Sodium and water intake restriction, oral diuretics, laxatives, removal of ascitic fluids, IV albumin, surgery

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