Liver failure and jaundice

Question 1

Define Liver Failure.

Answer 1

• Hepatocyte destruction is greater than hepatocyte regeneration
• when rate of hepatocyte death > regeneration various aetiologies

Question 2

what are the types of jaundice?

Answer 2

Acute:
Fulminant hepatic failure: normal liver and suddenly t dies within a few days. Due to paracetamol or viral hepatitis.

Chronic:
Chronic damage to the liver over many many years.

Question 3

What are the two main types of liver failure and how are they different?

Answer 3

Acute - occurs in a pre-existing normal liver

Chronic - due to chronic liver disease

Question 4

State five clinical features of acute liver failure.

Answer 4

Hepatic encephalopathy
Cerebral oedema 
Coagulopathy 
Metabolic changes
Infection

Question 5

What is hepatic encephalopathy and what causes it?

Answer 5

Reversible neuropsychiatric state caused by hepatocellular dysfunction and porto-systemic shunting
Blood bypasses the liver and hence is not detoxified so the brain is exposed to increased levels of ammonia and other neurotransmitters

Question 6

What metabolic changes take place in liver failure?

Answer 6

Plasma sodium, potassium and glucose concentration decreases.
There is an increase in urinary loss.
Metabolic acidosis

Question 7

Why is infection a feature of liver failure?

Answer 7

Caused by poor host defence - Kupffer cell and polymorph dysfunction and reduced conscious state (so you don’t clear their airways)

Question 8

What are some features of chronic liver disease?

Answer 8

Jaundiced, malnourished, muscle weakness, muscle wasting

Question 9

State some causes of chronic liver disease.

Answer 9

Alcoholic liver disease, Chronic viral hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, haemochromatosis

Question 10

How does bilirubin, plasma albumin, alanine aminotransferase (ALT) and alkaline phosphatase (ALP) change in liver disease

Answer 10

Bilirubin increases (the liver isn’t able to get rid of it quickly enough)
Albumin decreases
Alanine aminotransferse INCREASES (it is found in the hepatocytes so anything that destroys hepatocytes will increase ALT)
Alkaline phosphatate - increases if there is an obstruction

Question 11

State three symptoms of chronic liver failure.

Answer 11

Yellowish discoloration of the eyes and skin
Swelling of the body and, in particular, the stomach
Vomiting up blood
Rectal bleeding
Gynaecomastia (in males)

Question 12

what are the normal functions of the hepatocyte?

Answer 12

• Detoxification
• Glycogen storage
• Production of clotting factors
• Immunological function and globulin production
• Maintenance of homeostasis

Question 13

What are the consequences of hepatocyte failure?

Answer 13

• Encephalopathy and cerebral oedema
• Hypoglycaemia
• Coagulopathy and bleeding
• Increased susceptibility to infection
• Circulatory collapse, renal failure