2. Liver Failure

Question 1

What is the most common cause of portal hypertension?

Answer 1

Cirrhosis

Question 2

Give a cause of pre-hepatic hypertension?

Answer 2

Portal vein thrombosis

Question 3

Give a cause of non-cirrhosis hepatic portal hypertension?

Answer 3

Schistosomiasis

Question 4

What are the consequences of portal hypertension?

Answer 4

Varices
Shunting
Ascites and hepatorenal syndrome
Splenomegaly and hypersplenism

Question 5

What is the treatment for varices?

Answer 5

Drugs to reduce portal blood flow
Band ligation
Non-selective beta blockers

Question 6

What are the non-cirrhosis causes of ascites?

Answer 6

Ovarian and GI cancers
Hypertension
Heart failure
Pancreatitis
TB

Question 7

What tests can be done after paracentesis of ascites?

Answer 7

Cell count
Micro
Albumin
Cytology

Question 8

What is the treatment for ascites?

Answer 8

Sodium restriction
Spironolactone
Paracentesis
Avoid NSAIDs

Question 9

Why are NSAIDs avoided in ascites?

Answer 9

Cause vasoconstriction in the kidney

Question 10

What is spontaneous bacterial peritonitis?

Answer 10

Infection of ascites fluid with no evidence of a surgically treatable cause

Question 11

What are the most common pathogens in spontaneous bacterial peritonitis?

Answer 11

E. coli

Klebsiella

Question 12

What are the symptoms of spontaneous bacterial peritonitis?

Answer 12

Fever
Abdominal pain
Altered mental state

Question 13

When should spontaneous bacterial peritonitis be treated?

Answer 13

Cell count >250

Question 14

What results from severe hepatic encephalopathy?

Answer 14

Cerebral oedema

Hypoperfusion

Question 15

What factors might precipitate encephalopathy in a known cirrhotic liver?

Answer 15

Infection
Bleeding
Dehydration
Drugs and alcohol
Constipation

Question 16

What is the treatment for hepatic encephalopathy?

Answer 16

Reduce ammonia production
Lactulose (laxative to clear toxins from gut)
Non-absorbable antibiotics (remove bacteria from gut)

Question 17

Which liver tests show liver damage?

Answer 17

Transaminases

Question 18

Which liver tests show obstruction to bile flow?

Answer 18

Alk phos
GGT
Bilirubin

Question 19

What test shows acute liver damage?

Answer 19

Coagulation function

Question 20

What test shows chronic liver damage?

Answer 20

Albumin

Question 21

What tissues is AST released from?

Answer 21

Damaged hepatocytes
Muscle
Mycoardium
Kidneys

Question 22

What ratio is used to show alcohol-related liver damage?

Answer 22

AST/ALT >2

Question 23

Where is alk phos found?

Answer 23

Hepatocyte border of bile cannaliculi

Bone and placenta

Question 24

What is the use of GGT?

Answer 24

Correlate with alk phos to show it’s from liver
Increased by alcohol and drugs
Very sensitive but not specific

Question 25

What tests can be done to find the cause of liver failure?

Answer 25

``` Viral serology Transferrin saturation or ferritin Autoantibodies, IgG, IgM Copper metabolism A1AT ```

Question 26

What is a normal bilirubin level?

Answer 26

<18umol/L

Question 27

What bilirubin level presents as jaundice?

Answer 27

>50umol/L

Question 28

What is unconjugated bilirubin bound to?

Answer 28

Albumin

Question 29

What is bilirubin conjugated with?

Answer 29

Glucuronate

Question 30

What enzyme conjugates bilirubin?

Answer 30

UDPGT-1

Question 31

What investigations should be done into isolated hyperbilirubinaemia?

Answer 31

FBC, film, reticulocytes, haptoglobin and LDH for haemolysis | Gilbert's syndrome

Question 32

What investigation should be done into conjugated hyperbilirubinaemia?

Answer 32

Ultrasound to exclude extrahepatic duct obstruction

Question 33

What is Gilbert's syndrome?

Answer 33

Genetic defect in bilirubin conjugation enzyme | High bilirubin when fasting or sick

Question 34

What are the symptoms of cholestasis?

Answer 34

``` Jaundice, dark urine, pale stools Pruritis Fat and ADEK malabsorption Hypercholesterolaemia High alk phos and GGT ```

Question 35

What are the causes of extra-hepatic duct obstruction?

Answer 35

Stone Tumour Stricture

Question 36

What infection is associated with extra-hepatic duct obstruction?

Answer 36

Ascending cholangitis

Question 37

What are the uses of ultrasound in relation to the liver?

Answer 37

Dilated ducts Gallstones Focal liver lesions Liver texture and border

Question 38

What is used to remove stones from bile ducts?

Answer 38

Endoscopic retrograde choledochopancreatography

Question 39

What are the methods of biopsy for the liver?

Answer 39

Percutaneous Transjugular Laproscopic

Question 40

What are the contraindications to liver biopsy?

Answer 40

``` Clotting problems (do coag screen first) Biliary obstruction ```

Question 41

What is transient elastography used for?

Answer 41

Shows elasticity of liver