Gastrointestinal and Liver Disorders: Causes, Symptoms and Treatment

Crohn's Disease

Concept and synonymy: Inflammatory bowel disease of unknown cause that most frequently affects the ileum of young adults. It causes diarrhea and has a strong tendency toward fistulization (regional enteritis, terminal ileitis).

Clinical Features

• Acute ileitis, often confused with acute appendicitis, especially in children and adolescents.
• Chronic form: insidious onset with diarrhea, fever, a palpable abdominal mass and fistulas (20%).
• General symptoms: pallor, asthenia, weight loss and polyarthritis.

Treatment

Medical and surgical treatment, often a combination of both.

Acute Pancreatitis

1. Concept: Necrotizing-hemorrhagic inflammation of aseptic nature, caused by autodigestion of the gland by its own enzymes (trypsin), with activation of pancreatic enzymes in situ.
2. Epidemiology: Affects both sexes equally, most often between 30 and 50 years of age. Sudden onset, severe clinical course, with a mortality of about 20%.
3. Predisposing factors: Gallstones, obesity, binge eating, alcohol, corticosteroids, abdominal trauma, among others.
4. Clinical picture (Dieulafoy's triad and related signs):
   • Very severe abdominal pain.
   • Radiation to the back in a belt pattern.
   • Vomiting.
   • Paralytic ileus with reflux.
   • Tendency to collapse (shock).
   • Pancreatic enzymes elevated: hyperamylasemia, hyperamylasuria and hyperlipasemia.
5. Treatment: Continuous gastric suction, antibiotics, pain control, vagal stimulation (atropine), shock treatment and peritoneal dialysis.

Hepatic Insufficiency and Jaundice

1. Hepatocellular Insufficiency

Concept: The inability of the liver to carry out its metabolic functions effectively. It occurs when about 80% of the liver parenchyma is affected.

Causes: Acute and chronic hepatitis, cirrhosis, intra- or extrahepatic cholestasis, storage diseases (Wilson's disease, hemochromatosis, alpha-1 antitrypsin deficiency), vascular conditions such as hepatic vein or hepatic artery lesions.

Clinical features:

1. Jaundice.
2. Ascites.
3. Hepatic encephalopathy.
4. Endocrine alterations (testicular atrophy, loss of libido, gynecomastia, menstrual disorders, loss of axillary and pubic hair).
5. Cutaneous signs (spider angiomas, telangiectasias, palmar erythema, disappearance of the lunula of the nails).
6. Circulatory signs (tachycardia, bounding pulse, systolic ejection murmur at the precordium, polycythemia, hyperdynamic circulatory state).
7. Other nonspecific general signs: malaise, fever, hepatic foetor, weight loss.

Biological syndrome: Decreased albumin, decreased cholesterol, aminoaciduria, decreased coagulation factors.

2. Hepatic Encephalopathy (Hepatic Coma)

Concept: Neuropsychiatric syndromes that occur during the course of hepatocellular insufficiency. They begin with minimal changes and progress to coma.

Pathogenesis: Ammonia toxicity on the central nervous system, with many factors involved and interrelated in producing the effect.

Clinical features: Highly polymorphic. It is diagnosed in the context of personality changes, mood changes, sleep disturbances resembling Alzheimer's, hallucinations, megalomania, schizoid or paranoid pictures, asterixis (flapping tremor), hyperreflexia, Babinski sign, dysgraphia and disorientation.

Clinical grades:

• Grade I: Mild psychic disorders, memory loss, flapping tremor, disorientation.
• Grade II: Greater somnolence.
• Grade III: Marked confusion.
• Grade IV: Total loss of consciousness (coma).

Forms: Acute and chronic.

3. Jaundice

Yellow discoloration of the skin, sclerae and mucous membranes caused by elevated bilirubin levels, arising from hepatic, hemolytic or obstructive mechanisms.