Hepatic Disease

Question 1

Define acute liver failure

Answer 1

development of hepatocellular dysfunction associated with coagulopathy and encephalopathy in patients without prior known liver disease

Question 2

How is ALF classified?

Answer 2

According to time between jaundice and onset of encephalopathy

Question 3

How is ALF classified according to time line of symptoms?

Answer 3

Hyperacute
Acute
Subacute

Question 4

What are the causes of acute liver failure?

Answer 4

1. Infective: hep B 12%
2. Drug induced: acetaminophen 39%, phenitoin, halothane.
3. Autoimmune disease
4. Vascular :Budd chiari Syndrome
5. Pregnancy : HELLP, acute fatty liver of pregnancy.

Question 5

Define Chronic hepatic disease in

Answer 5

Chronic hepatitis is any hepatitis lasting >6months. Inflammation can lead to hepatic fibrosis, and, in some patients, there is progression to cirrhosis, characterized by nodular regeneration and disruption of the architecture of the liver, which can lead to portal hypertension.

Question 6

What is decompansated liver cirrhosis

Answer 6

Developof portal hypertension ascites, varicella haemorrhage or liver insufficiency as marked by coagulopathy,jaundiceand encephalopathy

Question 7

Schematic of decompensated liver dysfunction

Question 8

Management strategy cirrhosis

Question 9

Management

Answer 10

Management

Question 11

Effects on cvs

Answer 11

Increased production or reduced excretion of vasodilators resulting in increased splamchnic vessels capacity which stimulated retention of na should h20, this leased to portal hypotension and further increase in capacitance e by formation of potosystemic shunts. These changes lead to hyperdynamic circulation with hypotension and tachycardia and blunted b adrenalin stimulation leading to cardiomyopathy

Question 12

what are the ECG changes?

Answer 12

QT prolonged
BP
Coronary artery disease due to commodities

Question 13

Pathogenesis portopulmonary hypertension

Answer 13

Not completely understood but histology also changes include midealhypertro0hy, intimate proliferation, thrombosis, and fubrosis

Question 14

Diagnosis

Answer 14

Mean pulmonary pressure >25 /PVR > 240DYNES/s3c/m3

Question 15

MODERATE portopulmonary hyp

Answer 15

MPP > 35-45/ PVR >250

Question 16

Mortality rates associated with liver transplant in moderate ph

Answer 16

> 50%

Question 17

Severe portal hypertension

Answer 17

map > 50/

Question 18

Mortality rates associated with liver transplant in severe ph

Answer 18

100%

Question 19

Pulmonary effect

Answer 19

Pleural effusion hydrothorax
Atelectasis diaphragm displacement ascites
aspiration pneumonia
Poto pulmonary hpt

Hepatopupmonary sx

Question 20

Pathogenesis of hepatic pulmonary

Answer 20

Due 5o vasod8oatation 5here is increased blood flow with no matched increase in ventilation leading to vq mismatch. HPV is blunted due to blunting of vasoconstriction

Question 21

Diagnostic criteria for hps

Question 22

Clinical features

Answer 22

Exertional dyspnoea 
Fatigue 
Clubbing 
Spider angiomata 
Platypnia 
Orthodeoxia

Question 23

GIT effects; portal hypertension

Answer 23

Increased gradient between portal and hepatic vein by > 5mmhg secondary to 8ncreased vascular resistance from fibrosis and flow this inturn increase splanchnic blood flow which exacerbates pulmonary hpt

Question 24

Complications of portal hpt

Question 25

Ascites

Answer 25

Increase in hydrostatic pressure and translation of fluid | Reduced oncotoc pressure

Question 26

Management of ascites

Answer 26

Dietary salt restrictio Diuretic Paracentasis transjugular intrahepatic potosystemic shunt

Question 27

Varicella haemorrhage incidence

Answer 27

60%

Question 28

Management

Answer 28

A- protect from aspiration B- C- fluid, blood, POC guided haemostatic resus, vit k D- Endoscopic ligation banding or sclerotheraphy Balloon tampinade sengstaken blakemore TIPSS

Question 29

Secondary prevention

Answer 29

Propranolol | Ocreotide

Question 30

Spontaneous bacterial peritonitis

Answer 30

Asymptomatic Tap neutrophils cout> 200 Rx antibiotics Prophylactic cotrimox or quinolone

Question 31

Mortality rates of sbp

Answer 31

70% at 2y

Question 32

Renal

Answer 32

Hypovolaemia ATN DRUG induced Hepatorenal syndrome

Question 33

Pathophysiology of hepatic renal syndrom

Answer 33

Sympathetic and RASS activation 2nd to splachnic vasodilatation withrofound vasoconstriction

Question 34

Diagnosis of hrs

Answer 34

Cirrhosis with ascites, doubling Serum creatinine >1,5mg/dlnot reduced to < 1,5mg/dl with Albumin administration at dise 1g/kg and after min 2 day with no diuretic

Question 35

Type 1hrs

Answer 35

Acute Doubling Serum creatinine > 2,5g/dl Or 221mcmol/l in less than 2 weeks

Question 36

Type 2

Answer 36

Less aggressive course than type 1 Chara terized by asci

Question 37

Management

Answer 37

Vasoconstriction Albumin RRT

Question 38

Coagulation haemorrhage risk

Answer 38

Reduced vitamin dependent factor Thrombocytopenia hyperspenism 9r uterine Dysfibrinigenea High tpa

Question 39

Coagulation thrombosis risk

Answer 39

Low protein c s Low antithrombin, plaeminogen, heparin cofactor 2, alpha2 macroglobulin Increased procogulant factor vii,vWT

Question 40

Overall coagulation

Question 41

Assessment of coagulation

Question 42

Pharmacokinetic

Answer 42

Decreased: hepatic metabolism, renal excretion, protein synthesis Increased : total body water

Question 43

Volatile

Answer 43

Avoid enflurane and halothane Iso reduced hepatic clearance by o,2% improves hepatic blood flow sevoflurane 2_5 % biotransformation Des 0.02%

Question 44

Benzos

Answer 44

Prolonged duration policy action Worsen encephalopathy Loran,9xaz,Texas undergoing glucoronide conjugation and less affected by liver dysfunction

Question 45

Opioids

Question 46

Neuromuscular blockers

Answer 46

Slow onset | Cisco independent of liver function

Question 47

Induction

Answer 47

Protocol no change

Question 48

Risk stratification child Pugh score

Question 49

Meld

Question 50

Modified king college

Question 51

W3at haven score