Final · Week 14 · BIO 280 Pathophysiology
M14 · Liver, Biliary & Reproductive
What the liver does that nothing else can, why cirrhosis causes bleeding and confusion, and the reproductive conditions worth knowing cold.
▸M14Liver, Biliary & ReproductiveWeek 14
💡 The one idea
The liver makes clotting factors, makes albumin, and clears ammonia and bilirubin. Every sign of liver failure is one of those four jobs stopping.
No clotting factors → bleeding. No albumin → ascites. No ammonia clearance → confusion. No bilirubin clearance → jaundice.
🥪 Cirrhosis and portal hypertension
Chronic injury → fibrosis → nodules → scarred, stiff liver. Blood cannot get through, so pressure backs up into the portal system.
| Consequence | Why |
|---|---|
| Esophageal varices | Blood reroutes through small veins that were never built for it. They rupture and bleed catastrophically. |
| Ascites | Portal pressure pushes fluid out; low albumin means nothing pulls it back |
| Splenomegaly | Backpressure → spleen enlarges → it destroys platelets → thrombocytopenia |
| Hepatic encephalopathy | Ammonia is not converted to urea and reaches the brain. Confusion, sleep reversal, asterixis (flapping tremor), then coma. |
| Jaundice | Bilirubin not conjugated or excreted — yellow skin and sclera, dark urine, pale stool, itching |
| Bleeding | Clotting factors not made → prolonged PT/INR |
Lactulose treats encephalopathy by trapping ammonia in the gut and clearing it in the stool — the goal is 2–3 soft stools a day, and the measure of success is that the patient's thinking improves.
A cirrhotic patient with a low platelet count and a prolonged INR bleeds from everything. Falls, injections and invasive procedures all carry outsized risk.
🧬 Hepatitis, in one table
| Spread | Chronic? | Vaccine | |
|---|---|---|---|
| A | Faecal–oral — food, water | No | Yes |
| B | Blood, sexual, perinatal | Yes | Yes |
| C | Blood — mainly needles | Yes — most often | No |
| D | Only with B | Yes | Via the B vaccine |
| E | Faecal–oral | No | Limited |
A and E come from what you eat. B, C and D come from blood. Vowels from the bowels.
Acetaminophen/acetaminophen is the commonest cause of acute liver failure, and the ceiling is lower in anyone who drinks alcohol regularly or is malnourished.
🚨 Gallbladder and pancreas
- Cholelithiasis / cholecystitis — right upper quadrant pain radiating to the right shoulder, worse after a fatty meal, with nausea and vomiting. Classic risk profile: female, forty, fertile, fair, fat. Murphy sign — arrest of inspiration on palpation.
- Pancreatitis — the pancreas digests itself. Severe epigastric pain radiating straight through to the back, relieved by leaning forward, with vomiting. Raised lipase (more specific) and amylase. Gallstones and alcohol are the two dominant causes.
Cullen sign (periumbilical bruising) and Grey Turner sign (flank bruising) mean hemorrhagic pancreatitis. Hypocalcemia is a marker of severity.
♂️ Male reproductive
- BPH — benign enlargement compressing the urethra. Hesitancy, weak stream, dribbling, frequency, nocturia, incomplete emptying. Not a cancer risk in itself, but it can cause retention and postrenal kidney injury.
- Prostate cancer — often silent early. A hard, irregular nodule on examination; raised PSA. Spreads characteristically to bone, so new back pain matters.
- Testicular cancer — a painless hard lump, in young men (roughly 15–35). Undescended testis is the major risk factor.
- Testicular torsion — sudden severe pain, swelling, a high-riding testis, absent cremasteric reflex.
- Erectile dysfunction — frequently vascular, and therefore an early marker of cardiovascular disease and diabetes.
Testicular torsion is a surgical emergency with a window of about six hours. Painless lump = investigate. Sudden agonising pain = operate.
♀️ Female reproductive
The cycle: follicular phase (FSH grows a follicle, estrogen rises) → ovulation at the LH surge, around day 14 → luteal phase (the corpus luteum makes progesterone, which maintains the endometrium) → without pregnancy the corpus luteum dies, progesterone falls, and menstruation follows.
| Condition | Key features |
|---|---|
| Endometriosis | Endometrial tissue outside the uterus. Cyclic pelvic pain, painful periods and intercourse, infertility. |
| PCOS | Irregular or absent periods, hyperandrogenism (hirsutism, acne), insulin resistance, infertility. Raises long-term risk of type 2 diabetes and endometrial cancer. |
| Fibroids | Benign smooth-muscle tumors. Heavy periods, pelvic pressure; shrink after menopause. |
| PID | Ascending infection, often chlamydia or gonorrhea. Lower abdominal pain, cervical motion tenderness, fever, discharge. Scarring → infertility and ectopic pregnancy. |
| Cervical cancer | HPV is the cause; almost entirely preventable by vaccination and screening. Dysplasia on a Pap precedes it by years. |
| Ovarian cancer | Vague, easily dismissed symptoms — bloating, early satiety, pelvic discomfort, urinary frequency. No effective screening test, so it presents late. |
Menopause — 12 consecutive months without a period. Falling estrogen gives hot flushes, sleep disturbance, vaginal dryness, and accelerating bone loss.
Any postmenopausal bleeding is abnormal and must be investigated for endometrial cancer, however light it is.
🎯 Module quiz
Questions for this module.
Nothing here yet — drop it in when you have it