Liver Failure

Question 1

Signs of portal hypertension

Answer 1

Splenimegaly
Ascites
Oesophageal varices
Capital medusa

Question 2

Complications of CLD

Answer 2

Encephalopathy
GI bleed
Ascites
SBP
Bleeding
Portal hypertension
Hepatorenal syndrome
Hepatopulmonary syndrome

Question 3

Causes of deconpensation

Answer 3

GIB
SBP
High salt intake
Constipation
ongping alcohol or viral hepatitis
Sepsis

Question 4

Hepatic encephalopathy stages

Answer 4

0 - subtle. Small changers on memory/cognition

1 - mild confusion, euphoria, elation, depression, reduced cognition and memory

2 - drowsy, disorientation in time (also place maybe). Personality change

3 - somnolent but rousable to voice. Gross confusion. Incomprehensible speech

4 - comatose

Question 5

Severity of cirrhosis grade

Answer 5

Child Pugh score

Class A 5-6 points
Class B 7-9 points
Class C 10-15 points

Bilirubin
INR
Albumin
Encephalopathy
Ascites

Question 6

Management Ascites

Answer 6

Low salt diet

Spironolactone

Furosemide if Spiro not enough/tolerated

Therapeutic paracentesis if above doesn’t work or symptomatic

TIPS (transjugular intrahepatoc portisystemic shunt) (done by IR)

Surgical procedure (portisystemic and peritonvenous shunts) infrequent

Liver transplant