liver failure Flashcards

1
Q

describe paracetamol poisoning

A
less common
free radical damage to hepatocytes
overloading paracetamol pathways
sudden loss of liver function
assess with blood sample
rapid death from:
-bleeding
-encephalopathy
liver usually recover given time
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2
Q

what causes chronic liver failure?

A
cirrhosis
primary liver cancer
secondary liver cancer
-metastases
-bowel tumour common as cells washed through portal system and embed in liver
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3
Q

what is cirrhosis?

A

mixed picture of damage, fibrosis and regeneration of liver structure

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4
Q

what is the aetiology of cirrhosis? (multifactorial)

A
alcohol
primary biliary cirrhosis
viral disease-chronic active hepatitis
autoimmune chronic hepatitis
haemochromatosis
cystic fibrosis
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5
Q

what are the signs and symptoms of cirrhosis?

A
none
liver inflamed/shrunk
acute bleed
-portal hypertension
-oesophageal varices
jaundice
oedema & ascites
encephalopathy
spider naevi, palmar erythema
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6
Q

what are ascites?

A

high portal venous pressure

low plasma protein synthesis

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7
Q

how do oesophageal varices occur?

A

blood entering portal system has no exit as portal vein cannot communicate w/ hepatic vein
due to disordered portal triads in liver cirrhosis
blood engorges as passes through vessels and lower oesophagus
veins dilated and fragile
protrude into oesophageal lumen
-rupture -> catastrophic bleed

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8
Q

what is loss of synthetic function?

A

plasma proteins
-transporting proteins
-gamma globulin
clotting factors

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9
Q

what is loss of metabolic function?

A

drug metabolism
detoxification
conjugation of RBC breakdown products

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10
Q

what liver function tests are available?

A
hepatic cell enzyme levels
-ALT, GGT
-measures degree of inflammation not function
-proportional to number of hepatic cells
INR 
-most useful
-synthesis of clotting factors
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11
Q

what is INR?

A
measures prothrombin time against a control
prothrombin->thrombin
normal = 1
if on warfarin 2-4
if not 1 significant dysfunction
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12
Q

what are the effects of liver failure?

A
fluid retention
raised INR & prolonged bleeding
portal hypertension
-inability of GI blood to re-enter vena cava
-oesophageal varices
inability to remove waste/urea
-encephalopathy
build up of haem breakdown products- jaundice
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13
Q

what are the treatments for liver failure?

A
supportive
-end stage disease
-acute failure
transplant
-only cure
artificial liver systems
-MARS
-some function restored
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14
Q

what analgesics can you give a px with hepatic disease?

A

paracetamol
co-codamol
NO NSAIDS
-bleeding risk

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15
Q

what antifungals can hepatic dx px not take?

A

miconazole
erythromycin
tetracycline

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