Liver failure

Question 1

causes of acute liver failure

Answer 1

alcohol
HELLP syndrome
drugs (paracetamol overdose, isoniazid)
hepatitis A or B (extremely uncommon in C), EBV, CMV

Question 2

causes of chronic liver failure

Answer 2

PBC
Wilson's
alcohol
haemochromatosis
alpha 1 antitrypsin deficiency
NAFLD
HBV

Question 3

symptoms of acute liver failure

Answer 3

• hepatic encephalopathy
• cerebral oedema
• coagulopathy
• hyponatraemia
• jaundice

Question 4

what causes hepatic encephalopathy

Answer 4

build up of nitrous waste. astrocytes clear it. excess glutamine produced by astrocytic clearing leads to osmotic shift which causes cerebral oedema

Question 5

sx chronic liver failure

Answer 5

clubbing
spider naevia
gynaecomastica
anaemia
jaundice
ascites 
peripheral oedema

Question 6

what happens in alcoholic liver disease

Answer 6

inflammation of heptocytes (hepatitis) -> fibrosis -> eventually cirrhsis

Question 7

LFTs in alc liver disease

Answer 7

AST:ALT ratio >2:1
serum GGT raised
bilirubin and alk phos can be raised
(FBC high MCV)

Question 8

what can be seen on biopsy in alc liver disease

Answer 8

mallory bodies

Question 9

med used for para overdose

Answer 9

n acetylcysteine (NAC)

Question 10

how can cirrhosis be divided

Answer 10

micronodular

macronodular

Question 11

drugs to avoid in cirrhosis

Answer 11

aspirin

NSAIDs

Question 12

inheritance pattern of haemochromatosis

Answer 12

AR (but one type is AD)

Question 13

what organs does haemochromatosis affect?

Answer 13

deposition of iron in
joints
heart
liver
pancreas
skin
adrenals

Question 14

symptoms of haemochromatosis

Answer 14

arthralgia
fatigue
slate grey skin
signs of chronic liver disease

Question 15

rx haemochromatosis

Answer 15

regular venesection

low iron diet

Question 16

what stain is used on liver biopsy to show haemochromatosis

Answer 16

perls stain

Question 17

when may secondary haemochromatosis occur

Answer 17

pts who have received >40L of blood transfusion in short time

Question 18

what is wilson’s disease

Answer 18

rare AR disorder of biliary copper excretion

copper builds up in liver and CNS

Question 19

CNS symptoms in wilson’s

Answer 19

tremor, dyskinesia, dystonia, mood distrubance, memory problems

Question 20

treatment of wilson’s

Answer 20

penicillamine

low copper diet

Question 21

what are the name of the rings in the eye in Wilson’s

Answer 21

kayser-fleischer rings

Question 22

what disease if emphysema, cirrhosis and cholestatic jaundice

Answer 22

alpha 1 antitrypsin deficiency

Question 23

symptoms of liver abscess

Answer 23

RUQ pain
tender large liver
tachycardia
fever

-how interesting!

Question 24

two types of liver abscess

Answer 24

pyogenic - bacteria from other infections via portal blood

amoebic - from bowel to liver (entamoeba histolytica)

Question 25

what pyogenic organissm

Answer 25

``` staph strep e coli klebsiella anaerobes ```

Question 26

treatment of liver abscess

Answer 26

abx, possibly drainage | amoebic: metronidazole

Question 27

causes of portal HTN

Answer 27

- pre hepatic: portal vein thrombosis - hepatic: cirrhosis - post hepatic: hepatic vein thrombosis, right heart failure

Question 28

signs of portal HTN

Answer 28

ascites jaundice splenomegaly

Question 29

diagnosis of portal HTN

Answer 29

measure hepatic venous pressure gradient

Question 30

most common causes of portal hypertension worldwide?

Answer 30

schistosomiasis

Question 31

what may portal hyptertension lead to the formation of

Answer 31

oesophageal varices (collaterals)

Question 32

what classification for acute liver failure

Answer 32

o'grady | jaundice to encelphalopathy time (hyperacute is within 7 days, actue 8-28 days, subacute 29days-12wk)

Question 33

rare causes of ALF

Answer 33

``` ischaemic heaptitis autoimmune hep acute fatty liver of preg wilson's budd chiari ```

Question 34

when assessing paracetamol use, what to consider?

Answer 34

could be ACCIDENTAL e.g. taking cocodamol, lemsip and cold and flu remedy

Question 35

what value is used to assess coagulopathy

Answer 35

INR (nb 1 is normal because it's a ratio!)

Question 36

factors increasing risk of hepatotoxicity

Answer 36

``` staggered overdose excessive alc consumption malnutrtion HIV cancer chronic liver disease on antiepileptics, rifampicin, spirinolactone ```

Question 37

rx paracetamol overdose

Answer 37

n-acetylcysteine (NAC). GIVE BEFORE PARA LEVELS COME BACK AS THERE'S NO HARM! IV fluids