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
What are the other signs of cirrhosis?
Leukonychia- from hypalbuminaemia Clubbing Palmar erythema Spider naevi Xanthelasma Gynecomastia (enlarged male breasts) Hepatomegaly Splenomegaly
26
What are the facial signs of CLD?
Jaundice Parotid gland enlargement Xanthelasma
27
What are the chest signs of CLD?
Gynaecomastia Breast atrophy
28
What are the hands signs of CLD?
Leukonychia Palmar erythema Clubbing Dupuytren's contracture Hepatic flap
29
What are the general signs of CLD?
Skin pigmentation Loss of body hair Bruising Cachexia
30
What are the upper body signs of CLD?
Spider naevi
31
What are the abdominal signs of CLD?
Splenomegaly Hepatomegaly Dilated collateral vessels around umbilicus Ascites
32
What are the genital signs of CLD?
Testicular atrophy
33
What are the leg signs of CLD?
Oedema Hair loss Scratch marks