Pathophysiology

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Hepatobiliary diseases are classified according to the main pathologic processes involved and include hepatocellular, cholestatic, immunologic, and infiltrative disorders. Considerable overlap occurs among these different processes, with a common result being progressive hepatic dysfunction along with attendant complications. Ihe liver is the largest organ and serves as the command and control center for all major metabolic functions. Ihe liver is central to glucose homeostasis, plasma protein and coagulation factor synthesis, lipid and lipoprotein synthesis, bile acid synthesis and secretion, vitamin storage (B 12, A, D, E, and K), and the biotransformation, detoxification, and excretion of an array of both endogenous and exogenous substances.

Common to essentially all causes of chronic liver disease is ongoing hepatocellular injury and death with the progressive disruption of the functional microanatomy of the liver. Deposition of collagen in tracts of scar tissue accompanies this process and characterizes cirrhosis. Eventually, the metabolic function of the liver becomes both compromised and isolated, resulting in nutritional deficiencies, bleeding diatheses, and the accumulation of toxic metabolic wastes. Ihe cirrhotic liver becomes increasingly resistant to blood flow from the splanchnic circulation, contributing to development of portal hypertension and portosystemic shunting of splanchnic blood through collateral veins into the general circulation. Portal hypertension results in splenomegaly and the development of gastroesophageal varices. Ihese varices are thin-walled submucosal vessels prone to ulceration and hemorrhage. Splenomegaly contributes to anemia and thrombocytopenia. Ascites develops secondary to portal hypertension and abnormalities in renal sodium and water excretion caused by diminished glomerular filtration rate (GFR) and elevations in both aldosterone and antidiuretic hormone. Ascites is often massive, worsens chronic fatigue, and compromises respiratory function. Furthermore, ascites sets the stage for recurrent episodes of spontaneous bacterial peritonitis. Add to this the particularly debilitating occurrence of encephalopathy related to the accumulation of a variety of neurotoxic substances in the circulation. Each of these complications will be further addressed below. 110

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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