Predisposing Factors: Precipitating Factors:

• Age • Toxins Exposure

Etiology:
• Gender • Parasitic Infection
• Race UNKNOWN • Chronic Inflammation in
the Bile Ducts

Mutations in the oncogenes k-ras, c-myc, c-neu, e-

erb-b2, and c-met, and in the tumor suppressor
genes p53 and bcl-2

Affects the transcription of the

Fas-gene

Proliferation of genetically
unstable cells in the bile duct

Malignant transformation of
unstable cells in the bile duct
Diagnostic Tests:
• Abdominal USD
Management:
• CT scan
Surgery Obstruction in the bile duct • ERCP
• PTC
• PET
If unmanaged • MR – cholangiography
• Tumor markers

41
 A

Mgt.:
• Chemotheraphy Continuous proliferation Diminish host antibacterial
• Radiation of unstable cells and defenses in the bile duct
obstruction in the flow of
therapy
bile S/Sx:
• Jaundice
Mgt.: Bacterial colonization in Sx:
Mgt.: • Pruritus the bile duct and small • fever
Bile builds up in the liver and seeps • Clay-colored antibiotics bowel
PTBD out into the bloodstream stools
• Dark urine
• Abdominal
If unmanaged
If unmanaged pain

Diagnostic Tests: Sepsis

Damage to the liver cells • Liver
enzymes (ALT
& AST)
• Prothrombin
Scarring of the liver DEATH
time

Liver failure

Disorders of Disorders of
synthesis and metabolic and
storage functions excretory functions

B C

42
 B

Hepatocytes unable Hepatocytes unable

Hepatic cells to synthesize to synthesize
unable to take up B4
clotting factors transporter proteins
and store glucose
S/Sx:
• Visual Bleeding Signs: Hypoalbuminemia
disturbance • Bruising
Hypoglycemic
events s • Spontaneous
• Heart bleeding Sign:
If unmanaged • Blood in the Fluid shifting • edema
palpitations
• Tremors urine or stool
If unmanaged • Anxiety
• Sweating Hypovolemic If
shock Management: unmanaged Management:
• Infusion with • Albumin
Management:
Unconsciousness clotting factors transfusion
• Glucose
tablets or
candy Skin breakdown (ulceration)
• IV
Permanent
brain damage infusion of
dextrose
Management: Localized Infection Sx:
• Antibiotics • fever

If unmanaged

Overwhelming infection/sepsis

DEATH

43
 B4 C

Hepatocytes unable to synthesize

bile components such as bile salts
Liver unable to convert
J ammonia Kto urea C2 C3
Sx:
Impaired fat absorption • Fatty
stool Hepatic encephalopathy S/Sx:
• Asterixis
Deficiency of fat-soluble S/Sx: • Fetor
vitamins • Dry, scaly hepaticus
Coma • Lack of
skin
• Bruising mental
• Hair loss alertness
Malnutrition
• Cold
intolerance

Lower resistance to infection

Infection

Sepsis

DEATH

44
 C2 C3

Liver unable to modify the hormones Liver unable to

metabolize the drugs

S/Sx: Drug toxicity

• Gynecomas
Increased aldosterone Increased androgen/estrogen
tia
• Testicular
Sign: atrophy
Sodium and water • edema
retention

If unmanaged Management:
• Diuretics

Skin breakdown (ulceration)

Sx:
Localized Infection • fever

If unmanaged
Management:
• Antibiotics

Overwhelming infection/sepsis

DEATH

45
46