Gastro - Liver Flashcards
Defining feature of acute liver failure
Coagulopathy
Encephalopathy with raised icp
Jaundice
Defining features of chronic liver failure
Jaundice Ascites and SBP Varices Encephalopathy without raised ICP hepatorenal syndrome
Timing of acute liver failure
Hyperacute less than 7 days
Acute 7 to 28 days
Sub acute 5 to 12 weeks
Grade 1 encephalopathy
Trivial lack of awareness
Euphoric, anxiety
Short attention span
Impaired addition
Grade 2 encephalopathy
Lethargy or apathy
Minimal disorientation to time and place
Subtle personality change
Impaired subtraction
Grade 3 encephalopathy
Somnolence, semi stupour
Responds to verbal
Confusion
Grossly disorientated
Grade 4 encephalopathy
Coma, unresponsive to verbal or pain
Kings criteria for paracetamol overdose
pH less than 7.3 after fluid resus
OR
Encephalopathy grade 3/4
PT > 100 (INR 6.5)
Creatinine > 300
OR
lactate greater than 3 at 12 hours
Lactate grater than 3.5 4 hours
After fluid resus
Kings criteria non paracetamol
PT>100
(INR 6.5)
Or any three of PT>50 INR 3.5 Non hep A/B aetiology Age less than 10 or greater than 40 Bilirubin greater than 300 Jaundice prior to encephalopathy for more than 7 days
Components of the Child Pugh score
Bilirubin Albumin INR Ascites Encephalopathy
Types of hepatic encephalopathy as said by international society for hepatic encephalopathy and nitrogen metabolism
Type A relates to acute liver failure
Type B relates to Porto-systemic bypass
Type C relates to cirrhosis
Is it variceal or non variceal bleeding that is most common
Non-variceal
80%
Components of Glasgow Blatchford score
Urea Hb Systolic bp Presence of: pulse more than 100 Malaena Syncope Hepatic failure Cardiac failure
Components of rockall score
Age Shock Co morbidity Diagnosis Evidence of bleeding
Grading of varices
1 small epitheliasied and disappear on insufflation
2 everything in between
3 large varices occluding the lumen
Which balloon is inflated first in sengstaken
Gastric
Does the oesophageal balloon always need inflating
No
Volume of air into gastric balloon of sengstaken
250ml
Length of insertion of sengstaken
50 to 55cm
Weight of traction on sengstaken
500g
Maximum time for sengstaken
12 hours
If using oesophageal balloon deflate for five minutes every hour
Criteria for ranson score
Admission Age over 55 AST greater than 250 Glucose more than 11.2 LDH Greater than 350
24 hours Fall in Hct more than 10% PaO2 less than 8 BE 4 Fluid sequestration of more than 6 litres Rise in urea more than 1.8
Glascow Imrie score for pancreatitis
Oxygenation Age Wcc Calcium Urea LDH Albumin Glucose
Normal intra abdominal pressure
5-7mmHg
Grades of intra abdominal hypertension
1- 12-15
2 16-20
3 21-25
4 more than 25
Grade 1 intra ab hypertension
12-15 mmHg
Grade 2 intra ab hypertension
16-20
Grade 3 intra ab hypertension
21-25
Grade 4 intra ab hypertension
Greater than 25
Equation of abdominal perfusion pressure
APP = MAP - IAP
Definition of abdominal compartment syndrome
intra abdominal hypertension greater than 20 plus associated organ failure
At what intra abdominal pressure does renal perfusion reduce
15 mmHg
At what intra abdominal pressure does anuria occur
Greater than 30mmHg
Calorie requirements by schofield formula
25 kcal/kg/day if under 65
20 if over 65
More in burns
Carbohydrate needs in Itu
3-4g/kg per day
Should by 60% of the non protein carbs
Fat needs on Itu
0.7 to 1.5g/kg
Should be 40 percent of non protein calories
Protein needs
1-1.5g/kg
1.5-2 In burns
Protein needs In burns
1.5 to 2 g/kg
Water needs
30mls per kg
Sodium needs
1-2 mmol per kg
Potassium needs
0.7 to 1 mmol/kg
Calcium needs
0.1 mmol/kg
Magnesium needs
0.1mmol/kg
Phosphate needs
0.4mmol/kg
