2. Liver Failure Flashcards

1
Q

What is the most common cause of portal hypertension?

A

Cirrhosis

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2
Q

Give a cause of pre-hepatic hypertension?

A

Portal vein thrombosis

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3
Q

Give a cause of non-cirrhosis hepatic portal hypertension?

A

Schistosomiasis

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4
Q

What are the consequences of portal hypertension?

A

Varices
Shunting
Ascites and hepatorenal syndrome
Splenomegaly and hypersplenism

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5
Q

What is the treatment for varices?

A

Drugs to reduce portal blood flow
Band ligation
Non-selective beta blockers

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6
Q

What are the non-cirrhosis causes of ascites?

A
Ovarian and GI cancers
Hypertension
Heart failure
Pancreatitis
TB
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7
Q

What tests can be done after paracentesis of ascites?

A

Cell count
Micro
Albumin
Cytology

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8
Q

What is the treatment for ascites?

A

Sodium restriction
Spironolactone
Paracentesis
Avoid NSAIDs

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9
Q

Why are NSAIDs avoided in ascites?

A

Cause vasoconstriction in the kidney

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10
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascites fluid with no evidence of a surgically treatable cause

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11
Q

What are the most common pathogens in spontaneous bacterial peritonitis?

A

E. coli

Klebsiella

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12
Q

What are the symptoms of spontaneous bacterial peritonitis?

A

Fever
Abdominal pain
Altered mental state

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13
Q

When should spontaneous bacterial peritonitis be treated?

A

Cell count >250

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14
Q

What results from severe hepatic encephalopathy?

A

Cerebral oedema

Hypoperfusion

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15
Q

What factors might precipitate encephalopathy in a known cirrhotic liver?

A
Infection
Bleeding
Dehydration
Drugs and alcohol
Constipation
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16
Q

What is the treatment for hepatic encephalopathy?

A

Reduce ammonia production
Lactulose (laxative to clear toxins from gut)
Non-absorbable antibiotics (remove bacteria from gut)

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17
Q

Which liver tests show liver damage?

A

Transaminases

18
Q

Which liver tests show obstruction to bile flow?

A

Alk phos
GGT
Bilirubin

19
Q

What test shows acute liver damage?

A

Coagulation function

20
Q

What test shows chronic liver damage?

A

Albumin

21
Q

What tissues is AST released from?

A

Damaged hepatocytes
Muscle
Mycoardium
Kidneys

22
Q

What ratio is used to show alcohol-related liver damage?

A

AST/ALT >2

23
Q

Where is alk phos found?

A

Hepatocyte border of bile cannaliculi

Bone and placenta

24
Q

What is the use of GGT?

A

Correlate with alk phos to show it’s from liver
Increased by alcohol and drugs
Very sensitive but not specific

25
Q

What tests can be done to find the cause of liver failure?

A
Viral serology
Transferrin saturation or ferritin
Autoantibodies, IgG, IgM
Copper metabolism
A1AT
26
Q

What is a normal bilirubin level?

A

<18umol/L

27
Q

What bilirubin level presents as jaundice?

A

> 50umol/L

28
Q

What is unconjugated bilirubin bound to?

A

Albumin

29
Q

What is bilirubin conjugated with?

A

Glucuronate

30
Q

What enzyme conjugates bilirubin?

A

UDPGT-1

31
Q

What investigations should be done into isolated hyperbilirubinaemia?

A

FBC, film, reticulocytes, haptoglobin and LDH for haemolysis

Gilbert’s syndrome

32
Q

What investigation should be done into conjugated hyperbilirubinaemia?

A

Ultrasound to exclude extrahepatic duct obstruction

33
Q

What is Gilbert’s syndrome?

A

Genetic defect in bilirubin conjugation enzyme

High bilirubin when fasting or sick

34
Q

What are the symptoms of cholestasis?

A
Jaundice, dark urine, pale stools
Pruritis
Fat and ADEK malabsorption
Hypercholesterolaemia
High alk phos and GGT
35
Q

What are the causes of extra-hepatic duct obstruction?

A

Stone
Tumour
Stricture

36
Q

What infection is associated with extra-hepatic duct obstruction?

A

Ascending cholangitis

37
Q

What are the uses of ultrasound in relation to the liver?

A

Dilated ducts
Gallstones
Focal liver lesions
Liver texture and border

38
Q

What is used to remove stones from bile ducts?

A

Endoscopic retrograde choledochopancreatography

39
Q

What are the methods of biopsy for the liver?

A

Percutaneous
Transjugular
Laproscopic

40
Q

What are the contraindications to liver biopsy?

A
Clotting problems (do coag screen first)
Biliary obstruction
41
Q

What is transient elastography used for?

A

Shows elasticity of liver