Flashcards in Chronic Liver Failure - Last one Deck (24)
Edema is fluid within the tissues whereas ascites is free fluid
Acute Liver failure time frame defined as
Less than 6 mos
Chronic liver failure
More than 6 mos
Encephalopathy worse in chronic or acute
What is the mechanism behind encephalopathy?
- Ammonia and nitrogenous wastes crossing the BBB
- Increased intracellular glutamine
- Astrocyte swelling
- Inflammatory cytokines alter BBB
What about benzodiazepines and hepatic encephalopathy
-Increased amounts of benzo receptors makes them extremely sensitive to benzos like valium
- Increased neurosteroids
- Manganese- neurotoxin which binds in the basal ganglia
Which neurotoxin deposits in the basal ganglia?
the major cause of death from cerebral edema?
How many grades of hepatic encephalopathy>
4 is the worst, it = coma
Is chronic encephalopathy usually reversible?
Treatment of hepatic encephalopathy?
Lactulose- acts as a cathartic, decreases pH of the intestines,
Zinc- zinc is a cofactor in NH3 metabolism. zinc deficiency is common in liver disease. Treat teh deficiency and they should metabolize ammonia better
Antibiotics- also decrease NH3
Nutrition- this improves the liver disease. Skeletal muscle metabolizes NH3. High vegetable proteins with branched chain AAs advised
Protein restriction in hepatic encephalopathy
One of the most feared complications of acute liver failure
Hepatorenal syndrome...basically where the liver tells the kidneys to shut down but the kidneys themselves have no abnormalities
How do you reverse hepatorenal syndrome?
Reverse the liver failure
In order to have hepatorenal syndrome you pretty much need to have cirrhosis and ascites
WHat is the serum creatinine level usually at in hepatorenal syndrome?
Diagnosis of hepatorenal syndrome...two criteria:
- exclude other cuases like nephrotoxic durgs and dyes.
- Lack of return of renal function with intravascular volume repletion
Type 1 hepatorenal
Treatment of HRS
- look for underlying infection, often times there is spontaneous bacterial peritonitis
- Avoid meds which can worsen renal perfusion
- Avoid contrast
Ultimately replace the liver
Most common cause of secondary IgA nephropathy?
Membranous Glomerulonephritis associated with