Week 15 - Liver failure, viral hepatitis, drug overdose Flashcards
what will reverse the effect of opiate overdose, typically in the presence of CNS and respiratory depression
naloxone
what are the symptoms of benzodiazepine overdose
symptoms: agitation, euphoria, blurred vision, slurred speech, ataxia, slate-grey cyanosis
what can reverse the effect of benzodiazepine overdose
Flumazenil
what are the signs and symptoms of aspirin overdose
Tinnitus
Lethargy
Dizziness
Nausea / vomiting
what is usually the treatment of choice in beta-blocker overdose
glucagon
how is hypocalcaemia corrected
with calcium
what is the treatment for cocaine and amphetamine overdose
benzodiazepine e.g diazepam
what is the treatment for carbon monoxide poisoning
hyperbaric oxygen
what are the antidotes for anti-freeze poisoning
ethanol
what is the antidote for cyanide poisoning
dicobalt edetate
what is the antidote for lead poisoning
sodium calcium edetate
what is the antidote for organophosphate poisoning
atropine
what is the antidote for heparin overdose
protamine sulphate
what does fibrosis affect in the liver
affects the structure and blood flow, increasing the resistance of the vessels leading into the liver.
what is this increased resistance and pressure in the portal system called
portal hypertensionw
what are the four most common causes of liver cirrhosis
Alcohol-related liver disease
Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B
Hepatitis C
what are the signs of liver cirrhosis on examination
Cachexia (wasting of the body and muscles)
Jaundice caused by raised bilirubin
Hepatomegaly (enlargement of the liver)
Small nodular liver as it becomes more cirrhotic
Splenomegaly due to portal hypertension
Spider naevi (telangiectasia with a central arteriole and small vessels radiating away)
Palmar erythema caused by elevated oestrogen levels
Gynaecomastia and testicular atrophy in males due to endocrine dysfunction
Bruising due to abnormal clotting
Excoriations (scratches on the skin due to itching)
Ascites (fluid in the peritoneal cavity)
Caput medusae (distended paraumbilical veins due to portal hypertension)
Leukonychia (white fingernails) associated with hypoalbuminaemia
Asterixis (“flapping tremor”) in decompensated liver disease
what does a non-invasive liver screen include
ultrasound liver (diagnose fatty liver)
hepatitis B and C serology
autoantibodies
immunoglobulins
caeruloplasmin (Wilson’s disease)
Alpha 1 antitrypsinogen
ferritin and transferrin
what are the autoantibodies relevant to liver disease
Antinuclear antibodies (ANA)
Smooth muscle antibodies (SMA)
Antimitochondrial antibodies (AMA)
Antibodies to liver kidney microsome type-1 (LKM-1)
what do the liver markers look like in decompensated cirrhosis
raised;
Bilirubin
Alanine transaminase (ALT)
Aspartate transferase (AST)
Alkaline phosphatase (ALP)
what will albumin look like in decompensated liver cirrhosis
low due to reduced synthetic function
what is a tumour marker for hepatocellular carcinoma
alpha-fetoprotein
what is the first-line investigation for assessing fibrosis in non-alcoholic fatty liver disease
enhanced liver fibrosis blood test
what may be seen in an ultrasound of liver cirrhosis
Nodularity of the surface of the liver
A “corkscrew” appearance to the hepatic arteries with increased flow as they compensate for reduced portal flow
Enlarged portal vein with reduced flow
Ascites
Splenomegaly
what is used as a screeing tool for hepatocellular carcinoma
Ultrasound is used as a screening tool for hepatocellular carcinoma (alongside alpha-fetoprotein).
what is the MELD score
NICE recommend using the MELD (Model for End-Stage Liver Disease) score every 6 months in patients with compensated cirrhosis. The formula considers the bilirubin, creatinine, INR and sodium and whether they require dialysis, giving an estimated 3-month mortality as a percentage.
what is the child pugh score
The Child-Pugh scores uses 5 factors to assess the severity of cirrhosis and the prognosis. Each factor is considered and scored 1, 2 or 3. The minimum overall score is 5 (scoring 1 for each factor), and the maximum is 15 (scoring 3 for each factor).
what is the pneumonic for the child pugh score
You can remember the features with the “ABCDE” mnemonic:
A – Albumin
B – Bilirubin
C – Clotting (INR)
D – Dilation (ascites)
E – Encephalopathy
what are the four principles of management in liver cirrhosis
Treating the underlying cause
Monitoring for complications
Managing complications
Liver transplant
what are the monitoring systems in place for liver cirrhosis
MELD score every 6 months
Ultrasound and alpha-fetoprotein every 6 months for hepatocellular carcinoma
Endoscopy every 3 years for oesophageal varices
what are the four key features of decompensated liver disease
The four key features can be remembered with the “AHOY” mnemonic:
A – Ascites
H – Hepatic encephalopathy
O – Oesophageal varices bleeding
Y – Yellow (jaundice)
what is the 5 year survival rate once cirrhosis has developed
50%
what are the several important complications of cirrhosis
Malnutrition and muscle wasting
Portal hypertension, oesophageal varices and bleeding varices
Ascites and spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatic encephalopathy
Hepatocellular carcinoma
what does the back pressure of blood in portal hypertension result in
splenomegaly
Back pressure in the portal system causes swollen and tortuous vessels at sites where collaterals form between the portal and systemic venous systems. These collaterals can occur at several locations, notably the:
Distal oesophagus (oesophageal varices)
Anterior abdominal wall (caput medusae)
what is the prophylaxis of bleeding in stable oesophageal varcies:
Non-selective beta blockers (e.g., propranolol) first-line
Variceal band ligation (if beta blockers are contraindicated)
what is TIPS
Transjugular intrahepatic portosystemic shunt (TIPS) is a technique where an interventional radiologist inserts a wire under x-ray guidance into the jugular vein, down the vena cava and into the liver via the hepatic vein. A connection is made through the liver between the hepatic vein and portal vein, and a stent is inserted. This allows blood to flow directly from the portal vein to the hepatic vein, relieving the pressure in the portal system.
what are the two main indictors for TIPS
bleeding oesophageal varices
refractory acities
what does ascites refer to
fluid in the peritoneal cavity