1. Discuss the differences between primary and secondary cerebral injury
2. Identify the distinguishing characteristics for the patient with diffuse axonal injury
3. Describe the pathophysiology leading to portal hypertension
4. Identify the patient who would be a candidate for a liver transplant
5. Describe the presentation of the patient with fulminant hepatic failure
6. Discuss the purpose for a porto-caval shunt
7. Identify the significant labs and treatment options for a patient with acute pancreatitis
8. Identify the signs and symptoms for a patient experiencing abdominal compartment syndrome
9. Discuss the rationale for administering various types of blood products

 

1. Discuss the differences between primary and secondary cerebral injury

• Mechanical injury at the time of the trauma results from primary brain injury(focal and diffuse); secondary brain injury is triggered by the physiological reaction to the initial injury

Primary injuries can be caused by penetrating injury or nonpenentrating injury

• An open wound to the head from a foreign object requires a penetrating injury e.g. bullet. it is usually characterized by focal damage along the path the object has passed through the brain, including fractured/perforated skull, broken meninges and brain tissue damage
• A non-penetrating injury without the entry of any foreign object into the brain is characterized by brain damage due to indirect effects. The skull may or may not be harmed but the meninges do not penetrate .

Secondary injury emerges from the initial trauma initiated processes and usually progresses over time. This includes

• Hypoxia
• Ischemia
• Hypo/hypertension
• Brain abscess and meningitis
• Increased intracranial pressure which leads to herniation
• Cerebral edema
• Hypercapnia

2.Identify the distinguishing characteristics for the patient with diffuse axonal injury

• Swelling and degeneration of nerves
• Localized swelling
• Loss of consciousness
• Impaired memory

3.Pathophysiology of portal hypertension

A significant complication of liver disease is portal hypertension, which results from a number of pathological conditions that improve resistance to the flow of portal blood into the liver.An rise in intrahepatic vascular resistance due to massive structural changes associated with fibrosis and increased vascular tone in hepatic microcirculation is the primary cause of portal hypertension in cirrhosis. Progress in the development of collateral vessels and arterial vasodilation as portal hypertension progresses, resulting in increased blood flow to the portal circulation. The hyperdynamic circulatory syndrome gradually develops resulting in esophageal varices.

4.Identify the patient who would be a candidate for a liver transplant

• End-stage kidney failure patients on dialysis
• Patients with advanced chronic renal disease
• Patients with chronic kidney disease ( GFR<30ml, stage iv) who need to have another organ transplant
• A combination kidney-pancreas transplant can be considered for patients with chronic kidney disease who have type 1 diabetes and who have not responded to medical care

5.Describe the presentation of the patient with fulminant hepatic failure

• Change in personality such as disorientation
• Yellowing of the skin and the eyeballs (jaundice)
• Bruising so easily
• Feeling very confused
• Swelling of the stomach

6.Discuss the purpose for a portocaval shunt

• Reducing risks of bleeding
• Reducing hypertension in the liver because blood will bypass the liver
• Reducing the risks of rupturing the blood vessels by providing alternative routes of circulation

7.Identify the significant labs and treatment options for a patient with acute pancreatitis

• Blood tests to measure lipase and amylase. Lipase test is more specific for diseases of the pancreas specifically acute pancreatitis. Amylase test is sensitive for pancreatic diseases.
• Stool elastase-it measures elastase levels, the levels are reduced when you have pancreatic insufficiency.
• Sweat test-used to diagnose cystic fibrosis
• Fecal fat- used to determine the amount of fat in stool
• Immunoreactive trypsinogen
• Chymotrypsin

Treatment

• Pain medications- they reduce severe pain
• Fasting-this is done to give the pancreas time to recover
• Intravenous fluids- this is done to prevent dehydration and repairing the pancreas

8.Identify the signs and symptoms for a patient experiencing abdominal compartment syndrome

• Melana
• Alcohol abuse
• Decreased urine output
• Syncope
• Increased in abdominal girth
• Nausea
• Difficulty in breathing

9.Discuss the rationale for administering various types of blood products

• Red blood cells transfusion are used in treatment of hemorrhage and increase tissue perfusion
• Platelets transfusion is used to prevent hemorrhage in thrombocytopenia patients and defects of platelet function
• Fresh frozen plasma infusion is used to reverse effects of anticoagulants
• Cryoprecipitate is used in hypofibrinogenemia which occurs with excessive hemorrhage
• Whole blood transfusion is used in treatment of sickle cell crisis, symptomatic anaemia, congestive heart failure