Week 6 - Gastrointestinal Tract Disorders

Question 1

What is the Clinical Manifestations of Liver Disease

Answer 1

Acute or chronic liver disease leads to significant systemic, life-threatening complications, including:
- Portal hypertension
- Ascites
- Hepatic encephalopathy
- Jaundice

Question 2

Define Portal Hypertension

Answer 2

Abnormally high blood pressure in the hepatic portal venous system.

Question 3

Define the action of the Hepatic Portal Vein

Answer 3

The hepatic portal vein drains the nutrient-rich blood from the gastrointestinal tract to the liver

Question 4

What is the Pathophysiology of Portal Hypertension

Answer 4

It is caused by disorders that obstruct or interfere blood flow through the portal venous system (into the liver) or vena cava (out of the liver).
- The most common: obstruction caused by cirrhosis of the liver.

Question 5

Define Ascites

Answer 5

Accumulation of fluid in the peritoneal cavity.

Question 6

What is the Pathophysiology of Ascites

Answer 6

• Cirrhosis (the most common cause)
• Portal hypertension - blood backs up and leak into the peritoneal cavity.
• Reduced serum albumin levels
• Heart failure

Question 7

What are the Clinical Manifestation of Ascites

Answer 7

• The accumulation of ascitic fluid can result in weight gain
  and abdominal distension.
• Large fluid that is displaced in the diaphragm can lead to dyspnoea (decreased lung capacity).
• Can develop bacterial peritonitis which causes:
• Fever
• Chills
• Abdominal pain
• Cloudy ascitic fluid.

Question 8

What are the Treatments for Ascites

Answer 8

• If liver function restored, ascites diminishes spontaneously.
• Potassium-sparing diuretics
• Paracentesis to remove 1–2 L of ascitic fluid (to relieve respiratory distress).

Question 9

Define the Complications of Ascites

Answer 9

• Respiratory compromise due to pressure on the diaphragm, making breathing difficult.
• Increased risk of spontaneous bacterial peritonitis (SBP) — a potentially life-threatening infection of the ascitic fluid.

Question 10

Define Hepatic Encephalopathy

Answer 10

A reversible syndrome of impaired brain function occurring in patients with advanced liver diseases.
Characterised by:
- Impaired cerebral function
- Flapping tremor (known as asterixis)

Question 11

What is the Pathophysiology of Hepatic Encephalopathy

Answer 11

• Liver dysfunction can shunt blood around the liver to the systemic circulation.
• This leads to toxins absorbed from the gastrointestinal tract circulate freely to the brain.
• The most hazardous substances to the brain is ammonia which can affect neurotransmission, causing central nervous system disturbances & alterations in consciousness.

Question 12

What are the Clinical Manifestation of Hepatic Encephalopathy

Answer 12

• Subtle changes in personality
• Memory loss
• Irritability
• Confusion
• Flapping tremor of the hands
• Convulsions & coma
• Death.

Question 13

What are the Treatments for Hepatic Encephalopathy

Answer 13

• Restricting dietary protein intake & eliminating intestinal bacteria to reduce blood ammonia levels
• Lactulose prevent ammonia absorption in the colon.

Question 14

Define Jaundice

Answer 14

A yellow pigmentation of the skin caused by hyperbilirubinaemia.

Hyperbilirubinaemia and jaundice can result from:
- Excessive haemolysis of red blood cells
- Obstructive disorders of the bile ducts or liver cells

Question 15

What is the Pathophysiology of Prehepatic Jaundice

Answer 15

• The decrease ability of the liver to metabolise bilirubin which causes blood bilirubin levels to rise
• Prehepatic jaundice is caused by excessive haemolysis (breakdown) of red blood cells

Question 16

What is the Pathophysiology of Intrahepatic jaundice

Answer 16

• Commonly results from alcoholic cirrhosis and viral hepatitis
• Involves disturbances in hepatocyte function
• The metabolism of bilirubin impaired > elevated levels in the blood and urine

Question 17

What are the Clinical Manifestation of Jaundice

Answer 17

• Yellow discolouration - first occur in the sclera of the eye and then progress to the skin
• Dark urine
• Fever, chills and pain often accompany jaundice
• Pruritus (itching)

Question 18

What are the Treatment of Jaundice

Answer 18

• Evaluate serum bilirubin levels
• Identify underlying disorders

Question 19

Why Esophageal Varices Are Life-Threatening

Answer 19

• Varices are fragile, dilated veins in the esophagus caused by portal hypertension.
• If they rupture, they can cause massive upper gastrointestinal bleeding, leading to hypovolemic shock and death if not promptly treated.