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Fatty change, or steatosis is the accumulation of fatty acids in
liver cells.
Alcoholism causes development of large fatty globules (macro
vesicular steatosis) throughout the liver and can begin to occur
after a few days of heavy drinking.
Alcohol is metabolized by alcohol dehydrogenase (ADH) into
Acetaldehyde
Aldehyde dehydrogenase (ALDH) into acetic acid, which is
finally oxidized into carbon dioxide (CO2) and water ( H2O).
A higher NADH concentration induces fatty acid synthesis
while a decreased NAD level results in decreased fatty acid
oxidation.
triglycerides accumulate, resulting in fatty liver
80% of alcohol passes through the liver to be detoxified.
Chronic consumption of alcohol results in the secretion of
proinflammatory
cytokines (TNF-alpha, Interleukin 6 [IL6] and
Interleukin 8 [IL8]), oxidative stress, lipid peroxidation, and
acetaldehyde toxicity.
Appendicitis is a common surgical
emergency with a varied clinical
presentation
Several patient groups are at high risk of
misdiagnosis
Anatomic Aspects
Blind pouch off of cecum
Contains lymphoid tissue which peaks in
adolescence, atrophies with age
Function still unclear
Appendix can be anywhere within
peritoneal cavity
One study showed 65 % retrocecal, 31 %
pelvic
PATHOLOGY AND PATHOGENESIS
Appendix lumen obstruction leads to congestion within the
appendix
Inflammatory exudate and mucous increases luminal pressure
Initial stage might resolve in some patients
Appendix may distend with mucus- mucocele
Classic Presentation
Seen in 60 %
Anorexia
Periumbilical pain, nausea, vomiting
RLQ pain developing over 24 hrs.
Anorexia and pain are most frequent
Usually nausea, sometimes vomiting
Diarrhea, esp. with pelvic location
Usually tender to palpation
Rebound is a later finding
PERFORATED APPENDIX
APPENDICITIS COMPLICATIONS
 Gangrenous Appendicitis:
 Thrombosis of the appendiceal artery and veins
 Perforation:
 complication rates 58 %
 perforation rate increased at both ends of the age spectrum
 Peri-appendiceal abscess:
 most frequent complication
 peri-appendiceal fibrinous adhesions
 Peritonitis:
 Bacterial peritonitis in absence of fibrinous adhesions.
 Escherichia coli
 Bowel Obstruction
 Septic seeding of mesenteric vessels
 infection along the mesenteric–portal venous system
 pylephlebitis, pylethrombosis, or hepatic abscess
Fatty liver power point medicine medical

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Fatty liver power point medicine medical

  • 1.
  • 2.
  • 3. Fatty change, or steatosis is the accumulation of fatty acids in liver cells. Alcoholism causes development of large fatty globules (macro vesicular steatosis) throughout the liver and can begin to occur after a few days of heavy drinking. Alcohol is metabolized by alcohol dehydrogenase (ADH) into Acetaldehyde Aldehyde dehydrogenase (ALDH) into acetic acid, which is finally oxidized into carbon dioxide (CO2) and water ( H2O). A higher NADH concentration induces fatty acid synthesis while a decreased NAD level results in decreased fatty acid oxidation. triglycerides accumulate, resulting in fatty liver
  • 4. 80% of alcohol passes through the liver to be detoxified. Chronic consumption of alcohol results in the secretion of proinflammatory cytokines (TNF-alpha, Interleukin 6 [IL6] and Interleukin 8 [IL8]), oxidative stress, lipid peroxidation, and acetaldehyde toxicity.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. Appendicitis is a common surgical emergency with a varied clinical presentation Several patient groups are at high risk of misdiagnosis
  • 23. Anatomic Aspects Blind pouch off of cecum Contains lymphoid tissue which peaks in adolescence, atrophies with age Function still unclear Appendix can be anywhere within peritoneal cavity One study showed 65 % retrocecal, 31 % pelvic
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31. PATHOLOGY AND PATHOGENESIS Appendix lumen obstruction leads to congestion within the appendix Inflammatory exudate and mucous increases luminal pressure Initial stage might resolve in some patients Appendix may distend with mucus- mucocele
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37. Classic Presentation Seen in 60 % Anorexia Periumbilical pain, nausea, vomiting RLQ pain developing over 24 hrs. Anorexia and pain are most frequent Usually nausea, sometimes vomiting Diarrhea, esp. with pelvic location Usually tender to palpation Rebound is a later finding
  • 39.
  • 40.
  • 41. APPENDICITIS COMPLICATIONS  Gangrenous Appendicitis:  Thrombosis of the appendiceal artery and veins  Perforation:  complication rates 58 %  perforation rate increased at both ends of the age spectrum  Peri-appendiceal abscess:  most frequent complication  peri-appendiceal fibrinous adhesions
  • 42.  Peritonitis:  Bacterial peritonitis in absence of fibrinous adhesions.  Escherichia coli  Bowel Obstruction  Septic seeding of mesenteric vessels  infection along the mesenteric–portal venous system  pylephlebitis, pylethrombosis, or hepatic abscess