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Y3R5: Medicine I 🩺 > L5: Liver Cell Failure Manifestations > Flashcards

L5: Liver Cell Failure Manifestations Flashcards

1
Q

Def of LCF

A
  • Is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology.
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2
Q

Forms of LCF

A
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3
Q

CP of LCF

A
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4
Q

Failure of general Health

CP of LCF

A

with fatigue & weight loss

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5
Q

Fever

CP of LCF

A

of low grade due to pyrogens released from damaged liver cells, HCC, or infection (SBP)

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6
Q

Fetor Hepaticus

CP of LCF

A
  • sweetish, fecal smell due to failure to detoxify mercaptans due to LCF or shunts
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7
Q

IGT

CP of LCF

A
  • Acute liver failure → hypoglycemia.
  • Chronic liver failure → impaired glucose tolerance & rarely DM.
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8
Q

Endocrinal Manifestations in males

CP of LCF

A
  • Gynecomastia, feminine hair distribution, decreased libido, impotence, testicular atrophy.
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9
Q

Endocrinal Manifestations in female

CP of LCF

A
  • Atrophy of the breasts, decreased libido, amenorrhea, infertility
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10
Q

mechanism of Endocrinal Manifestations

CP of LCF

A

Unknown but may be increased estrogen & decreased testosterone

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11
Q

Increased Incidence of Infection

CP of LCF

A

SBP

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12
Q

Cutaneous Signs of LCF

A
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13
Q

Spider Naevi

A
  • Central artery with radiating capillaries, at the distribution of SVC
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14
Q

Palmar Erythema

A

Palms are red in color

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15
Q

Paper Money Skin

A

Many small B.V. scattered through the skin in random fashion

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16
Q

Leukonychia

A

due to hypoproteinemia

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17
Q

Kolionychia

A

due to IDA

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18
Q

Cardiovascular system effects in LCF

A
  • Hyperkinetic circulation
  • Hepato-pulmonary syndrome
  • Platypnea & orthodeoxia
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19
Q

Hyperkinetic circulation in LCF

A
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20
Q

Hepato-pulmonary syndrome in LCF

A
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21
Q

Platypnea & orthodeoxia

A
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22
Q

Hematological Effects in LCF

A
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23
Q

Jaundice in LCF

A

Hepatocellular Jaundice

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24
Q

Def of Ascites

A

Accumulation of excess fluid in the peritoneal cavity

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25
Q

Types of Ascites

A
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26
Q

Theories of Ascitis Formation

A
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27
Q

pathogenesis of Ascitis in Liver Cirrhosis

A
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28
Q

Grades of Ascites

29
Q

CP of Ascites

30
Q

Complications of Cirrohtic Ascites

31
Q

Def of SBP

A

Infected ascetic fluid in absence of a cause of peritonitis.

32
Q

CAusative Organism of SBP

A

Gram -ve in 70% of pathogens:
- E. coli (most common), Streptococcus, Klebsiella

33
Q

CP of SBP

A

Occurs in 10% of cirrhotic patient.

34
Q

Dx of SBP

A
  • PMNL > 250 cells/mm3 even if no symptoms
  • TLC 500 cells/mm3, but symptoms should be there
  • SAAG > 1.1 = Portal HTN ascites
35
Q

Prophylaxis of SBP

36
Q

TTT of SBP

37
Q

investigations in Ascites

A
  • Detection of ascites
  • Ascetic tapping
  • SAAG (Serum Ascites Albumin Gradient)
38
Q

Ascetic Tapping for investigations on Ascites

39
Q

Uses of SAAG

A

To differentiate portal HTN from non-portal HTN ascites

40
Q

Causes of SAAG >11 g/L (1.1 mg/dL)

41
Q

Causes of SAAG < 11 g/L (1.1 mg/dL)

42
Q

DDx of Ascites

43
Q

TTT of Cirrohtic Ascites

A

The Dark Circle

44
Q

Diet in Cirrhotic Ascites

45
Q

Follow up in Cirrhotic Ascites

A

Measurement of:
- Urine volume & body weight.
- Electrolytes (K & Na), renal function.

46
Q

Diuretics in Cirrhotic Ascites

47
Q

Tapping of Cirrhotic Ascites

48
Q

TTT of Resistant Ascites

49
Q

Severe Terminal Cases of Cirrhotic Ascites are TTT by …..

50
Q

what is Diuretic-resistant ascites?

A
  • Ascites early recurring or not responding (weight loss < 200 gm/d) to adequate salt & fluid restriction & maximum doe diuretics (Lasix up to 160
    mg / day & spironolactone up to 400mg/day), for at least one week.
  • NSAIDs must be excluded, since NSAIDs blunt the response to diuretics.
51
Q

What is Diuretic-Intractable Ascites?

A
  • Ascites that cannot be treated adequately with diuretics because diuretic-associated complications, such as hepatic encephalopathy, renal insufficiency, hyponatremia and hypo- or hyperkalemia.
52
Q

Causes of Rapidly accumulating ascites

53
Q

Causes of Ascites without edema LL

54
Q

Def of Hepatic Encephalopathy

A

Neuropsychiatric disorder that may complicate severe acute or chronic liver disease.

55
Q

Types of Hepatic Encephalopathy

56
Q

Pathogenesis of Hepatic Encephalopathy

57
Q

Production of Toxic Substances

Pathogenesis of Hepatic Encephalopathy

58
Q

Toxic Substances involved in Hepatic Encephalopathy

A

These toxic substances include: Ammonia (most
accepted theory), GABA, mercaptans

59
Q

Disturbance of AA

Pathogenesis of Hepatic Encephalopathy

60
Q

Alkalosis & Hypokalemia

Pathogenesis of Hepatic Encephalopathy

61
Q

PPT Factors of Hepatic Encephalopathy

62
Q

CP of Hepatic Encephalopathy

63
Q

TTT of Hepatic Encephalopathy

64
Q

Pharmacological TTT of Hepatic Encephalopathy

65
Q

Def of HRS

A

Functional renal failure in cirrhotic patients in the absence of renal pathology

66
Q

Pathogenesis of HRS

67
Q

Types of HRS

68
Q

Dx of HRS

69
Q

TTT of HRS

Y3R5: Medicine I 🩺 (47 decks)

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