Acute and Chronic Liver Failure

Question 1

Loss of liver function

Excretory

Exocrine

Synthetic

Metabolic

Answer 1

Hyperbilirubinemia

Bile salt metabolism

Plasma protein production
Coag factors (es 7)
Albumin

Glycogen (hypogly)
Drug
Ammonia

Question 2

MCC of acute hepatic failure

Compensated liver failure

Decomp liver failure

Answer 2

Acetominophen

Asx, varices

Jaundice/variceal hemorrhage/ascites/enceph/SBP/hepatorenal/hepatopulmonary/HCC

Question 3

Cirrhosis

Consequences
Altered blood flow

Labs

Answer 3

Hepatitc fibrosis/nodules

Dec hepatocellular mass/fxn

Vasoconstrict portal veins- angiogenesis of portosystemic collaterals
Followed by splanchnic arterial VD- inc blood flow to portal system

Inc AST/ALT, AlkPhos, INR
Thrombocytopenia

Question 4

Dx cirrhosis

Portocaval anastamoses

Answer 4

Upper endoscopy for varices
US

Esophageal
Paraumbilical
Rectal
Retroperitoneal

Question 5

Esophageal varices

Prophylaxis

Answer 5

most have them

Non selective BB (prop/nadolol)
HR 55-60
Esophageal variceal ligation- occlusion via thrombosis

Question 6

SBP organisms

Dx criteria

Tx

Answer 6

E coli, K pneumo, S pneumo (gut overgrowth)

Inc ascitic fluid PMN
+ ascitic fluid culture
Low protein

Cephalosporin (cefotaxime)
Albumin

Question 7

Hepatic enceph

Sudden development w

Answer 7

Potentially reversible neuropsych abnormalities
Advanced liver dz
Exclude others

Bleeding esophageal varices
SBP
HypoNa/K

Question 8

Typical enceph sx

Psych

Neuro

Answer 8

Psych- sleep disturb, euphoria, depression, disoreintation, sleepy, confusion/unconscious

Neuro- asterixis, slurred speech, ataxia, nystagmus, areflexia

Question 9

Patho of enceph

Neurotoxins are ___ in GI tract

Failed

Circulating neurotoxins cross BBB

Impairs

Answer 9

absorbed (NH3, SCFA)

Hepatic detox- inc collateral flow, dec hepatocyte mass

Inc uptake

NT- inc GABA

Question 10

Triggers of renal failure

Answer 10

Hypovolemia
Infection
Acute tubular necorsis
Glomerular dz

Question 11

Treat chronic liver dz

Answer 11

Manage fluids- IV
stop diuretics

Treat SBP

Question 12

Hepatorenal syndrome

Absent other causes

Failed

No

Low

Answer 12

Cr >1.5

Shock/SBP/nephrotoxic drugs

diuretcs, plasma expansion

proteinuria/hematuria

Urine Na

Question 13

Mx hepatorenal

Answer 13

Vasopresin- splanchnic VC (inc SVR)
Terlipressin/octreotide

Alpha-Arendo agonists
VC, inc renal perfusion pressure
Midodrine/NorEpi

Liver trxnpl