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1972
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Clinical Manifestations of hepatic/Biliary insufficiency?
- Edema and Emaciation (Submandibular/Abdominal)
- Diarrhea/Constipation/Pale feces
-Photosensitization
- Hemorrhagic diathesis
- Abdominal Pain
- Liver size alteration/Displacement/Rupture
The major hepatic functions include? (4)
1) Maintenance of normal blood glucose by glycogen synthesis
2) Formation of some blood plasma proteins (albumin fibrinogen)
3) Formation and excretion of bile salts and excretion of bile pigments
4) Detoxification and excretion of toxic substances
Hepatic or Hepatocellular jaundice billirubin type and causes?
Unconjugated and conjugated
Viral Hepatitis
Toxic Hepatitis
Intrahepatic cholestasis
Gilbert's syndrome
The only accurate way for the differentiation between jaundice with impaired bile flow and jaundice without impaired flow is ?
-Presence of bilirubin and urobilinogen in the urine
- the amounts of conjugated and unconjugated bilirubin in the serum
impaired bile flow:
1) marked increase in the serum level of conjugated (direct) bilirubin
2) marked increase in urine of the bilirubin content
Jaundice without impaired bile flow:
1)marked increase of indirect bilirubin in the serum
2)urine - increased amount of urobilinogen, no bilirubin
PARENCHYMATOUS JAUNDICE is due to:
Due to the partial obstruction of biliary excretion
the changes in serum and urine are between those of hemolytic jaundice and extrahepatic biliary obstruction
Serum levels of total bilirubin - increased (retention of direct bilirubin)
Bilirubin levels in the urine– elevated Urobilinogen levels in the urine - elevated
EXTRAHEPATIC BILIARY OBSTRUCTION causes?
- Biliary calculi (gall blader, bile ducts)
- Compression by tumor
- Nematodes (Ascaridae - pigs,Dicrocoelium dentriticum - ruminants)
- Inflammation of the bile ducts (from an enteritis or by infestation with trematodes)
Extrahepatic biliary obstruction signs:
Usually complete obstruction » disappearance of bile pigments from the feces (acholuric)
Serum levels of conjugated and total bilirubin elevated
Urine – conjugated bilirubin, no urobilinogen (because of the failure of excret. into intest.)
Classification of the diffuse liver diseases according to pathological change?
Hepatitis and hepatosis (clinically not marked differences)
PORTAL CIRCULATION Very important part of the liver blood circulation!
Any obstruction results in:
Any obstruction results in damming of blood in the portal system, portal hypertension, compromising of digestion, absorption and in the final stages the accumulation of fluid in the peritoneal cavity (ASCITIS)
MANIFESTATIONS OF LIVER AND BILIARY DISEASE JAUNDICE Jaundice is a clinical sign of:
-the liver and biliary system diseases
- sometimes there are no lesions of these organs
-Its the result of the accumulation of bilirubin
Pre-hepatic or hemolytic jaundice type of billirubin and causes:
Unconjugated billirubin
Hemolytic anemia
Thalassemia
Drug toxicity
Hemoglobinopathies
HEMOLYTIC JAUNDICE Common in animals associated with:
- bacterial toxins (Clostridium haemolyticum)
- invasion of erythrocytes by protozoa (babesiosis, anaplasmosis)
-inorganic and organic poisons (snake bites, chronic copper poisoning)
- immunological reactions (neonatal isoerythrolysis)
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