L2: Liver Failure Flashcards
What is the commonest cause of portal hypertension?
Cirrhosis
What is an example/cause of pre-hepatic portal hypertension?
portal vein thrombosis - block in portal vein
What is an example/cause of (intra)hepatic portal hypertension?
- cirrhosis
- non-cirrhotic cause like portal tract fibrosis due to schistosomiasis
What can schistosomiasis cause?
portal tract fibrosis which can lead to portal hypertension
What is schistosomiasis?
s a disease caused by parasitic flatworms called schistosomes
What is an example/cause of post-hepatic portal hypertension?
obstruction venous outflow from liver (e.g. Budd Chiari Syndrome)
What is caput medusae? Why does it occur?
- dilation of the abdominal wall veins
- due to portal hypertension and backup of blood in porto-systemic anastomoses
What is the commonest cause of ascites?
Cirrhosis
What are some of the common bacteria associated with SBP?
E. coli
Klebsiella
If a person has ascites, when would you start to suspect that they have SBP?
- fever
- abdominal pain/tenderness
- altered mental state
If hepatic encephalopathy is severe, what 2 things may it be associated with?
- cerebral oedema
2. cerebral hypoperfusion
Why might Type A HE occur?
acute liver failure
Why might Type B HE occur?
porto-systemic shunting with a NORMAL liver
Why might Type C HE occur?
cirrhosis (decompensation)
What are the 4 stages of HE?
- Confusion
- Drowsiness
- Somnolence
- Coma
What is considered covert HE?
minimal HE + stage 1 HE
What is considered overt HE?
HE from stages 2 to 4
What is the treatment for HE?
- Lactulose
- Rifaximin
What liver blood tests are associated with liver cell (hepatocellular) damage?
ALT, AST
What liver blood tests are associated with obstruction to bile flow?
Alkaline Phosphatase, gGT, Bilirubin
What liver blood tests are associated/related to liver function
Bilirubin, Albumin, Coagulation Function (PT/INR)
If the AST/ALT ratio is greater than 2, what does this suggest?
alcohol-related damage
Alk Phos may indicate bile flow obstruction, but it my also be found in what 2 other places?
Bone, Placenta
Does albumin have a long or short half life?
Long half-life (so reflects chronic injury to liver)
Do clotting factors have a long or short half-life?
Short half-life (so reflects acute damage to the liver)
What is Wilson’s Disease?
there is excess amount of copper in body
What is the liver blood test that is done to check for Wilson’s disease?
Caeruloplasmin
Which enzyme helps with the conjugation of bilirubin with glucuronate?
UDPGT-1 Enzyme
If there is isolated hyperbilirubinaemia, would it most likely be conjugated or unconjugated?
most commonly unconjugated bilirubin
If there is jaundice associated with liver and biliary tract disease, would it most likely be conjugated or unconjugated?
conjugated bilirubin
What is Gilbert’s Syndrome?
- autosomal recessive
- liver doesn’t properly process bilirubin
- genetic defect in bilirubin conjugation enzyme
- have mildly raised bilirubin
What type of bilirubinaemia will cholestasis cause?
conjugated hyperbilirubinaemia
- pale stools
- dark urine
- jaundice
- elevated Alk Phos/gGT
- fat malabsorption
How is an extrahepatic duct obstruction most commonly identified?
via ultrasound
What are the 3 different types of liver biopsies?
- Percutaneous
- Transjugular
- Laparoscopic
What is a fibroscan?
it is a specialized ultrasound which measures fibrosis and fatty change in the liver
What is the treatment for primary and secondary prevention of oesophageal and gastric varices?
- Band Ligation
2. Non-Selective Beta Blockers
When is a paracentesis/therapeutic tap done for ascites?
for diuretic-resistant ascites in cirrhosis
What is the treatment for ascites?
- Na+ restrictions
- Diuretics (e.g. spirinolactone or furosemide)
- therapeutic paracentesis
- avoid NSAIDs
WHY does hepatic encephalopathy mainly occur?
due to SHUNTING, the ammonia that is normally filtered out by the liver is not being filtered out anymore
MINIMAL hepatic encephalopathy can be revealed by what type of testing?
Psychometric Testing
What is the typical value for the ALT/AST ratio?
<1
What is the normal level of bilirubin in the body?
< 18 umol/L
What is the value range for Biochemical Jaundice?
> 18 but < 50 umol/L
What is the value for clinical jaundice?
> 50 umol/L
List 2 possible causes of unconjugated, isolated hyperbilirubinaemia (± jaundice)
- Increased Haemolysis
2. Gilbert’s Syndrome
Gilbert’s Syndrome is a inherited condition which leads to isolated, unconjugated hyperbilirubinaemia. Bilirubin levels typically rise in a/w…..[2]
- Fasting
2. Illness
What markers will be elevated in response to cholestasis?
Alk Phos, gGT
List some of the effects of cholestasis
- conjugated hyperbilirubinaemia
- pruritis (due to retained bile salts)
- fat malabsorption (steatorrhea)
- fat soluble vitamin malabsorption (ADEK)
- hypercholesterolaemia
List some contraindications for liver biopsy
- clotting problems
- anti-clotting drugs
- biliary obstruction
What stain is used to stain for a) fibrosis and b) iron in the liver?
a) Trichrome Stain
b) PERL (Prussian Blue) Stain
