Liver Failure Flashcards

Question

What does cholestasis do?

Answer 1

leads to liver damage aggravates any bleeding tendency - ↓ bile salts - → ↓ micelles & absorption of vit K - → ↓ γ-carboxylation of vit K-dependent clotting factors prothrombin (II), VII, IX, & X

Answer 2

Mechanisms: Canalicular dilation ↓ cell membrane fluidity Deformed brush border Biliary transporters ↑ tight junction permeability ↓ mitochondrial ATP synthesis

Answer 3

Portal hypertension ↓ lymphatic flow → makes ascites worse thrombocytopenia (low platelet count) resulting from splenomegaly oesophageal varices (enlarged or swollen veins) ↓ active clotting factors, thrombocytopenia, & varices → severe bleeding exudative enteropathy ↑ ascites → loss of albumin from plasma favours bacteria in large bowel being “fed” with proteins ↑ liberation of ammonium (toxic to brain)

Answer 4

causes: ↑ vascular resistance Prehepatic Portal vein thrombosis (blocking of blood vessels) Posthepatic right heart failure constrictive pericarditis (inflammation of lining around the heart) Intrahepatic - Presinusoidal -chronic hepatitis, PBC, granulomas (schistosomiasis, TB, etc.) - Sinusoidal - acute hepatitis, alcohol, fatty liver, toxins, amyloidosis, etc. - Postsinusoidal - venous occlusive disease of venules & small veins; Budd– Chiari syndrome (obstruction of large HVs).

Answer 5

(↑ portal vein pressure) Malabsorption Splenomegaly (anaemia & thrombocytopenia) Vasodilators (glucagon, VIP, substance P, prostacyclins, NO, etc.) → ↓BP → ↑CO → hyperperfusion of abdo. organs & varices Encephalopathy - Toxins from intestine (NH3, biogenic amines, FFAs, etc.) normally extracted from portal blood by hepatocytes → CNS Varices - Thin walled collateral vessels + thrombocytopenia & ↓ clotting factors → bleeding +++

Answer 6

Encephalopathy - apathy, memory gaps, tremor & liver coma) Hyperammonemia ↑s - GI bleeding ↑s colonic proteins - liver can’t convert (NH3 NH4+) to urea Hypokalaemia - → intracellular acidosis → activates ammonium formation in proximal tubules → systemic alkalosis. Toxins (amines, phenols & FFAs) bypass liver → not extracted → encephalopathy. “false transmitters” (e.g., serotonin) from aromatic amino acids in brain → ↑ed in liver failure = transmitters → encephalopathy.

Answer 7

Porto-systemic anastomosis also known as portocaval anastomosis is the collateral communication between the portal and the systemic venous system picture is of varices of portal-systemic anastomoses

Answer 8

Child-Pugh score Assesses disease severity for end-stage liver disease, and a prognosticator for peri-op death 1-3 points for each category

Answer 9

Encephalopathy (any disease of the brain that alters brain function or structure) - reduce protein intake - phosphate enemas/lactulose - no sedation Hypoglycaemia - infusion 10-50% dextrose Hypocalcaemia - 10 ml 10% calcium gluconate Renal failure - haemofiltration

Answer 10

Respiratory failure - ventilation Hypotension - albumin - vasoconstrictors Infection - frequent cultures - A/Bs Bleeding - Vit K - FFP - platelets

Answer 11

Bacterial and fungal infections Circulatory instability Cerebral Oedema Renal failure Respiratory failure Acid-base and electrolyte disturbance Coagulopathy

Answer 12

Artificial (MARS, Bio-Logic DT) - Albumin exchange system - based on selective removal of albumin-bound toxins from blood Bioartificial (Hepatocytes in culture) Hepatocyte transplantation

Answer 13

(in order of most) cirrhosis cancer cholestasis disease acute liver failure metabolic disease other: Budd-Chiari Benign Liver tumours Polycystic liver disease

Answer 14

a condition in which the hepatic veins (veins that drain the liver) are blocked or narrowed by a clot (mass of blood cells)

Answer 15

Ascites Coagulopathy Cholestasis Portal hypertension

Answer 16

Pre-hepatic - haemolysis, transfusion, haematoma, ineffective erythropoiesis Intrahepatic - defective uptake, conjugation & bilirubin excretion Extrahepatic