Liver Failure

Question 1

what is the MELD score? What goes into the calculation?

Answer 1

rank patients 12yo+
ranges from 6 - 40
most patients on transplant list are 11- 20
serum creatinine, bilirubin, INR

Question 2

What is hepatopulmonary syndrome?

Answer 2

• indication for liver transplant
  triad:
  liver disease
  decreased oxygenation (A-a gradient > 20 or PaO2 < 70 on RA)
  intrapulmonary vascular dilation (Dx by CT)

Question 3

What’s the major criteria of hepatorenal syndrome?

Answer 3

• advanced liver disease w/ portal HTN
• low GFR (Cr > 1.5)
• no other causes like shock, infection, fluid loss
• no improvement with fluid challenge (1.5L)
• no proteinuria (< 500mg/day)

Question 4

what is the pathophys of hepatorenal syndrome?

Answer 4

• liver disease –> increased nitric oxide and prostacycline –> splanchnic arterial vasodilation –> less “effective blood volume” –> JG apparatus –> RAAS + sympathetic NS –> systemic and renal vasoconstriction

Question 5

hepatorenal syndrome, what’s the difference between Type 1 and Type 2?

Answer 5

• Type 1 = rapidly progressing renal failure, Cr > 2.5
• Type 2= slower onset, Cr > 1.5

type 1 has a worse prognosis
treatment = albumin, midodrine (vasoconstrictor), octreotide (inhibits splanchnic vasodilation)

Question 6

What are the classifications for portopulmonary hypertension (PPH) for mild, mod, severe?

Answer 6

mild mean PAP 25 - 35
mod PAP = 35 - 45
severe PAP = 45+
must have normal PCWP (means it’s not due to RHF)

liver transplant contraindicated if PAP > 50. If the TTE shows this pre-op, recommend RHC to get more accurate value