Physical Findings

Stop & Think

Lab and X-Ray

Differential Diagnosis

The Disease

Treatment

Conclusions

Quiz & Evaluation

• Other nitrogenous compounds likely play a role, but ammonia is easy to follow.
• Bacteria in the GI tract breakdown proteins, generating ammonia.
• The ammonia is absorbed and metabolized by the liver to urea by means of the Krebbs-Henseleit cycle.
• Urea goes out in the urine.
• Impaired liver function reduces the metabolism of ammonia. It builds up in the blood and subsequently the CNS.
• Increased protein load in the GI tract (such as a hemoglobin "meal" from bleeding varices or hemorrhagic gastritis) increases ammonia production.