Liver failure

Question 1

What is cholestasis

Answer 1

Bile plugs in cannaliculi
Bilirubin elevated
Alkaline phosphatase elevated

Question 2

What is prehepatic jaundice usually due to

Answer 2

RBC destruction (most bilirubin comes from Haem in RBCs)

• -Hereditary speherocytosis
• -Autoimmune haemolytic anaemia
• -Blood group incompatibility
• -Sickle cell
• -Thalassemia
• -Malaria

Question 3

What is type of bilirubin does prehepatic jaundice have to do with

Answer 3

Unconjugated

Question 4

What is hepatic jaundice due to and what is it

Answer 4

Due to abnormality in liver

-Conjugated plus unconjugated bilirubin

Question 5

Causes of hepatic jaundice

Answer 5

Congenital-
Immaturity of liver enzymes. Enzyme defects in processing of Bilirubin

e.g. Criglar Najar, Gilbert’s, Dubin-Johnson

Acquired-
Viral hepatitis, alcoholic hepatitis

Question 6

What is post hepatic jaundice and what type of bilirubin does it have to do with

Answer 6

Conjugated bilirubin.

Due to obstruction to bile flow

Question 7

Causes of post hepatic jaundice

Answer 7

Congenital- biliary atresia (bile ducts are scarred and blocked)

Acquired- bile duct problem

In the lumen- gall stone, tumour, worm

In the wall- tumour, benign stricture

outside the wall- tumour (Ca head of pancreas)

Question 8

2 main pathways of acute liver failure

Answer 8

Acute liver damage

Decompensation in chronic liver disease

Question 9

Causes of acute liver failure

Answer 9

Acute liver damage
Toxic, viral, ischaemic

–> leads to massive liver cell necrosis and so acute liver failure

Stable chronic liver disease leads to acute decline and so acute liver failure

Question 10

Specific causes of acute liver failure

Answer 10

Alcoholic liver disease
Paracetamol overdose
Viral hepatitis (A,B,E)
Idiosyncratic reaction to medication 
Acute fatty Liver of pregnancy

Question 11

How does failure to detoxify nitrogenous compounds present

Answer 11

Encephalopathy (altered mental state)

Question 12

Consequences of ALF

Answer 12

High mortality. Transplantation now frequently used. Treatment is supportive and manage complications. If survive, liver may regenerate and return to normal or develop post-necrotic cirrhosis

Question 13

Causes of chronic hepatitis

Answer 13

Hepatitis BCD
Autoimmune
Drugs
Metabolic disease

Question 14

What is assessed to give the grade of chronic hepatitis

Answer 14

Necrosis and inflammation

Question 15

What is assessed to give the stage of chronic hepatitis

Answer 15

Extent of fibrosis

Question 16

What is primary biliary cirrhosis

Answer 16

Diagnosed by serology

-Portal inflammation, damage to bile ducts and granulomas

Question 17

What is primary sclerosis cholangitis

Answer 17

Best diagnosed by imaging

-Portal inflammation with periductal sclerosis

Question 18

What is cirrhosis

Answer 18

Final common pathway of chronic liver injury

• Widespread nodules separated by fibrous bands
• May be asymptomatic
• Increase in portal pressure result in:
• -> splenomegaly (consumption of blood cells)
• -> varices (enlarged veins shunting blood past liver to systemic circulation which may bleed
• ->ascites-fluid in abdominal cavity

Question 19

Complications of cirrhosis

Answer 19

Variceal haemorrhage 
Spontaneous bacterial peritonitis 
Hepatic encephalopathy
Chronic liver failure
Hepatocellular carcinoma