complications of liver disease

Question 1

5. Recognize the components of the Model for End-Stage Liver Disease (MELD score) and describe its use in ranking patients on the transplant list.

Answer 1

INR, bilirubin, dialysis frequency, Creatinine

used to stage liver transplant

Question 2

hepatorenal syndrome

Answer 2

there can be a sentinel event like a med to set this off

renal failure in patients in patients with cirrhosis advanced liver failure and severe sinusoidal portal HTN

absence of signif histology changes in kidney

marked arteriolar vasodilation in the extrarenal circulation
marked renal vasoconstriction leading to reduced GFR

Question 3

type 1 hepatorenal

Answer 3

rapid progressive renal failure

doubling of Cr or halving of CrCl

Question 4

type 2 hepatorenal

Answer 4

more slowely progressive

creatinine > 1.5, CrCl

Question 5

hepatorenal criteria

Answer 5

portal HTN or liver failure

Cr >1.5 or CrCl

Question 6

what two things are always present in hepatorenal syndrome?

Answer 6

ascites and hyponatremia

Question 7

Tx of hepatorenal syndrome

Answer 7

liver transplant

under investigation- vasoconstrictor + albumin, TIPS, ECAD

Question 8

SBP

Answer 8

most common infection with patients in cirrhosis
bacterial translocation by gram - organism
-intestinalk bacterial overgrowth
-intestinal permeability
-impaired immuntiy
often can have no symptoms
early diagnosis is important

PMN count >250

Treat cefotaxime, augmentin
low total protein in fluid increases ur risk

Question 9

Hepatic encephalopathy

Answer 9

result of shunting of blood around the liver
failure to neutalize nuerotoxic ammonia
gaba related

risk factors- high protein load, GI bleeding, TIPS, sedatives hypnotics, diuretics

dont check ammonia levels. has 4 stages

asterixis, have issues driving

not seen as permanent damage

Tx- treat causes, lactulose–> acidifies stool and makes non absorbable ammonium, non-absorbale antibiotic