Chronic Liver Failure II

Question 1

What are several proposed mechanisms of hepatic encephalopathy?

Answer 1

ammonia, nitrogenous wastes, increased intracellular glutamine, astrocyte swelling, cerebral edema, inflammatory cytokins alter bbb

Question 2

what is chronic hepatic encephalopathy?

Answer 2

often slow and subtle on onset, family notices, coworkers wont

Question 3

what are physical signs of encephalopathy

Answer 3

hyperextended the wrists and reprititive movement, inability to perform sustained grip of hand, hyperextension of he ankles

Question 4

what is a treatment of encephalopathy

Answer 4

lactulose, poorly absorbable sugar, cathartic, decreases intestinal pH, decreases glutamine absorpption, reduces syntehsis and absorption of nh3

zinc, cofactor in nh3 metabolism
antibiotics - alter intestinal flora, decrease nh3

Question 5

do people with encephalopathy need to cut down protein

Answer 5

nope

Question 6

what are alzhemier type ii astrocytes?

Answer 6

seen in metabolic encephalopathy, large round vasicular nuceei with scanty chromatin and prominent nucleolus

Question 7

what is hepatorenal syndrome?

Answer 7

a syndrome where the kidneys are not damaged yet shut down from signs from the liver. liver failure causes renal arterial vasoconstriction and renal failure

Question 8

what do you see on labs and eval with hepatorenal syndrome?

Answer 8

cirrhosis and ascites
serum creat over 1.5
no imporvement

Question 9

what are teh two types of hepatorenal syndrome?

Answer 9

i - rapid worsening

ii - slow progression

Question 10

what is mpgn associated with?

Answer 10

hep c