chronic liver failure W5

Question 1

what is chronic liver failure often called

Answer 1

decompensated cirrhosis

Question 2

features of chronic liver failure

Answer 2

impaired hepatocyte function leading to jaundice, coagulopathy, low albumin

Question 3

complications of chronic liver failure

Answer 3

hepatic encephalopathy

Question 4

what is hepatic encephalopathy

Answer 4

failure of hepatocyte function (NH3 clearance)
portosystemic shunting

Question 5

what is portosystemic shunting? affected veins?

Answer 5

shunting of blood from portal to systemic circulation, bypassing liver via new vessels forming (oesophageal/gastric varices)

affects superior/inferior mesenteric vein, splenic vein (all enter liver via portal vein)

Question 6

what can hepatic encephalopathy be triggered by?

Answer 6

constipation
drugs (opiates, sedatives)
dehydration (diuretics)
infections
GI bleeding

Question 7

causes of ascites?

Answer 7

low albumin
portal hypertension
renal hypoperfusion

Question 8

how does low albumin contribute to ascites?

Answer 8

causes decreased oncotic intravascular pressure, making leakage of fluid out of the blood vessels more likely

Question 9

how does portal hypertension cause ascites?

Answer 9

increased pressure in portal vein resulting in vasodilatation of splanchnic circulation (blood around intestines), blood starts to pool.

Question 10

how does renal hypoperfusion contribute to ascites?

Answer 10

under perfused kidneys, activates RAAS and sympathetic nervous system to try and improve renal perfusion. this cause salt and water retention causing ascites

Question 11

causes of CLF?

Answer 11

any causes of cirrhosis:
-alcohol
-non-alcoholic fatty liver disease
-hep B/C
-haemochromatosis
-Wilsons disease
-primary biliary cholangitis
-primary sclerosing cholangitis
-autoimmune hepatitis

Question 12

spider naevi?

Answer 12

dilation of pre-existing central arterioles from which numerous thin-walled capillary branches radiate like spider legs, carrying away freely flowing blood

Question 13

US scan features for cirrhosis?

Answer 13

coarse liver texture (fibrosis), irregular outline (nodules), free fluid

Question 14

treatments for cirrhosis caused by alcohol?

Answer 14

observe for alcohol withdrawal (diazepam)
treat with vit B supplements (Pabrinex/thiamine)
ascites treated with low salt diet, diuretics
oesophageal varices treated with beta-blocker

Question 15

what is IV Pabrinex given to protect against in cirrhosis?

Answer 15

brain injury