Liver Disease coagulopathy - Vitamin K Dieficiency and Hemorrhage

Question 1

Enlarged and collateral esophageal vessels are called

Answer 1

Esophageal varices

Question 2

Occurs in liver disease–associated thrombocytopenia, often accompanied by decreased platelet function.

Answer 2

Mucocutaneous Bleeding

Question 3

Consequence of procoagulant dysfunction and deficiency.

Answer 3

Anatomic Bleeding

Question 4

May suppress the biosynthetic function of hepatocytes, reducing either the concentrations or activities of the plasma coagulation factors to less than hemostatic levels (<40 units/dL)

Answer 4

Hepatitis, cirrhosis, obstructive jaundice, cancer, poisoning, and congenital disorders of bilirubin metabolism

Question 5

In liver disease these seven factors are produced in their des-y-carboxyl forms, which cannot participate in coagulation

Answer 5

Factors II (prothrombin), VII, IX, and X and control proteins C, S, and Z.

Question 6

On the onset of liver dse, this factor has the shortest plasma half-life at 6 hours, is the first coagulation factor to exhibit decreased activity.

Answer 6

Factor VII

Question 7

Is a more specific marker of liver disease than deficient factors II, VII, IX, or X because this factor is non-vitamin K dependent

Answer 7

Factor V

Question 8

Acute phase reactant that frequently becomes elevated in early or mild liver disease.

Answer 8

Fibrinogen

Question 9

A condition called __ is characterized by moderately and severely diseased liver produces fibrinogen that is coated with excessive sialic acid,

Answer 9

Dysfibrinogenemia

Question 10

Causes generalized soft tissue bleeding associated with a prolonged TT and an exceptionally prolonged reptilase clotting time.

Answer 10

Dysfibrinogenemia

Question 11

This condition will make the fibrinogen level fall to less than 100 mg/dL, a mark of liver failure

Answer 11

End-stage liver disease

Question 12

Are acute phase reactants that may be unaffected or elevated in mild to moderate liver disease.

Answer 12

VWF and factors VIII and XIII

Question 13

VWF is produced from

Answer 13

Endothelial cells and megakaryocytes

Question 14

occurs in one-third of patients with liver disease. Platelet counts of less than 150,000/􏰀L may result from sequestration and shortened platelet survival associated with portal hypertension and resultant hepatosplenomegaly

Answer 14

Moderate thrombocytopenia

Question 15

A significant complication of liver disease that is caused by decreased liver pro- duction of regulatory antithrombin, protein C, or protein S and by the release of activated procoagulants from degenerating liver cell

Answer 15

Chronic or compensated Disseminated Intravascular Coagulation

Question 16

May also produce nonspecific procoagulant substances that trigger chronic DIC, leading to ischemic complications

Answer 16

Hepatocytes

Question 16

T/F: The failing liver cannot clear activated coagulation factors.

Answer 16

TRUE

Question 17

PT, PTT, and TT are pro- longed, the fibrinogen level is reduced to less than 100 mg/dL, and D-dimers are significantly increased

Answer 17

Acute, uncompensated DIC

Question 18

A hallmark of unregulated coagulation and fibrinolysis.

Answer 18

D-dimer assay value

Question 19

Are used to characterize the hemostatic abnormalities in liver disease

Answer 19

PT, PTT, TT, fibrinogen concentration, platelet count, and D-dimer concentration

Question 20

Factors that may be may be used in combination to differentiate liver disease from vitamin K deficiency.

Answer 20

Factor V and VII

Question 21

Test that is occasionally may be useful to confirm dysfibrinogenemia

Answer 21

Reptilase time test

Question 22

Venom of reptile __ is substituted for the thrombin reagent. It triggers fibrin polymerization by cleaving fibrinopeptide A

Answer 22

Bothrops atrox (common lancehead viper)

Question 23

Is unaffected by standard unfractionated heparin therapy and can be used to assess fibrinogen function even when there is heparin in the specimen

Answer 23

Reptilase time test

Question 24

May correct the bleeding associated with nonfunctional des-􏰔-carboxyl factors II (pro- thrombin), VII, IX, and X

Answer 24

Oral or intravenous vitamin K therapy

Question 25

This is likely to occur when 30 mL/kg has been administered, but it may occur with even smaller volumes in patients with compromised cardiac or kidney function

Answer 25

TACO

Question 26

If the fibrinogen level is less than __g/dL, spontaneous bleeding is imminent and cryoprecipitate or fibrinogen concentrate (RiaSTAP, CSL Behring) may be selected for therapy

Answer 26

less than 50mg/dL

Question 27

IS often associated with platelet dysfunction and mild to moderate mucocutaneous bleeding

Answer 27

Chronic Renal Failure

Question 28

Platelet adhesion to blood vessels and platelet aggregation are suppressed, perhaps because these compounds coat the platelets

Answer 28

Guanidinosuccinic acid or phenolic compounds

Question 29

Decreased RBC mass (anemia) and thrombocytopenia contribute to the bleeding so these treatment may correct these disorders

Answer 29

Dialysis, RBC transfusions, or erythropoietin therapy

Question 30

This syndrome deposits fibrin in the renal microvasculature which reduce glomerular function

Answer 30

Hemostasis activation syndromes

Question 31

Examples of hemostasis activation syndrome

Answer 31

DIC, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura

Question 32

May be deposited in renal transplant rejection and in the glomerulonephritis syndrome of systemic lupus erythematosus.

Answer 32

Fibrin

Question 33

Lab results for bleeding in renal disease

Answer 33

Bleeding time: Prolonged PTT and PT are normal

Question 34

Temporarily activates platelets and may ultimately improve platelet function, particularly when anemia is well controlled

Answer 34

Renal dialysis

Question 35

May be administered intravenously (DDAVP) or intra- nasally (Stimate, Behring) to increase the plasma concentration of VWF high-molecular-weight multimers.

Answer 35

Desmopressin

Question 35

Patients with renal failure should not take _ ; because these drugs increase the risk of hemorrhage

Answer 35

Aspirin, clopidogrel, prasugrel, ticagrelor, or other platelet inhibitors

Question 36

A state of increased glomerular permeability associated with a variety of conditions, such as chronic glomerulonephritis, diabetic glomerulosclerosis, systemic lupus erythematosus, amyloidosis, and renal vein thrombosis.

Answer 36

Nephrotic Syndrome

Question 36

Required for normal function of the vitamin K- dependent prothrombin group of coagulation factor, is ubiquitous in foods, especially green leafy vegetables, and the daily requirement is small, so pure dietary deficiency is rare.

Answer 36

Vitamin K

Question 37

is fat soluble and requires bile salts for absorption, biliary duct obstruction (atresia), fat malabsorption, and chronic diarrhea may cause vitamin K deficiency.

Answer 37

Vitamin K

Question 38

Disrupt normal gut flora may cause a slight reduction because they destroy bacteria that produce vitamin K.

Answer 38

Broad-spectrum antibiotics

Question 39

Condition where the activity levels of factors II (prothrombin), VII, IX, and X are lower in normal newborns than in adults

Answer 39

Hemorrhagic disease of the newborn

Question 40

prolongs the deficiency because passively acquired maternal antibodies delay the establishment of gut flora

Answer 40

Breastfeeding

Question 41

This is interrupted by coumarin-type oral anticoagulants such as warfarin (Coumadin) that disrupt the vitamin K epoxide reductase and vitamin K quinone reductase reactions

Answer 41

y-carboxylation cycle of coagulation factors

Question 42

In this situation the liver releases dysfunctional des-y-carboxyl factors II (prothrombin), VII, IX, and X and proteins C, S, and Z; these inactive forms are called

Answer 42

Proteins induced by vitamin K antagonists (PIVKA) factors.

Question 43

Often used as a rodenticide, lasts for weeks to months, and treatment of poisoning with this substance requires repeated administration of vitamin K with follow-up PT monitoring

Answer 43

brodifacoum or “superwarfarin"

Question 44

The single most common reason for hemorrhage-associated emergency department visits.

Answer 44

Inadvertent Coumadin overdose