Liver insufficiency

Question 1

If we have liver injury, the hepatocytes will respond in 2 ways

Answer 1

Toxicity or metabolic alterations of carbs and lipids= hypertrophy: increase in smooth endoplasmic reticulum

After necrosis or apoptosis after transplant=
hyperplasia: increase in number of cells

Question 2

Hepatic tests

Answer 2

Albumin
Prothrombin time
Bilirubin
ALT/AST transaminases

Imaging test: ultrasound and CT

Liver biopsy

Question 3

Hepatic insufficiency

Answer 3

Liver function below normal

Symptoms: Jaundice, bleeding, secondary infections, renal dysfunction

Can lead to liver failure –> HEPATIC ENCEPHALOPATHY terminal stage

Question 4

Acute hepatocellular insufficiency

Answer 4

No fibrogenesis

Common cause: ischemia, toxicity and viruses

Question 5

Chronic hepatocellular insifficiency

Answer 5

Fibrosis occurs

Common cause: alcoholic cirrhosis

Question 6

Acute hepatocellular insufficiency symptoms

Answer 6

• Jaundice,
• Hypoglycemia,
• Blood clotting (coagulation) impairment,
• Early encephalopathy

More continuous progression

Question 7

Chronic hepatocellular insifficiency symptoms

Answer 7

• Less acute symptoms,
• No alterations of the blood clotting system,
• No hypoglycemia,
• Late encephalopathy.

Question 8

Causes of Acute chronic insufficiency

Answer 8

Viruses
Drugs
Toxic
Vascular
Other: Wilsons disease, Reyes syndrome

Question 9

Pathophysiology of liver insufficiency: ALTERATIONS IN METABOLIC PROCESSES!!!!

Answer 9

Alteration of carbohydrate metabolism:

Alterations of protein metabolism: Ammonium = encephalopathy

Alteration of the lipid metabolism:

Alterations of vitamins metabolism:

Alterations of coagulation factors: increase prothrombin

Decreased excretion of bile:

Question 10

Hepatic failure: consequences and manifestations

Answer 10

Hematologic syndrome: Anemia and hemorrhagic problems

Endocrine-cutaneous syndrome: signs of feminization (testicular atrophy)

Hyperdynamic circulatory syndrome: portan hypertension

Renal syndrome: renal failure

Neuropsychatric syndrome: hepatic encephalopathy

Question 11

Hepatic encephalopathy

Answer 11

It is a neuropsychiatric syndrome with neurological, mental and electroencephalographic manifestations.

AMMONIA (NH3) = CORNERSTONE IN THIS DISORDER!!!!

Question 12

Hepatic encephalopathy: Consequences

Answer 12

CNS: Asterixis = Flapping tremor of hand & behavioral alterations

Motor muscle hypertonia = Apraxia

Sleep disorders

Question 13

Diagnostic test Hepatic encephalopathy?

Answer 13

West Haven Classification

EEG.

Lab test: increased plasma ammonia