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BRS Y1 > Week 11- Liver Failure > Flashcards

Week 11- Liver Failure Flashcards

1
Q

What is the main pathophysiological characteristic of jaundice

A

High levels of bilirubin

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2
Q

What is the normal level of plasma BR?

A

17 micro ml

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3
Q

What happens when BR exceeds 30 micro ml?

A

Yellow sclera and mucous membranes

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4
Q

What happens when BR exceeds 34 micro ml?

A

Yellow skin

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5
Q

What is cholestasis?

A

Slow bile flow/ cessation of bile flow

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6
Q

Does jaundice always indicate cholestasis?

A

No

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7
Q

What are pre hepatic causes of jaundice?

A

Haemolysis, ineffective erythropoiesis, massive transfusion etc reducing bile production

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8
Q

What are intra hepatic causes of jaundice?

A

Problems with conjugation of bilirubin, decreased uptake, decreased secretion, reduced outflow (cholestasis), liver failure

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9
Q

What are post hepatic causes of jaundice?

A

Gallstones, tumors etc reducing extra hepatic outflow

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10
Q

What is liver disease from pathophysiological point of view?

A

Hepatocyte death rate > hepatocyte regeneration

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11
Q

How does cell death occur in liver failure?

A

Can apoptosis or necrosis (or a combination)

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12
Q

How serious is liver failure?

A

Very serious, can lead to multiple organ failure and coma

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13
Q

What are the 2 types of acute liver failure? Define them

A

Fulminant hepatic failure= rapid development in less than 8 weeks of severe acute liver injury, impaired synthetic function, encephalopathy, previously normal liver
Sub fulminant= same but develops in less than 6 monthds

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14
Q

What is chronic liver failure?

A

Over years, cirrhosis

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15
Q

What are the 2 common causes of liver failure and where are they most common?

A

Toxins (western world): Paracetamol, bacillus cereus

Inflammation (eastern world): Hep E (India) and chronic Hep B exacerbations (Hong Kong)

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16
Q

What are some other uncommon causes of acute liver failure?

A

Disease of pregnancy
Idiosyncratic drug reactions
Vascular disease
Metabolic disease

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17
Q

What are causes of chronic liver failure?

A 
Inflammation
Alcohol abuse
Side effects of drugs
Cardiovascular disease
Inherited disease
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18
Q

What is the consequence during hepatocyte failure of lack of production of clotting factors?

A

Coagulopathy and bleeding

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19
Q

What is the consequence during hepatocyte failure of lack of protein synthesis?

A

Ascites

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20
Q

What is the consequence during hepatocyte failure of lack of detoxification?

A

Encephalopathy and cerebral oedema

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21
Q

What is the consequence during hepatocyte failure of lack of glycogen storage?

A

Hypoglycaemia

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22
Q

What is the consequence during hepatocyte failure of lack of immunological function and globulin production?

A

Increased susceptibility to infection

23
Q

What is the consequence during hepatocyte failure of lack of maintenance of homeostasis?

A

Circulatory collapse, renal failure

24
Q

Why do ascites arise?

A

Reduced albumin

25
Q

What are the consequences of cholestasis pathophysiologically?

A

Aggravates bleeding tendency, reduced bile salts results in reduced absorption of vit K and its carboxylation

26
Q

What are the clinical consequences of cholestasis?

A 
Increased BR leads to jaundice
Pruritus (itching)
Cholesterol deposition
Malabsorption
Cholangitis
27
Q

What condition associated with blood cell count occurs due to liver failure and why?

A

Thrombocytpenia due to splenomegaly

28
Q

What does exudative enteropathy in liver failure lead to?

A 
Increased ascites (loss of albumin from plasma)
Increased liberation of ammonia (toxic to the brain)
29
Q

What makes ascites worse during liver failure?

A

Reduced lymphatic flow

30
Q

What are pre hepatic causes of portal hypertension?

A

PV thrombosis

31
Q

What are intra hepatic causes of portal hypertension?

A 
Presinusoidal= chronic hepatitis, granulomas
Sinusoidal= acute hepatitis, alcohol, fatty liver, toxins
Postsinusoidal= venous occlusive disease of venules and small veins
32
Q

What are consequences of portal hypertension?

A

Malabsorption
Splenomegaly- anaemia and thrombocytopenia
Vasodilators- glucagon, prostacyclins etc lead to hyperperfusion of abdominal organs and varices
Encephalopathy- toxins from the intestine get into the CNS
Varices- thin walled collateral vessels and reduced clotting factors w thrombocytopenia lead to bleeding

33
Q

What is hepatic encephalopathy?

A

Apathy, memory gaps, tremor and liver coma

34
Q

What is clinically observable in someone with hepatic encephalopathy?

A

Hyperammonaemia (liver cant NH3 or NH4+ to ammonia)
Hypokalaemia
Toxins (bypass the liver)
False transmitters

35
Q

How is the severity of liver failure measured?

A

Via the Child- Pugh score

36
Q

What total bilirubin level gives 1/2/3 points on the Child- Pugh score?

A

1: <34
2: 35-51
3: >51

37
Q

What serum bilirubin level gives 1/2/3 points on the Child- Pugh score?

A

1: >35
2: 28-35
3: <28

38
Q

What INR level gives 1/2/3 points on the Child- Pugh score?

A

1: <1.7
2: 1.71- 2.3
3: >2.3

39
Q

What ascites level gives 1/2/3 points on the Child- Pugh score?

A

1: none
2: slight/surpressed with medication
3: moderate despite diuretics/refractory

40
Q

What hepatic encephalopathy level gives 1/2/3 points on the Child- Pugh score?

A

1: none
2: grade I-II
3: grade III-IV

41
Q

How is the Child Pugh scale used?

A

Class A: 5-6 points (expectancy of 15-20 yrs)
Class B: 7-9 points (transplant candidate)
Class C: 10-15 points (life expectancy 1-3 months)

42
Q

What treatment is offered to those with liver failure for encephalopathy?

A

Reduce protein intake

Phosphate enemas/lactulose

43
Q

What treatment is offered to those with liver failure for hypoglycaemia?

A

Infusion 10-50% dextrose

44
Q

What treatment is offered to those with liver failure for hypoglycalcaemia?

A

10ml 10% gluconate

45
Q

What treatment is offered to those with liver failure for renal failure?

A

Haemofiltration

46
Q

What treatment is offered to those with liver failure for respiratory failure?

A

Ventilation

47
Q

What treatment is offered to those with liver failure for hypotension?

A

Albumin and vasoconstrictors

48
Q

What treatment is offered to those with liver failure for infection?

A

Frequent cultures

Antibiotics

49
Q

What treatment is offered to those with liver failure for bleeding?

A

Vit K
FFP
Platelets

50
Q

What are causes of death from liver failure?

A 
Bacterial and fungal infections
Circulatory instability
Cerebral oedema
Renal failure
Respiratory failure
Acid/base or electrolyte disturbance
Coagulopathy
51
Q

What are some liver support devices used to treat liver failure?

A

Artficial albumin exchange system- based on selective removal of albumin bound toxins from blood
Bioartificial- hepatocytes in culture
Hepatocyte transplantation

52
Q

What are the main indications for liver transplantation

A

Cirrhosis
Cancer
Cholestatic disease

53
Q

What is required lifelong after liver transplation

A

Immunosurpression

54
Q

What is the 5 year survival rate of liver transplants?

A

60-80% and no recurrence of disease

BRS Y1 (52 decks)

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