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GIHEP > L2: Liver Failure > Flashcards

L2: Liver Failure Flashcards

1
Q

What is the commonest cause of portal hypertension?

A

Cirrhosis

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2
Q

What is an example/cause of pre-hepatic portal hypertension?

A

portal vein thrombosis - block in portal vein

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3
Q

What is an example/cause of (intra)hepatic portal hypertension?

A
  • cirrhosis

- non-cirrhotic cause like portal tract fibrosis due to schistosomiasis

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4
Q

What can schistosomiasis cause?

A

portal tract fibrosis which can lead to portal hypertension

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5
Q

What is schistosomiasis?

A

s a disease caused by parasitic flatworms called schistosomes

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6
Q

What is an example/cause of post-hepatic portal hypertension?

A

obstruction venous outflow from liver (e.g. Budd Chiari Syndrome)

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7
Q

What is caput medusae? Why does it occur?

A
  • dilation of the abdominal wall veins

- due to portal hypertension and backup of blood in porto-systemic anastomoses

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8
Q

What is the commonest cause of ascites?

A

Cirrhosis

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9
Q

What are some of the common bacteria associated with SBP?

A

E. coli

Klebsiella

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10
Q

If a person has ascites, when would you start to suspect that they have SBP?

A
  • fever
  • abdominal pain/tenderness
  • altered mental state
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11
Q

If hepatic encephalopathy is severe, what 2 things may it be associated with?

A
  1. cerebral oedema

2. cerebral hypoperfusion

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12
Q

Why might Type A HE occur?

A

acute liver failure

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13
Q

Why might Type B HE occur?

A

porto-systemic shunting with a NORMAL liver

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14
Q

Why might Type C HE occur?

A

cirrhosis (decompensation)

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15
Q

What are the 4 stages of HE?

A
  1. Confusion
  2. Drowsiness
  3. Somnolence
  4. Coma
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16
Q

What is considered covert HE?

A

minimal HE + stage 1 HE

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17
Q

What is considered overt HE?

A

HE from stages 2 to 4

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18
Q

What is the treatment for HE?

A
  • Lactulose

- Rifaximin

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19
Q

What liver blood tests are associated with liver cell (hepatocellular) damage?

A

ALT, AST

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20
Q

What liver blood tests are associated with obstruction to bile flow?

A

Alkaline Phosphatase, gGT, Bilirubin

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21
Q

What liver blood tests are associated/related to liver function

A

Bilirubin, Albumin, Coagulation Function (PT/INR)

22
Q

If the AST/ALT ratio is greater than 2, what does this suggest?

A

alcohol-related damage

23
Q

Alk Phos may indicate bile flow obstruction, but it my also be found in what 2 other places?

A

Bone, Placenta

24
Q

Does albumin have a long or short half life?

A

Long half-life (so reflects chronic injury to liver)

25
Q

Do clotting factors have a long or short half-life?

A

Short half-life (so reflects acute damage to the liver)

26
Q

What is Wilson’s Disease?

A

there is excess amount of copper in body

27
Q

What is the liver blood test that is done to check for Wilson’s disease?

A

Caeruloplasmin

28
Q

Which enzyme helps with the conjugation of bilirubin with glucuronate?

A

UDPGT-1 Enzyme

29
Q

If there is isolated hyperbilirubinaemia, would it most likely be conjugated or unconjugated?

A

most commonly unconjugated bilirubin

30
Q

If there is jaundice associated with liver and biliary tract disease, would it most likely be conjugated or unconjugated?

A

conjugated bilirubin

31
Q

What is Gilbert’s Syndrome?

A
  • autosomal recessive
  • liver doesn’t properly process bilirubin
  • genetic defect in bilirubin conjugation enzyme
  • have mildly raised bilirubin
32
Q

What type of bilirubinaemia will cholestasis cause?

A

conjugated hyperbilirubinaemia

  • pale stools
  • dark urine
  • jaundice
  • elevated Alk Phos/gGT
  • fat malabsorption
33
Q

How is an extrahepatic duct obstruction most commonly identified?

A

via ultrasound

34
Q

What are the 3 different types of liver biopsies?

A
  1. Percutaneous
  2. Transjugular
  3. Laparoscopic
35
Q

What is a fibroscan?

A

it is a specialized ultrasound which measures fibrosis and fatty change in the liver

36
Q

What is the treatment for primary and secondary prevention of oesophageal and gastric varices?

A
  1. Band Ligation

2. Non-Selective Beta Blockers

37
Q

When is a paracentesis/therapeutic tap done for ascites?

A

for diuretic-resistant ascites in cirrhosis

38
Q

What is the treatment for ascites?

A
  • Na+ restrictions
  • Diuretics (e.g. spirinolactone or furosemide)
  • therapeutic paracentesis
  • avoid NSAIDs
39
Q

WHY does hepatic encephalopathy mainly occur?

A

due to SHUNTING, the ammonia that is normally filtered out by the liver is not being filtered out anymore

40
Q

MINIMAL hepatic encephalopathy can be revealed by what type of testing?

A

Psychometric Testing

41
Q

What is the typical value for the ALT/AST ratio?

A

<1

42
Q

What is the normal level of bilirubin in the body?

A

< 18 umol/L

43
Q

What is the value range for Biochemical Jaundice?

A

> 18 but < 50 umol/L

44
Q

What is the value for clinical jaundice?

A

> 50 umol/L

45
Q

List 2 possible causes of unconjugated, isolated hyperbilirubinaemia (± jaundice)

A
  1. Increased Haemolysis

2. Gilbert’s Syndrome

46
Q

Gilbert’s Syndrome is a inherited condition which leads to isolated, unconjugated hyperbilirubinaemia. Bilirubin levels typically rise in a/w…..[2]

A
  1. Fasting

2. Illness

47
Q

What markers will be elevated in response to cholestasis?

A

Alk Phos, gGT

48
Q

List some of the effects of cholestasis

A
  • conjugated hyperbilirubinaemia
  • pruritis (due to retained bile salts)
  • fat malabsorption (steatorrhea)
  • fat soluble vitamin malabsorption (ADEK)
  • hypercholesterolaemia
49
Q

List some contraindications for liver biopsy

A
  • clotting problems
  • anti-clotting drugs
  • biliary obstruction
50
Q

What stain is used to stain for a) fibrosis and b) iron in the liver?

A

a) Trichrome Stain

b) PERL (Prussian Blue) Stain

GIHEP (24 decks)

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