Pathogenesis of Acute and Chronic Liver Failure Flashcards
Most common cause of acute liver failure
- Worldwide
- North America
- Viral
2. Drug
Pathogenesis of viral hepatitis
Secondary to immune response to infection
Pathogenesis of drug and toxin injury to ive
Acetaminophen makes toxic metabolites when oversaturated enzymes
Other reactions are idiosyncratic
What is one symptom when someone has acute liver failure from acetaminophen that points to need for transplant?
Encephalopathy (grade 3 or 4)
Symptoms of chronic liver disease decompensation
Encephalopathy (confusion) Spare body hair Spider angioma Muscle wasting Dilated vessels Red palms Ascites Jaundice
What cells cause liver fibrosis?
Stellate cells
Pathophys of portal hypertension
Splanchnic vasodilation causes a decrease in effective circulating volume
RAAS increases causing renal vasoconstriction
Cardiac output increases and systemic vascular resistance decreases
4 MELD criteria used for transplant listing
INR
Bilirubin
Creatinine
Na
Signs of encephalopathy
Decreased LOC
Slurred speech all the way to coma
Asterixis
Mechanism of hepatic encephalopathy
Increased GABA activity
Hyperammonemia from gut, false gut NTs (mechanisms unknown)
How to treat encephalopathy
Correct precipitating events
Lactulose (trap ammonia)
Intra-lumenal antibiotics