S09C83 - Hepatic disorders, jaundice, hepatic failure

Question 1

Liver function

Answer 1

• production of anticoagulation and coagulation factors

- produces vit K dependend facotrs: II, VII, IX, X,protein C and S

Question 2

Ascites

Answer 2

• risk for SBP b/c normal flora in gut go across edematous bowel into the peritoneum
• ascites also causes respiratory compromise

Question 3

Hepatic Encephalopathy

Answer 3

-etiology not well understood, related to ammonia?
-portal HTN allows ammonia formed by colonic bacteria to enter the general circulation
-levels of ammonia do not correlate with degree of encephalopathy
STAGES
I apathy
II lethargy, drowsy, disoriented, asterixes
III Stupor, hyperreflexia, extensor plantar reflexes
IV Coma

-cerebral edema and intracranial htn ar eominous signs

Question 4

Hepatitis: Rx causes

Answer 4

• tylenol
• vit A
• isoniazid
• phenytoin
• valproate

Question 5

Hepatitis: Infx causes

Answer 5

• hepatitis A/B/C
• HAV- from oysters commonly, fecal-oral, incubates for 15-50d, dark urine, clay-colored stool, flu=like illness
• HBV: sex or blood tfn and needles, incubates 1-3mo, infxs for 5-15w after Sx onset if infxn cleared (if not cleared then infxs forever), flu-like with jaundice
• HCV - contaminated blood products, needles, often asymptomatic, >75% of pts advance to chronic stage
• HDV: uncommon, pre-existing HBV, rapid progressive fulminant liver dz, high mortality rate
• CMV
• HSV
• cosxsackie
• EBV
• schistosomiasis causes portal HTN
• echinococcus causes liver cysts
• ascariasis causes hepatobiliary obstruction
• entamoeba histolytica causes liver abscesses

Question 6

Hepatitis: herbal causes

Answer 6

• skullcap
• mistletoe
• valerian
• comfrey
• senna
• coltsfoot
• gree tea
• block cohosh

Question 7

Alcoholic liver dz

Answer 7

• 35% 5y mortality
• malnutrition
• neuropathy
• pityriasis rosea
• cardiomyopathy

Question 8

Mushrrom poisoning

Answer 8

-amanita phalloides (death cap) europe and n. amercia

Question 9

SBP

Answer 9

• high mortality rate (30% survival at 6mo)

- paracentesis should be performed if: ascites for first time, or ascites plus fever, pain, GI bleed, or encephalopthy

Question 10

Hepatorenal syndrome

Answer 10

-complication of cirrhosis
-dvpt of acute renal failure in pts with normal kidneys in presence of known or acute hepatic cailure
Type 1: progressive oliguria and doubling of serum Cr over 2w (mean survival

Question 11

Other non-med non-toxic causes of liver failure:

Answer 11

• wilson dz
• hemochromatosis
• alpha 1 antitrypsin
• autoimmune hepatitis

Question 12

Portal vein thombosis

Answer 12

• portal htn

- assoc with trauma, sepsis, pancreatitis, hypercoaguable state

Question 13

Liver tests:

Answer 13

• hepatocyte injury (AST, ALT, ALP)
• hepatocyte catabolism (direct and indirect bilirubin)
• hepatocyte synthetic fxn (PT, albumin)
• other test for catabolic fxn: ammonia

-other: viral serology, tylenol level, paracentesis

-bili: conjugated=direct=produced by liver
normal is 70% unconjugated
-ALT more specific for liver than AST
-ALP more assoc with biliary obstruction and cholestasis, can double in pregnancy (normal)
-GGT - indicates EtOH but also MI, COPD, pancreatitis, warfarin

Question 14

PT prolongation

Answer 14

• indicates depletion of vit K dependent factors (II, VII, IX, X)
• also caused by vit K deficiency

Question 15

LIver failure: supportive

Answer 15

-ascites: if mild/moderate, can salt restrict, use diuretics, if mod/severe asc. then can paracentese (if platelets >42 and INR