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BRS > Liver failure > Flashcards

Liver failure Flashcards

1
Q

What is normal plasma bilirubin?

A

17 μmol/L

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2
Q

At what bilirubin level do you develop yellow sclera?

A

30 μmol/L

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3
Q

At what bilirubin level do you develop yellow skin?

A

34 μmol/L

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4
Q

What is cholestasis?

A

Slow/cessation of bile flow.

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5
Q

What does cholestasis cause?

A

Jaundice.

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6
Q

What causes prehepatic jaundice?

A

Haemolysis, massive transfusion, large haematoma reabsorption, ineffective erythropoiesis

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7
Q

What are the 3 principle causes of intrahepatic jaundice?

A

Decreased uptake of bilirubin, decreased conjugation of bilirubin (decreased processing) and decreased secretion of bilirubin.

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8
Q

What inherited disorder causes decreased uptake of bilirubin?

A

Gilberts syndrome.

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9
Q

What inherited disorder causes decreased conjugation of bilirubin?

A

Crigler-najar syndrome.

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10
Q

What inherited disorder causes decreased secretion of bilirubin?

A

Dublin-johnson syndrome, rotor syndrome.

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11
Q

How would you describe decreased outflow of bilirubin due to a mechanical problem?

A

Cholestasis.

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12
Q

What can cause intrahepatic cholestasis?

A

Sepsis, total parenteral nutrition.

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13
Q

What is liver failure?

A

Rate of hepatocyte death is greater than regeneration.

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14
Q

What are the two ways in which hepatocytes can die?

A

Apoptosis and necrosis.

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15
Q

Rate of development of fulminant (acute) hepatic failure?

A

Less than 8 weeks.

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16
Q

Rate of development of subfulminant hepatic failure?

A

Less than 6 months.

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17
Q

What can liver failure cause?

A

Hepatic encephalopathy, coagulopathy, ascites, hypoglycemia (due to impaired glycogen production), increased risk of infection (due to lack of globulin production).

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18
Q

Biomarkers for liver failure?

A

Reduced albumin and increased prothrombin time.

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19
Q

What is an example of chronic liver failure?

A

Liver cirrhosis.

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20
Q

What is hepatitis?

A

Inflammation of liver.

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21
Q

What are some toxins that can cause acute liver failure?

A

Paracetamol, amanita phalloides and bacillus cereus.

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22
Q

Causes of acute liver failure?

A

Toxins, inflammation (hepatitis), disease of pregnancy, idiosyncratic drug reaction, vascular diseases and metabolic causes.

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23
Q

What is an idiosyncratic drug reaction?

A

Adverse reaction that does not occur in most patients treated with a drug.

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24
Q

Causes of chronic liver failure?

A

Inflammation, alcohol abuse, side effects of drugs, reduced venous return, inherited diseases, non alcoholic steatohepatatis, autoimmune hepatitits.

25
Q

What are some inherited diseases that can casue chronic liver disease?

A

Haemochromatosis, alpha1-antitrypsin deficiency,

26
Q

Liver cirrhosis mechanism?

A

Factor (e.g alcohol abuse) causes necrosis of hepatocytes. Enzyme leak (e.g lysosomal enzymes) causes release of cytokines. This results in activation of kupffer cells, granulocytes and lymphocytes which results in release of cytokines and growth factors. Hepatic stellate cells gets converted to myofibroblasts and macrophages form fibroblasts. Extracellular matrix deposit which results in fibrosis.

27
Q

What causes ascites in liver failure?

A

Low albumin production.

28
Q

What can ascites result in?

A

Reduction in plasma volume causes second degree hyperaldosteronism which causes hypokalemia which causes intracellular acidosis, this activates ammonium formation in proximal tubules, and this results in systemic alkalosis.

29
Q

What coagulation factors does hepatocytes not make?

A

VWF, factor VIII.

30
Q

Why does liver failure cause coagulopathy which can lead to bleeding?

A

Reduction in clotting factor synthesis.

31
Q

What does cholestasis in liver failure result in?

A

Decrease in fat absorption and fat soluble vitamins. Reduced absorption of vitamin K which is a fat soluble vitamin can result in reduced carboxylation of vitamin K depending clotting factors which leads to coagulopathy and bleeding.

32
Q

What are the vitamin K dependent clotting factors?

A

Factors II, VII, IX and X.

33
Q

What are the mechanisms that lead to cholestasis?

A

Canalicular dilation, decreased cell membrane fluidity of hepatocytes, biliary transporter insertion on wrong side of hepatocyte, increase in tight junction permeability and decreased mitochondrial ATP synthesis.

34
Q

Consequences of cholestasis?

A

Pruritus (itching), cholesterol deposition around eyes and cholangitis (inflammation of bile duct system).

35
Q

What causes portal hypertension in liver failure?

A

Blockage of blood flow through the liver, thus causing blood to back up in the portal vein.

36
Q

What does portal hypertension in liver failure cause?

A

Splenomegaly which results in thrombocytopenia (caused by platelet pooling). Oesophageal varices. Exudative enteropathy.

37
Q

What are 3 thing that cause bleeding in liver failure?

A

Decrease in active clotting factors, thrombocytopenia and varices.

38
Q

What is exudative enteropathy?

A

When albumin and other protein-rich materials leak into your intestine.

39
Q

What does exudative enteropathy result in?

A

Bacteria feed on plasma proteins leading to liberation of ammonium which can cause hyperammoniemia which leads to encephalopathy and alkalosis.

40
Q

What is a prehepatic cause of portal hypertension?

A

Portal vein thrombosis.

41
Q

What is a post hepatic cause of portal hypertension?

A

Right heart failure, constrictive pericarditis.

42
Q

Division of intrahepatic causes of portal hypertension?

A

Presinusoidal, sinusoidal and post sinusoidal all can cause build up of pressure in portal vein.

43
Q

What presinusoidal causes of portal hypertension?

A

Chronic hepatitis, primary biliary cirrhosis.

44
Q

What sinusoidal causes of portal hypertension?

A

Acute hepatitis, alcohol and fatty liver.

45
Q

What post sinusoidal causes of portal hypertension?

A

Venous occlusive diseases.

46
Q

Why does portal hypertension cause malabsorption?

A

Nutrients from portal vein can’t get to liver to be processed.

47
Q

What does splenomegaly cause?

A

Thrombocytopenia and anaemia due to pooling and then destruction.

48
Q

How does your body counterregulate portalhypertension? What is the consequence of this?

A

Secretes vasodilators. Drop in blood pressure but increase in cardiac output resulting in hyperperfusion of abdominal organs and varices.

49
Q

Why do varices happen in veins?

A

Thin walls.

50
Q

What results in excessive bleeding due to varices in liver failure?

A

Thrombocytopenia and reduction of clotting factors present due to liver failure.

51
Q

Why does varices occur?

A

Blood not being taken away by portal vein and so pressure builds up in thin wall collateral vessels (close by vessels) and these can rupture.

52
Q

What molecules are increased in the brain during liverfailure and can contribute to encephalopathy?

A

Aromatic amino acids (e.g serotin). Known as false transmitters.

53
Q

What varices are common in liver failure?

A

Oesophageal varices and rectal varices.

54
Q

What is used to assess severity of liver failure?

A

Child-pugh score.

55
Q

What factors are used to assess child pugh score?

A

Total bilirubin, serum albumin, prothrombin time, ascites, hepatic encephalopathy.

56
Q

What class of child pugh score makes them a transplant candinate?

A

Class B.

57
Q

What is child pugh score used for?

A

To assess severity of liver disease and peri-operative mortality.

58
Q

How to treat liver failure?

A

Reduce protein intake and phosphate enemas (empties bowels) for encephalopathy. Dextrose and calcium gluconate for hypoglycaemia and hypocalcaemia. Haemofiltration for renal failure. Albumin and vasoconstrictors for hypotension. Vitamin K, FFP and platelets for bleeding. Antibiotics for infection.

59
Q

What can be used to support liver for 24-48 hours?

A

Albumin exchange system such which remove albumin bound toxins from blood.

BRS (52 decks)

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