2. Liver Failure Flashcards
What is the most common cause of portal hypertension?
Cirrhosis
Give a cause of pre-hepatic hypertension?
Portal vein thrombosis
Give a cause of non-cirrhosis hepatic portal hypertension?
Schistosomiasis
What are the consequences of portal hypertension?
Varices
Shunting
Ascites and hepatorenal syndrome
Splenomegaly and hypersplenism
What is the treatment for varices?
Drugs to reduce portal blood flow
Band ligation
Non-selective beta blockers
What are the non-cirrhosis causes of ascites?
Ovarian and GI cancers Hypertension Heart failure Pancreatitis TB
What tests can be done after paracentesis of ascites?
Cell count
Micro
Albumin
Cytology
What is the treatment for ascites?
Sodium restriction
Spironolactone
Paracentesis
Avoid NSAIDs
Why are NSAIDs avoided in ascites?
Cause vasoconstriction in the kidney
What is spontaneous bacterial peritonitis?
Infection of ascites fluid with no evidence of a surgically treatable cause
What are the most common pathogens in spontaneous bacterial peritonitis?
E. coli
Klebsiella
What are the symptoms of spontaneous bacterial peritonitis?
Fever
Abdominal pain
Altered mental state
When should spontaneous bacterial peritonitis be treated?
Cell count >250
What results from severe hepatic encephalopathy?
Cerebral oedema
Hypoperfusion
What factors might precipitate encephalopathy in a known cirrhotic liver?
Infection Bleeding Dehydration Drugs and alcohol Constipation
What is the treatment for hepatic encephalopathy?
Reduce ammonia production
Lactulose (laxative to clear toxins from gut)
Non-absorbable antibiotics (remove bacteria from gut)
Which liver tests show liver damage?
Transaminases
Which liver tests show obstruction to bile flow?
Alk phos
GGT
Bilirubin
What test shows acute liver damage?
Coagulation function
What test shows chronic liver damage?
Albumin
What tissues is AST released from?
Damaged hepatocytes
Muscle
Mycoardium
Kidneys
What ratio is used to show alcohol-related liver damage?
AST/ALT >2
Where is alk phos found?
Hepatocyte border of bile cannaliculi
Bone and placenta
What is the use of GGT?
Correlate with alk phos to show it’s from liver
Increased by alcohol and drugs
Very sensitive but not specific
What tests can be done to find the cause of liver failure?
Viral serology Transferrin saturation or ferritin Autoantibodies, IgG, IgM Copper metabolism A1AT
What is a normal bilirubin level?
<18umol/L
What bilirubin level presents as jaundice?
> 50umol/L
What is unconjugated bilirubin bound to?
Albumin
What is bilirubin conjugated with?
Glucuronate
What enzyme conjugates bilirubin?
UDPGT-1
What investigations should be done into isolated hyperbilirubinaemia?
FBC, film, reticulocytes, haptoglobin and LDH for haemolysis
Gilbert’s syndrome
What investigation should be done into conjugated hyperbilirubinaemia?
Ultrasound to exclude extrahepatic duct obstruction
What is Gilbert’s syndrome?
Genetic defect in bilirubin conjugation enzyme
High bilirubin when fasting or sick
What are the symptoms of cholestasis?
Jaundice, dark urine, pale stools Pruritis Fat and ADEK malabsorption Hypercholesterolaemia High alk phos and GGT
What are the causes of extra-hepatic duct obstruction?
Stone
Tumour
Stricture
What infection is associated with extra-hepatic duct obstruction?
Ascending cholangitis
What are the uses of ultrasound in relation to the liver?
Dilated ducts
Gallstones
Focal liver lesions
Liver texture and border
What is used to remove stones from bile ducts?
Endoscopic retrograde choledochopancreatography
What are the methods of biopsy for the liver?
Percutaneous
Transjugular
Laproscopic
What are the contraindications to liver biopsy?
Clotting problems (do coag screen first) Biliary obstruction
What is transient elastography used for?
Shows elasticity of liver
