II. Liver 2 - AI

Question 1

What is jaundice, and how is it visually manifested in individuals with liver dysfunction?

Answer 1

Jaundice is characterized by the yellowing of the skin, conjunctiva, and mucous membranes, primarily due to an elevated concentration of bilirubin in the bloodstream. It becomes evident when the bilirubin level exceeds 3 mg/dl, and it follows a ‘top to bottom’ progression, often starting with the face and gradually extending downward towards the feet.

Question 2

At what bilirubin level does jaundice typically become evident?

Answer 2

Jaundice becomes evident when the bilirubin level exceeds 3 mg/dl.

Question 3

Describe the ‘top to bottom’ progression of jaundice in individuals with liver dysfunction.

Answer 3

The ‘top to bottom’ progression of jaundice refers to its onset starting with the face and gradually extending downward towards the feet.

Question 4

How are liver function tests categorized in relation to prehepatic, intrahepatic, and posthepatic causes?

Answer 4

Liver function tests can be categorized into prehepatic, intrahepatic, and posthepatic causes based on the patterns of enzyme and bilirubin level changes.

Question 5

In prehepatic conditions, what changes are observed in unconjugated bilirubin levels and liver enzymes?

Answer 5

In prehepatic conditions, there is an elevation in unconjugated bilirubin, while levels of AST, ALT, Alkaline Phosphatase (Alk Phos), and Gamma Glutamyltransferase (GGT) remain within normal ranges.

Question 6

What are the characteristics of intrahepatic conditions in terms of liver enzymes and bilirubin levels?

Answer 6

In intrahepatic situations, characterized by hepatocellular injury and inflammation, there is an increase in AST and ALT levels.

Question 7

How do posthepatic or cholestatic conditions manifest in terms of liver enzyme and bilirubin levels?

Answer 7

Posthepatic or cholestatic conditions are marked by elevated alkaline phosphatase, GGT, and conjugated bilirubin levels.

Question 8

What factors contribute to excessive bleeding in individuals with liver dysfunction?

Answer 8

Excessive bleeding in individuals with liver dysfunction may be attributed to various factors, including thrombocytopenia, endothelial dysfunction, portal hypertension, chronic kidney disease, and sepsis.

Question 9

How does chronic liver disease affect the synthesis of coagulation factors?

Answer 9

Chronic liver disease contributes to impaired synthesis of coagulation factors, resulting in prolonged PT/INR values. Additionally, there is a reduction in protein C and antithrombin III.

Question 10

Describe the clinical manifestations and complications of viral hepatitis, particularly hepatitis B and C.

Answer 10

Viral hepatitis, including types A, B, and C, presents with clinical manifestations such as a viral prodrome and jaundice. Complications are more pronounced with hepatitis B and C infections, occasionally leading to rare cases of fulminant hepatic failure.

Question 11

Why is elective surgery challenging for individuals with acute hepatitis, and what are the associated risks?

Answer 11

Elective surgery is challenging for individuals with acute hepatitis due to the heightened risk of complications, leading to increased morbidity and mortality.

Question 12

What are the preoperative considerations for individuals with acute hepatitis, and why is careful evaluation necessary?

Answer 12

Preoperative considerations for individuals with acute hepatitis include evaluating encephalopathy, assessing cognitive function, checking for symptoms like nausea and vomiting, and correcting electrolyte abnormalities. Careful evaluation is necessary to ensure optimal outcomes.

Question 13

Which anesthetic agents are generally preferred for patients with acute hepatitis, and why?

Answer 13

Isoflurane and sevoflurane are generally preferred anesthetic agents for patients with acute hepatitis. These agents provide effective anesthesia and contribute to the preservation of hepatic blood flow and oxygen delivery.

Question 14

How does cirrhosis impact hepatic cellular and vascular architecture?

Answer 14

Cirrhosis is characterized by the distortion of normal hepatic cellular and vascular architecture, resulting in the obstruction of portal venous flow and ultimately leading to portal hypertension and varices.

Question 15

List the major causes of cirrhosis in the United States.

Answer 15

Major causes of cirrhosis in the United States include nonalcoholic steatohepatitis, chronic alcohol abuse, chronic active hepatitis, chronic biliary inflammation or obstruction, autoimmune disorders, and hemochromatosis (iron overload).

Question 16

What are the initial manifestations of cirrhosis, and how do symptoms progress as the condition advances?

Answer 16

Initially, manifestations of cirrhosis are often absent, but as the condition progresses, jaundice and ascites tend to develop. Other signs include spider angiomas, palmar erythema, gynecomastia, and splenomegaly.

Question 17

Explain the gastrointestinal manifestations of cirrhosis, focusing on variceal bleeding.

Answer 17

Gastrointestinal manifestations of cirrhosis include portal hypertension and the development of extensive portosystemic venous collaterals. Variceal bleeding emerges as a major cause of morbidity and mortality in cirrhotic patients.

Question 18

How is ascites linked to cirrhosis, and what are the contributing factors to its development?

Answer 18

Ascites in cirrhosis is linked to factors such as portal hypertension, which elevates hydrostatic pressure, hypoalbuminemia, hepatic lymphatic fluid, renal sodium and water retention, secondary hyperaldosteronism, and impaired free water clearance.

Question 19

Describe the clinical features and treatment options for Hepatopulmonary Syndrome.

Answer 19

Hepatopulmonary Syndrome is characterized by decreased oxygen saturation, advanced liver disease, and intrapulmonary arteriolar dilation. Liver transplant is observed to reverse the symptoms over a period of 6 months to 2 years.

Question 20

What is Portopulmonary Hypertension, and how does it relate to chronic liver disease?

Answer 20

Portopulmonary Hypertension is characterized by pulmonary vascular remodeling associated with chronic liver disease. It reflects a series of pathologic changes that impede the normal flow of blood in the pulmonary vessels.

Question 21

What respiratory manifestations are associated with Portopulmonary Hypertension, and how can they be managed preoperatively?

Answer 21

Respiratory manifestations of Portopulmonary Hypertension include hyperventilation, hypoxemia, and ventilation-perfusion mismatching. Preoperative management may involve considering preoperative paracentesis.

Question 22

Define portal hypertension and explain its common manifestations.

Answer 22

Portal hypertension refers to an elevation in portal vein pressure, exceeding 12 cmH20. Common manifestations include the formation of varices, caput medusae, and the accumulation of fluid in the abdominal cavity known as ascites.

Question 23

How does ascites develop in the context of portal hypertension, and what are the mechanisms involved?

Answer 23

Ascites develops in the context of portal hypertension due to increased hydrostatic pressure, hypoalbuminemia, hepatic lymphatic fluid, enhanced renal sodium and water retention, secondary hyperaldosteronism, and impaired free water clearance.

Question 24

What is Hepatorenal Syndrome, and how is it managed in individuals with cirrhosis?

Answer 24

Hepatorenal Syndrome is a condition characterized by a functional renal defect in individuals with cirrhosis. Judicious fluid management, including cautious diuretics, colloid infusions, and vasoconstrictors, is crucial for addressing this syndrome.

Question 25

What are the stages of Hepatic Encephalopathy, and what are the treatment strategies for this condition?

Answer 25

The stages of Hepatic Enceph