Nonalcoholic fatty liver disease causes damage to the liver via what mechanism?
Increased transport of FFA from adipose to liver
Decreased oxidation of FFA in the liver
Decreased clearance of FFA from the liver
**Insulin resistance leads to increased peripheral lipolysis and subsequent hepatic uptake of fatty acids–> increased oxidative stress on liver
Spontaneous bacterial peritonitis presentation (translocation of bacteria to ascitic fluid)
- cirrhosis/ascites w/ fever, abdominal pain/tenderness, altered mental status, hypotension
- ascitic fluid- >250 PMNs, positive culture
fluoroquinolones- trophy
tx= 3rd gen cephalosporin
Chronic pancreatitis presentation
on CT: calcifications in pancreas, dilated ducts
- bloating, frequent bulky, foul smelling bowel movements consistent with steatorrhea (impaired secretion digestive enzymes)
- malabsorption- weight loss
- potential abdominal pain/diabetes mellitus (pancreatic endocrine insufficiency)
- *alcohol use
Complications of Roux-en-Y gastric bypass
Early: anastomotic leak (sepsis), bowel ischemia (diffuse abdominal pain)
Late: anastomotic stricture (bowel obstruction)
- marginal ulcer
- Cholecystitis due to rapid weight loss encouraging stone formation
- dumping syndrome - diarrhea, crampy abdominal pain
Tx of actively bleeding esophageal varices
Primary prophylaxis to prevent bleeding in moderate esophageal varices
- octreotide
- Beta blockers (propranolol, nadolol), or endoscopic variceal ligation
