PATHOPHYSIOLOGY Ashley Christensen

PANCREATITIS
Pathophysiology: Pancreatitis is defined as the inflammation of the pancreas, which can be acute or chronic in nature. In men, this disease is commonly associated to alcoholism, peptic ulcer or trauma; in women its associated to bilary tract disease. It is thought that alcohol-induced pancreatitis may include a physiochemical alteration of protein that results in plugs that block the small pancreatic ductules. Clinical Manifestations: Sudden onset of sharp, twisting, deep, upper abdominal pain, abdominal distention, decreased peristalsis, nausea, vomiting, fever and jaundice are all symptoms of Pancreatitis. Diagnostic Studies: Pancreatitis is diagnosed by the characteristic abdominal pain, serum amylase and/or lipase level three times greater than normal, and a positive abdominal CT scan. Complications: Potential complications of Pancreatitis include shock from hypovolemia, electrolyte imbalances such as hypocalcemia, renal failure, paralytic ileus, and lastly progression to chronic pancreatitis.

ACUTE KIDNEY INJURY

Pathophysiology: Acute kidney injury is defined as an abrupt decreased in kidney function within 48 hours that includes an increase in serum Creatinine or a decrease in urine output. AKI is categorized as prerenal, intrarenal, and postrenal. Prerenal refers to conditions that decrease renal perfusion such as hypovolemia, decreased cardiac output, and impaired renal blood flow. Intrarenal results from direct injury to the kidneys caused by ischemia, nephrotoxins, infections, and primary renal disease. Postrenal results from obstruction of urine outflow by tumors calculi or prostate gland enlargement causing urine to back up into kidney structures causing increased pressure and ultimately kidney injury. Clinical Manifestations: Symptoms of Acute Kidney Injury include the following: Edema, oliguria, anuria, hypertension, lower back pain, and nausea. Diagnostic Studies: AKI can be diagnosed by the following: blood urea nitrogen to Creatinine ratio, urine osmolity, sodium in urine, and renal ultrasonography. Complications: Potential complications of AKI include metabolic acidosis, hyperkalemia, and pulmonary edema.

TRANSAMINITIS
Pathophysiology: The liver has transaminases to synthesize and break down amino acids and to convert energy storage molecules. The concentrations of these transaminases in the serum are normally low. However, if the liver is damaged, the liver cell becomes more permeable and some of the enzymes leak out into the blood circulation. Possible causes for high ALT levels are liver inflammation secondary to alcohol abuse, injury to muscles secondary to acute kidney failure and many toxins and drugs. Clinical Manifestations: Transaminitis symptoms include feeling fatigue, having abdominal pain, jaundice, nausea and vomiting. Diagnostic Studies: Elevated ALT levels can be seen when a blood test is ordered with a liver panel to diagnose liver disease. Ultrasound and CT Scan of the abdomen are sometimes used to exclude gallstones or tumors obstructing the ducts that drain the liver. Complications: Transaminitis can be an early indication of liver disease or a sign that hepatitis A, B, or C has taken hold in the liver.