Chronic Liver Failure - Last one

Question 1

Edema is fluid within the tissues whereas ascites is free fluid

Answer 1

ok

Question 2

Acute Liver failure time frame defined as

Answer 2

Less than 6 mos

Question 3

Chronic liver failure

Answer 3

More than 6 mos

Question 4

Encephalopathy worse in chronic or acute

Answer 4

Acute

Question 5

What is the mechanism behind encephalopathy?

Answer 5

• Ammonia and nitrogenous wastes crossing the BBB
• Increased intracellular glutamine
• Astrocyte swelling
• Inflammatory cytokines alter BBB

Question 6

What about benzodiazepines and hepatic encephalopathy

Answer 6

• Increased amounts of benzo receptors makes them extremely sensitive to benzos like valium
• Increased neurosteroids
• Manganese- neurotoxin which binds in the basal ganglia

Question 7

Which neurotoxin deposits in the basal ganglia?

Answer 7

Manganese

Question 8

the major cause of death from cerebral edema?

Answer 8

Cerebral herniation

Question 9

How many grades of hepatic encephalopathy>

Answer 9

4

Question 10

4 is the worst, it = coma

Answer 10

ok

Question 11

Is chronic encephalopathy usually reversible?

Answer 11

Yes

Question 12

Treatment of hepatic encephalopathy?

Answer 12

Lactulose- acts as a cathartic, decreases pH of the intestines,

Zinc- zinc is a cofactor in NH3 metabolism. zinc deficiency is common in liver disease. Treat teh deficiency and they should metabolize ammonia better

Antibiotics- also decrease NH3

Nutrition- this improves the liver disease. Skeletal muscle metabolizes NH3. High vegetable proteins with branched chain AAs advised

Question 13

Protein restriction in hepatic encephalopathy

Answer 13

Hell no

Question 14

One of the most feared complications of acute liver failure

Answer 14

Hepatorenal syndrome…basically where the liver tells the kidneys to shut down but the kidneys themselves have no abnormalities

Question 15

How do you reverse hepatorenal syndrome?

Answer 15

Reverse the liver failure

Question 16

In order to have hepatorenal syndrome you pretty much need to have cirrhosis and ascites

Answer 16

ok

Question 17

WHat is the serum creatinine level usually at in hepatorenal syndrome?

Answer 17

Over 1.5

Question 18

Diagnosis of hepatorenal syndrome…two criteria:

Answer 18

• exclude other cuases like nephrotoxic durgs and dyes.

- Lack of return of renal function with intravascular volume repletion

Question 19

Type 1 hepatorenal

Answer 19

rapidly worsening

Question 20

Type 2

Answer 20

Slow progression

Question 21

Treatment of HRS

Answer 21

• VOLUME REPLETION
• look for underlying infection, often times there is spontaneous bacterial peritonitis
• Avoid meds which can worsen renal perfusion
• Avoid contrast

Ultimately replace the liver

Question 22

Most common cause of secondary IgA nephropathy?

Answer 22

Liver disease

Question 23

Membranous Glomerulonephritis associated with

Answer 23

Hep C

Question 24

cooler temperatures leading to protein precipitation?

Answer 24

Cryoglobulinemia