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Abnormally high blood pressure in the portal venous system caused by resistance to portal blood flow...
(Prehepatic, Intrahepatic, Posthepatic)
Portal Hypertension
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Consequences of PORTAL HYPERTENSION
- Varices -- outpouching of the vesels that can eventually rupture and cause bleeding: Lower esophagus, stomach, rectum
- Splenomegaly -- enlargement of the spleen
- Ascites -- fluid in the perineal cavity
- Hepatic encephalopathy
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Increased pressure in peritoneal capillaries results in:
Ascites
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Portosystemic shunting of blood which then leads to the development of collateral channels results in:
Hemorrhoids and Esophageal Varices
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Portosystematic Shunting of Blood which leads to Shunting of Ammonia and toxins from the intestine into the general circulation results in:
Hepatci Encephalopathy
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Splenomegaly results in:
Anemia, Leukopenia, Bleeding
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This specific type of disease can lead to ascites
Cirrhosis
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A neurologic syndrome of impaired cognitive function, flapping tremor, and EEG changes
Hepatic Encephalopathy
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How does Hepatic Encephalopathy develop?
- It develops rapidly during fulminant hepatitis or slowly during
- chronic liver disease
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What are problems occuring with Hepatic Encephalopathy
Cells in the nervous system are vulnerable to neurotoxins absorbed from the GI tract that because of liver dysfunction circulate to the brain
Patients may become very CONFUSED
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Types of Jaundice
- Obstructive jaundice
- -Extrahepatic obstruction
- -Intrahepatic obstruction
- Hemolytic jaundice
- -Prehepatic jaundice
- -Excessive hemolysis of red blood cells or absorption
- of a hematoma
- -Problem in the blood before it even gets to the liver
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Route to Jaundice (Know the LEFT side)
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Renal failure demonstrating oliguria, sodium and water retention, hypotension, and peripheral vasodilation as a result of advanced liver disease
- Hepatorenal Syndrome
- Liver/Kidney Syndrome
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Systemic viral disease that primarily affects the liver
HEPATITIS
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Formally known as infectious hepatitis
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Formally known as serum hepatitis
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Where is Hepatits A found; How is it transmitted; What are the Risk Factors?
- Found:
- In the feces, bile, and sera of infected individuals
- Transmitted by:
- Fecal-oral route
- Risk factors:
- Crowded, unsanitary conditions
- Food and water contamination
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How is Hep. B transmitted
- Transmitted:
- -Contact with infected blood, body fluids, or contaminated needles
- -IF mother is infected during the third trimester
**The hepatitis B vaccine prevents transmission and development of hepatitis B
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How is Hep. C transmitted? What does chronic Hep. C lead to?
- *Hepatitis C is responsible for most cases of posttransfusion hepatitis
- *Implicated in infections related to IV drug use
- *50% to 80% of hepatitis C cases result in chronic hepatitis...
- *CHRONIC
Hep C leads to Cirrhosis
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What does Hepatitis D depend on for replication???
- Hepatitis B
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can't get Hep D until you've had Hep B)
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What are facts about Hepatitis E
- *Fecal-oral transmission
- *Often in Developing countries
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What is the newer-found case of Hepatitis that can be transmitted parentally or sexually
Hepatitis G
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What are the sequences/stages of Hepatitis
- Incubation phase --> unaware
- Prodromal (preicteric) phase
- Icteric phase --> person is very sick, jaundice, lab tests
- Recovery phase
- -Chronic active hepatitis --> hepatitis C
- -Fulminant hepatitis:
- Results from impairment or necrosis of hepatocytes
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Irreversible inflammatory disease that disrupts liver function and even structure
oDecreased hepatic function caused by nodular and fibrotic tissue synthesis (fibrosis/scar tissue)
CIRRHOSIS
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What happens in Cirrhosis
- Biliary channels become obstructed and cause portal
- hypertension. Because of the hypertension, blood can be shunted away from the liver, and a hypoxic necrosis develops
- (Further increase of pressure à portal hypertension;
- Hypoxic necrosisà no blood flow to the liver/area)
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2 Types of Cirrhosis
- Alcoholic-- The oxidation of alcohol damages hepatocytes
- Biliary (bile canaliculi)-
Cirrhosis begins in the bile canaliculi and ducts (really can’t reverse it)... - *Primary biliary cirrhosis (autoimmune)
- *Secondary biliary cirrhosis (obstruction)
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Most common cause of gallbladder problems
Obstruction or inflammation (Cholecystitis)
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Gallstone formation
Cholelithiasis
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Types of Cholelithiasis (formation of gallstones)
- Cholesterol (most common)
- Cholesterol stones form in bile that is supersaturated with cholesterol
- Pigmented (cirrhosis)
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What increases a person's Risks of Gallstones
Obesity, middle age, female, Native American ancestry, and gallbladder, pancreas, or ileal disease
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Theories of Gallstones
- Enzyme defect increases cholesterol synthesis,
- Decreased secretion of bile acids to emulsify fats,
- Decreased resorption of bile acids from ileum
- Gallbladder smooth muscle hypomotility and stasis
- Genetic predisposition
- Combination of any or all of the above
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What causes Pancreaitis
Caused by an injury or damage to pancreatic cells and ducts, causing a leakage of pancreatic enzymes into the pancreatic tissue...These enzymes cause autodigestion of pancreatic tissue and leak into the bloodstream to cause injury to blood vessels and other organs
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Manifestations of Pancreaitis
Epigastric pain radiating to the back
Fever and leukocytosis
Hypotension and hypovolemia
Enzymes increase vascular permeability
- Characterized by an increase in a patient’s serum amylase level--
- Serum Amylase levels
- Serum Lipase levels
- Chronic pancreatitis:
- Related to chronic alcohol abuse
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