GI

• Functions of the Normal Liver

  • Energy metabolism and substrate interconversion
  • Protein synthetic functions
  • Solubilization, transport and storage functions
  • Protective and clearance functions
• Failure of the Liver's four broad functions


  • Hepatocyte dysfunction
  • Portal Hypertension
• Mechanisms of Liver Dysfunction

  • Acute Hepatitis
  • Chronic Hepatitis
  • Cirrhosis
• Causes of Liver Dysfunction

  • Inflammation
  • Cell death
  • Viral infection
  • Drugs
  • Toxins
• Acute Hepatitis

  • Ranges from asymptomatic to fatal
  • Variable clinical presentation
  • Anorexia, fatigue, weight loss, nausea, vomiting
  • Right upper quadrant abdominal pain, jaundice, fever
  • Splenomegaly, ascites
• Acute Hepatitis


  • Liver cell necrosis + inflammation, >6 months
  • Viral infections, Drugs, Toxins, Genetics, Metabolic causes, autoimmunity
• Chronic Hepatitis


  • Ranges from asymptomatic to liver failure and death
  • Progressive liver disease leads to cirrhosis and liver failure
  • Fatigue, malaise, low-grade fever, anorexia, weight loss
  • Mild intermittent jaundice, mild hepatosplenomegaly
• Chronic Hepatitis Complications

  • Variceal bleeding
  • Coagulopathy
  • Encephalopathy
  • Jaundice
  • Ascites
  • Extrahepatic: skin rash, diarrhea, arthritis, autoimmune disorders
• Cirrhosis

  • Irreversible structural changes in the liver
  • Cell death, fibrosis, nodular degeneration
  • Not all patients develop life-threatening complications
  • Wide range of causes
  • Liver injury is chronic and progressive
• Causes of Cirrhosis

  • Alcohol abuse
  • Infections
  • Chronic biliary obstruction
  • Drugs
  • Genetic and metabolic disorders
  • Chronic heart failure
  • Primary (autoimmune) biliary cholangitis
• Cirrhosis


  • Fatigue, loss of vigour, weight loss
  • Nausea, vomiting, jaundice, tender hepatomegaly
  • Palmar erythema, spider angiomas, muscle wasting, parotid and lacrimal gland enlargement, gynecomastia, testicular atrophy, menstrual irregularity, coagulopathy
  • Ascites, portosystemic shunting, encephalopathy, splenomegaly, oesophageal and gastric varices with intermittent haemorrhage
• Functions of the Exocrine Pancreas

  • Synthesis and Secretion of Pancreatic Juice (digestive functions)
• Acute Pancreatitis

  • Acute inflammation
  • Destructive autodigestion of the pancreas and peripancreatic tissues
  • Significant morbidity and mortality
  • Many different causes
  • Biliary tract disease, alcohol ingestion, metabolic causes, mechanical causes, drug reactions, traumatic injuries
• Chronic Pancreatitis

  • Relapsing disorder
  • Exocrine and endocrine insufficiency
  • Severe duct abnormalities
  • Pancreatic calcifications
  • Chronic inflammation of parenchyma
  • Progressive destruction of tissue
  • Fibrosis
• Causes of Chronic Pancreatitis

  • Chronic alcoholism 70% – 80%
  • Other causes: gallstones and duct obstruction, etc.
• Chronic Pancreatitis

  • Abdominal pain: constant or intermittent
  • Pain radiates to midback or scapular region, increases after eating
  • Vomiting
  • Painless pancreatitis: diabetes, jaundice, maldigestion, malabsorption, steatorrhea, anorexia, weight loss
  • Poor nutrition, malabsorption, pancreatic insuficiency
• Cholelithiasis

  • Often asymptomatic
  • Symptoms range from mild nausea and abdominal discomfort after fatty or fried foods to severe right upper quadrant or midepigastric pain and jaundice
  • Females, high dietary fat intake, prior pregnancies, 40s
  • Gallstones: cholesterol with or without Ca deposits
  • Stone presentation depends on pathophysiologic mechanism