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Phase 2a Revision > Liver > Flashcards

Liver Flashcards

1
Q

what is liver failure

A

when the liver loses the ability to regenerate and repair

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2
Q

what symptoms occur in liver failure

A
  • hepatic encephalopathy
  • abnormal bleeding
  • ascites
  • jaundice
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3
Q

what are the 3 classifications of liver failure

A
  • Fulminant hepatic failure
  • Late-onset hepatic failure
  • Chronic decompensated hepatic failure
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4
Q

How is Fulminant hepatic failure defined

A

when failure takes place within 8wks of the onset of the underlying illness

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5
Q

How is Late-onset hepatic failure defined

A

when there has been a gap of 8-26wks between failure and onset of underlying illness

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6
Q

How is Chronic decompensated hepatic failure defined

A

when the latent period is >6mths

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7
Q

what are the 7 broad categories of causes of hepatic failure

A
  • toxins
  • infection
  • metabolism
  • pregnancy
  • neoplastic
  • vascular
  • other
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8
Q

what toxins commonly cause liver failure

A
  • paracetamol
  • chronic alcohol use
  • illicit drugs
  • poisening
  • drug toxicity (eg. methotrexate)
  • Reye’s syndrome
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9
Q

infective causes of hepatic failure

A
  • Viral Hepatitis
  • Adenovirus
  • EBV
  • Cytomegalovirus
  • viral haemorrhagic fevers
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10
Q

neoplastic causes of hepatic failure

A
  • hepatocellular carcinoma

- metastatic carcinoma

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11
Q

metabolic causes of hepatic failure

A
  • wilson’s disease

- alpha-1-antitrypsin deficiency

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12
Q

how can pregnancy cause hepatic failure

A

acute fatty liver of pregnancy

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13
Q

vascular causes of hepatic failure

A
  • ischaemia
  • veno-occlusive disease
  • budd-chiari syndrome
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14
Q

other causes of hepatic failure

A

autoimmune liver disease

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15
Q

what is hepatic encephalopathy

A

a spectrum of neuropsychiatric abnormalities in patients with liver failure after exclusion of other known brain disease

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16
Q

what are the two types of hepatic encephalopathy

A
  • covert

- overt

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17
Q

what is covert hepatic encephalopathy

A

a subclinical, less severe manifestation

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18
Q

what are the common causes of hepatic encephalopathy

A
  • AKI
  • electrolyte imbalance
  • GI bleed
  • infection
  • constipation
  • sedative drugs (eg. opiates/BZs)
  • diuretics
  • high protein intake
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19
Q

what Ix can be used to assess the severity of hepatic encephalopathy

A

psychometric testing

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20
Q

which criteria is used to grade the severity of hepatic encephalopathy

A

west haven criteria

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21
Q

Symptoms of Grade 1 hepatic encephalopathy

A
  • trivial lack of awareness
  • euphoria/anxiety
  • shortened attention span
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22
Q

symptoms of Grade 2 hepatic encephalopathy

A
  • lethargy / apathy
  • minimal disorientation for time and place
  • subtle personality change
  • inappropriate behaviour
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23
Q

symptoms of grade 3 hepatic encephalopathy

A
  • somnolence to semi-stupor
  • responsive to verbal stimuli
  • confusion
  • gross disorientation
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24
Q

symptoms of grade 4 hepatic encephalopathy

A

coma

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25
what other Ix is done for hepatic encephalopathy
- arterial/serum ammonia levels - EEG - MRI/CT
26
differential diagnosis for hepatic encephalopathy
- Intracranial lesions - infection - metabolic - toxic - drugs - post-seizure
27
Mx for hepatic encephalopathy
- Abx (typically given empirically) | - lactulose/lactitol (converts ammonia to an non-absorbable ammonium)
28
what is the recommended prevention for hepatic encephalopathy
Rifaximin
29
what is ascites
an excessive accumulation of fluid in the abdominal cavity
30
what is diuretic-resistant ascites
ascites that isn't affected by dietary sodium restriction therefore requires intensive diuretic tx for at least 1wk
31
what in diuretic-intractable ascites
ascites that isn't affected by therapy due to the development of diuretic-induced complications that preclude the use of an effective diuretic dose
32
what are the possible causes of ascites
- cirrhosis - malignancy - HF - nephrotic syndrome - protein-losing enteropathy - TB - pancreatitis
33
presenting symptoms of ascites
- abdominal distention - weight gain - discomfort - nausea/appetite suppression
34
what is the best Ix to assess ascites
US
35
Tx for ascites
- salt-restricted diet - diuretics (best = spironolactone) - midodrine (vasopressor) - paracentesis
36
how do vasopressors help tx ascites
results in an increase MAP and urine sodium excretion and decreases in plasma renin and aldosterone
37
what causes jaundice
increased bilirubin level
38
what is the normal bilirubin level
3-20 umol/L
39
what bilirubin level is jaundice seen in
>35umol/L
40
what are the causes of jaundice split into
- pre-hepatic - hepatocellcular - cholestasis
41
how is bilirubin produced
the breakdown of haemoglobin in the reticuloendothelial system
42
what are the common pre-hepatic causes of Jaundice
- Gilbert's syndrome - Haemolytic anaemia - thalassaemia - trauma - Crigler-Nijjar syndrome
43
what are the common hepatocellulcar causes of jaundice
- viral hepatitis (Hep A&B) - alcoholic hepatitis - autoimmune hepatitis - drug-induced hepatitis - decompensated cirrhosis
44
what are the types of cholestasis
- intrahepatic | - extrahepatic
45
causes of intrahepatic cholestasis
- primary biliary cholangitis - drugs - primary sclerosing cholangitis - dubin-johnson syndrome - Rotor's syndrome
46
causes of extrahepatic cholestasis
- bile duct strictures - common duct stone - CA of the head of the pancreas - tumour of the ampulla of Vater - Pancreatitis - Gallbladder CA
47
differential diagnosis for hepatic failure
- structural lesions - cerebral infection - drug/alcohol intoxication - delirium tremens - wernicke's encephalopathy - hypoglycaemia
48
what may an FBC show in hepatic failure
- iron-deficiency anaemia - thombocytopenia **raised MCV**
49
Main Mx of hepatic failure
liver transplant
50
tx for raised ICP
mannitol
51
what are the three steps of alcoholic liver disease
1) alcohol related fatty liver 2) alcoholic hepatitis 3) cirrhosis
52
what is the recommended alcohol limit
14 units/wk
53
What does CAGE stand for
C- cut down A - anger G - guilty E - eye opener
54
what is the audit questionnaire
Alcohol Use Disorders Identification Test
55
what is the purpose of the audit questionnaire
designed by WHO to screen people for harmful alcohol use
56
What are the signs of Liver disease
- jaundice - hepatomegaly - spider naevi - palmar erythema - gynaecomastia - bruising - ascites - caput medusae - asterixis ("flapping tremor")
57
what will LFTs show in liver disease
- elevated ALT & AST - very elevated gamma-GT - low albumin - elevated bilirubin (IN CIRRHOSIS)
58
what will the clotting factors show in liver disease
elevated prothrombin time
59
Will U&Es be normal in liver disease
maybe, but may be deranged in hepatorenal syndrome
60
other than bloods what other Ix can be used for liver disease
- US (can be used to visualise the fatty changes) - fibroscan - endoscopy - CT - MRI - biopsy
61
general management principals with alcoholic liver disease
- stop drinking - detoxication regime - nutritional support (***Thiamine**) - steriods - tx complications - referral for transplant
62
what symptoms are seen in alcohol withdrawal and when
- 6-12hrs : tremor, sweating, headache, craving, anxiety - 12-24hrs : hallucinations - 24-48hrs : seizures - 24-72hrs : delerium tremens
63
what receptor does alcohol stimulate in the brain
GABA
64
what receptor does alcohol inhibit in the brain
glutamate (aka NMDA)
65
what is the effect of GABA stimulation
relaxes the brain
66
what is the effect of glutamate inhibition
further inhibitory effect of the electrical activity of the brain
67
what is the brain chemistry that is seen in chronic alcohol user going cold turkey
GABA system being up-regulated and the glutamate system being down-regulated to balanced Therefore, when alcohol is removed GABA under-functions and glutamate over-functions resulting in extreme excitability of the brain with excessive adrenergic activity
68
what medication is used to tx the effects of alcohol withdrawal
Chlordiazepoxide
69
What is used to prevent Wernicke-Korsakoff Syndrome
IV high-dose B vitamins **Pabrinex**
70
what causes Wernicke-Korsakoff Syndrome
Thiamine (Vit B1) deficiency
71
What are the main symptoms wernicke's encephalopathy
- confusion - oculomotor disturbances - ataxiaq
72
What are the main features of Korsakoffs syndrome
- memory impairment (retro & anterograde) | - behavioural changes
73
what are the possible complications of cirrhosis
- malnutrition - portal hypertension - varices - ascites - spontaneous bacterial peritonitis - hepatorenal syndrome - hepatic encephalopathy - hepatocellular CA
74
management of malnutrition in cirrhosis pts
- regular meals - low Na diet (minimise fluid retention) - high protein & high calorie diet - avoid alcohol
75
management of portal HTN in cirrhosis pts
- propanolol
76
where can varices form
- gastro-oesophageal junction - ileocaecal junction - rectum - anterior abdo wall (caput medusae)
77
Mx of varices
- control portal HTN | - ligation
78
management of bleeding varices
- resuscitation - vasopressin analogues(terlipressin) - correct coagulopathy (Vit K) - prohphylatic broad spec abx - urgent endoscopy
79
Mx of ascites
- low Na diet - anti-aldosterone iuretics (spironolactone) - paracentesis - prohphylatic abx
80
what is spontaneous bacterial peritonitis (SBP)
- infection developing in the ascitic fluid or peritoneal lining without any clear cause
81
what are the most common causes of spontaneous bacterial peritonitis (SBP)
- e.coli - Klebsiella pnuemoniae - gram positive cocci
82
Mx of spontaneous bacterial peritonitis (SBP)
- ascitic culture (*prior to abx*) | - IV cephalosporin (eg. cefotaxime)
83
what is hepatorenal syndrome
when portal HTN causes dilation in the portal vascular system reducing blood volume in in other areas (eg. kidneys). Hypotension in the kidneys leads to activiation in the renin-angiotensin system = constriction, causing starvation to the kidney
84
what is the prognosis of hepatorenal syndrome
fatal within a week unless liver transplant performed

Phase 2a Revision (13 decks)

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