Liver Failure

Question 2

Define liver failure. Classify according to the time since symptom onset.

Answer 2

Question 3

What is Cirrhosis?
Gold standard dx of cirrhosis?

Answer 3

Question 4

Is cirrhosis and liver failure the same?

Answer 4

Question 5

What are the causes of acute liver failure?

Answer 5

Question 6

What are the causes of chronic liver failure?

Answer 6

Question 7

What are the causes of acute and chronic liver failure?

Answer 7

Question 8

List the RFs for liver failure

Answer 8

Question 9

Describe the pathogenesis of cirrhosis.

Answer 9

Question 10

Describe the pathogenesis of portal HTN.

Answer 10

Question 11

List the ddx for liver failure

Answer 11

The causes are also ddx

Question 12

List the symptoms/RFs you would like to ellict from a liver failure history.

Answer 12

Question 13

How would you grade hepatic encephalopathy

Answer 13

Question 14

Outline the exam findings you would expect in a liver failure case.

Answer 14

Question 15

What are the diagnostic investigations for liver failure.

Answer 15

Question 16

How would you assess for synthetic function of the liver?

Answer 16

Question 17

Alcoholic hepatitis on LFT will show

Answer 17

2:1 AST:ALT
Raised GGT

Question 18

What does the liver autoimmune screen test for?

Answer 18

Autoimmune hep - anti-LKM1, IgG4, ASMA
PBC - AMA

Question 19

What is the tumour marker for HCC?

Answer 19

AFP

Question 20

What is the use of an U/S liver in Liver failure?

Answer 20

Question 21

What is the use of a fibroscan in Liver failure? What imaging is it based on

Answer 21

Question 22

What is the ideal timeframe in which an ascitic tap should be performed in liver failure?
What information would the tap provide?

Answer 22

Question 23

What are the findings on liver biopsy in cirrhosis (4)

Answer 23

Question 24

What test can be to detect alcohol consumption within the last 30 days?

Answer 24

Question 25

What are the supportive investigations for liver failure?(justify)

Answer 25

Question 26

What are ALL the investigations for liver failure?(justify)

Answer 26

Question 27

What is the use of the following classification systems: 1.Child-Pugh? 2. MELD? 3. Maddrey's Discriminant Function for Alcoholic Hepatitis? 4. King's College Criteria for Liver Transplant?

Answer 27

1.Child-Pugh - cirrhosis severity. 2. MELD - 3 month mortality of end-stage liver disease. 3. Maddrey's Discriminant Function for Alcoholic Hepatitis - predicts prognosis and steroid benefit in alcoholic hepatitis. 4. King's College Criteria for Liver Transplant - used to list patients for acute urgent liver transplant.

Question 28

How would you grade prognosis of end stage liver disease?

Answer 28

Question 29

Outline the grading system used to list patients for an acute liver transplant.

Answer 29

Question 30

Outline the grading system that predicts prognosis and steroid benefit in alcoholic hepatitis.

Answer 30

Question 31

In the setting of a paracetamol OD, when would you prescribe activated charcoal over NAC and vice versa. How are they given?

Answer 31

Question 32

High risk patients may develop toxicity to paracetamol at lower plasma levels. WHat are these high risk groups?

Answer 32

Question 33

Outline the management of acute liver failure secondary to paracetamol OD

Answer 33

Question 34

Describe to preventative measures to decrease risk of liver failure?

Answer 34

Question 35

What is Hepatic encephalopathy? How would you treat hepatic encephalopathy?

Answer 35

Hepatic encephalopathy is caused by high ammonia (NH3) in the blood which accumulates leading to toxic effects in the brain. Lactulose binds to ammonia making it ammonium (NH4+). This is a less toxic and less absorbable version => Increased excretion and elimination Rifaximin is used as an adjunct by targetting the bacteria in the gut which produce ammonia. lactulose - prevention and treatment Rifaximin - for recurrent encephalopathy Gallstone disease: Ursodeoxycholic acid, cholestyramine

Question 36

When performing a therapeutic abdominal paracentesis, what must be given to the patient?

Answer 36

Question 37

What is the TIPSS procedure and what is its main risk?

Answer 37

Question 38

What is the definitive management for liver failure?

Answer 38

Transplant ttek

Question 39

Outline the pharmacological management for chronic liver failure.

Answer 39

Question 40

Outline the non-consertive, non-pharmacological management for chronic liver failure. Describe them.

Answer 40

Question 41

What are the S+S of decompensated liver disease?

Answer 41

Question 42

What are the S+S of hepatopulmonary syndrome?

Answer 42

Question 43

What is the treatment of SBP?

Answer 43

Question 44

What are the S+S of Wernicke's Encephalopathy?

Answer 44

Question 44

How often in screening for HCC done in CLD patients? How is it done?

Answer 44

Question 45

What are the S+S of Korsakoff's psychosis?

Answer 45

Question 46

Describe the possible complications of liver failure.

Answer 46

Question 47

Describe this image.

Answer 47

Question 48

Compare the prognosis of compensated vs decompensated liver failure.

Answer 48