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Flashcards in Chronic Liver Failure - Last one Deck (24):
1

Edema is fluid within the tissues whereas ascites is free fluid

ok

2

Acute Liver failure time frame defined as

Less than 6 mos

3

Chronic liver failure

More than 6 mos

4

Encephalopathy worse in chronic or acute

Acute

5

What is the mechanism behind encephalopathy?

- Ammonia and nitrogenous wastes crossing the BBB
- Increased intracellular glutamine
- Astrocyte swelling
- Inflammatory cytokines alter BBB

6

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

7

Which neurotoxin deposits in the basal ganglia?

Manganese

8

the major cause of death from cerebral edema?

Cerebral herniation

9

How many grades of hepatic encephalopathy>

4

10

4 is the worst, it = coma

ok

11

Is chronic encephalopathy usually reversible?

Yes

12

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

13

Protein restriction in hepatic encephalopathy

Hell no

14

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

15

How do you reverse hepatorenal syndrome?

Reverse the liver failure

16

In order to have hepatorenal syndrome you pretty much need to have cirrhosis and ascites

ok

17

WHat is the serum creatinine level usually at in hepatorenal syndrome?

Over 1.5

18

Diagnosis of hepatorenal syndrome...two criteria:

- exclude other cuases like nephrotoxic durgs and dyes.

- Lack of return of renal function with intravascular volume repletion

19

Type 1 hepatorenal

rapidly worsening

20

Type 2

Slow progression

21

Treatment of HRS

-VOLUME REPLETION
- look for underlying infection, often times there is spontaneous bacterial peritonitis
- Avoid meds which can worsen renal perfusion
- Avoid contrast

Ultimately replace the liver

22

Most common cause of secondary IgA nephropathy?

Liver disease

23

Membranous Glomerulonephritis associated with

Hep C

24

cooler temperatures leading to protein precipitation?

Cryoglobulinemia