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Alimentary System > Liver Failure & Cirrhosis > Flashcards

Liver Failure & Cirrhosis Flashcards

1
Q

What is liver failure?

A

A complication of acute liver injury or chronic liver injury and cirrhosis

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2
Q

What is fulminant hepatic failure?

A

A clinical syndrome resulting from massive necrosis of liver cells leading to sever impairment of liver function

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3
Q

What are the causes of acute liver failure?

A

Viral hepatitis
Paracetamol overdoes
Isoniazid
Rifampicin
Ecstasy
Magic mushrooms
Alcohol abuse

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4
Q

What are the causes of Chronic liver failure?

A

Chronic viral hepatitis
Haemachromatosis
Alcohol abuse
AIH, PBC, PSC
a1-antitrypsin deficiency
Wilson’s disease
Malignancy

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5
Q

What are the signs of liver failure?

A

Jaundice
Hepatic encephalopathy
Fetor hepaticus
Asterixis/flap

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6
Q

What is hepatic encephalopathy?

A

A loss of brain function as a result of failure in the removal of toxins from the blood due to liver damage
Graded I-IV

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7
Q

What is Grade I of hepatic encephalopathy?

A

Altered mood/behaviour
Sleep disturbance
Dyspraxia
Poor arithmetic
No liver flap

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8
Q

What is Grade II of hepatic encephalopathy?

A

Increasing drowsiness
Confusion
Slurred speech
Liver flap
Inappropriate behaviour

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9
Q

What is Grade III of hepatic encephalopathy?

A

Incoherent
Restless
Live flap
Stupor (near unconsciousness)

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10
Q

What is Grade IV of hepatic encephalopathy?

A

Coma

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11
Q

What is Fetor hepaticus?

A

Chronic odour in the breath

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12
Q

What is asterixis/liver flap?

A

Inability to maintain a fixed posture

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13
Q

What blood tests are done in liver failure?

A

FBC
U&E
LFT
Clotting
Glucose
Paracetamol level
Hepatitis
Ferritin
a1- antitrypsin

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14
Q

What imaging is done for liver failure?

A

CXR
Abdominal ultrasound

Doppler flow studies of portal vein

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15
Q

What is Cirrhosis?

A

A degenerative disease of the liver resulting in irreversible damage.

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16
Q

What are the causes of cirrhosis?

A

Alcohol
HBV/HCV infection
Genetics: hemochromatosis, a1-antitrypsin deficiency, Wilson’s disease, CF
Autoimmune disease: AIH, PBC, PSC
Drugs
Vascular problems

17
Q

What pathological changes occur in the liver in cirrhosis?

A
  • Infiltrating lymphocyte
  • ECM proteins
  • Apoptotic hepatocyte
  • Activated Kupffer cell
  • Sinusoid lumen with increased resistance to blood flow
18
Q

What is the clinical presentation of cirrhosis?

A

Ascites
Variceal bleeding
Hepatorenal syndrome
Hepatic encephalopathy

19
Q

What is ascites?

A

An abnormal accumulation of fluid in the abdominal cavity, which can lead to a very large distended abdomen

20
Q

What causes ascites?

A

Portal HTN
Low serum albumin causing reduced plasma oncotic pressure
Hypoperfusion of kidneys leading to activation of RAAS leading to salt and water retention

21
Q

What are the treatment options for ascites?

A

Diuretics
Large volume paracentesis
Sodium restriction
Fluid restriction
Antibiotics to prevent bacterial peritonitis
TIPSS (transjugular intrahepatic portosystemic shunts)
Discontinuation of drugs causing fluid retention (NSAIDs, steroids)

22
Q

What is variceal bleeding?

A

A condition in which the veins enlarge due to malfunction of their valves causing improper flow of blood, and pooling as a result.
Sometimes the swollen veins may rupture and bleed.

23
Q

What is the management of variceal haemorrhage?

A

Dedicated bleeding unit
Fluid resuscitation
Blood transfusion
Vasconstrictors- terlipressin
Emergency endoscopy

24
Q

What is hepatorenal syndrome?

A

Impaired kidney function due to liver disease
Cirrhosis + ascites + renal failure = HRS

25
Q

What are the other signs of cirrhosis?

A

Leukonychia- from hypalbuminaemia
Clubbing
Palmar erythema
Spider naevi
Xanthelasma
Gynecomastia (enlarged male breasts)
Hepatomegaly
Splenomegaly

26
Q

What are the facial signs of CLD?

A

Jaundice
Parotid gland enlargement
Xanthelasma

27
Q

What are the chest signs of CLD?

A

Gynaecomastia
Breast atrophy

28
Q

What are the hands signs of CLD?

A

Leukonychia
Palmar erythema
Clubbing
Dupuytren’s contracture
Hepatic flap

29
Q

What are the general signs of CLD?

A

Skin pigmentation
Loss of body hair
Bruising
Cachexia

30
Q

What are the upper body signs of CLD?

A

Spider naevi

31
Q

What are the abdominal signs of CLD?

A

Splenomegaly
Hepatomegaly
Dilated collateral vessels around umbilicus
Ascites

32
Q

What are the genital signs of CLD?

A

Testicular atrophy

33
Q

What are the leg signs of CLD?

A

Oedema
Hair loss
Scratch marks

Alimentary System (24 decks)

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