GI/Renal Flashcards
(27 cards)
What is acute liver failure and what are the subtypes?
occurrence of encephalopathy, coagulopathy & jaundice in an individual with previously normal liver function or well-compensated liver disease
Subtypes:
hyperacute - within a week of onset of jaundice
acute - within 2-4 weeks post onset of jaundice
subacute - >4 weeks post onset of jaundice
What are causes of acute liver failure?
- toxicity eg paracetamol overdose
- Acute viral hepatitis
- Alcoholic hepatitis
- Acute Fatty liver of pregnancy
What are clinical features of acute liver failure on history?
- nausea, vomiting, agitation, abdominal pain
What are clinical features of acute liver failure on exam?
- jaundice
- encephalopathy
- Ascites
- Septic shock/hypotension
What are Ix in acute liver failure?
- FBE - high WCC in infective/inflammatory cause
- Coags
- BSL - risk of hypoglycaemia
- UEC - renal impairment
- Ammonia
- Paracetamol level
What are the main two types of chronic liver disease?
Chronic hepatitis
Cirrhosis
What are the causes of chronic liver disease?
Chronic hepatitis - HCV, HBV, autoimmune, drug induced
Cirrhosis - alcohol, HCV, HBV, drugs
What are clinical features of chronic liver failure on history?
fatigue, pruritis, bleeding, abdominal pain, nausea, anorexia,
myalgia, jaundice, dark urine, pale stools, fever, weight loss
What are clinical features of chronic liver failure on exam?
o Hands – leuconychia, clubbing, palmar erythema, bruising, asterixis
o Face – jaundice, scratch marks, spider naevi, fetor hepaticus
o Chest – gynaecomastia, loss of body hair, spider naevi, bruising, pectoral muscle wasting
o Abdomen – hepatosplenomegaly, ascites, signs of portal hypertension (splenomegaly, collateral veins /
haematemesis from oesophageal or gastric varices, ascites), testicular atrophy
o Legs – oedema, muscle wasting, bruising
o Fever – occurs in up to 1/3 of patients with advanced cirrhosis or if there is infected ascites
What are Ix for chronic liver failure?
- Bilirubin (normal <20)
- FBE - anaemia, thrombocytopaenia
- Coag
- Synthetic function - albumin, INR, glucose
- Liver injury - ALT, AST, ALP, GGT
- Liver USS - ultrasound, portal hypertension
What is used to calculate child pugh classification?
AABIE
Albumin, ascites
Bilirubin
INR
Encephalopathy
What is the periop mortality for child pugh A, B, C?
A = <5%
B = 5-50%
C = >50%
What are some complications of chronic liver disease?
Liver:
- Ascites
- Portal hypertension
Cardiac:
- Hyperdynamic circulation (high CO, low SVR)
- Cirrhotic cardiomyopathy
Resp:
- Portopulmonary hypertension
- Hepatopulmonary syndrome
Renal:
- Hepatorenal syndrome
What are some anaesthetic implications of chronic liver disease?
A - aspiration risk due to delayed gastric emptying
B - Ascites can cause restrictive lung disease
C - Check coags, risk of hyperdynamic circulation
Altered pharmacology
What is Haemochromatosis ?
Autosomal recessive disorder that disrupts the body’s regulation of iron & is characterised by increased accumulation of iron in various organs
What are the possible complications of haemochromatosis?
- liver cirrhosis
- diabetes (pancreatic fibrosis)
- Cardiac iron deposition (heart failure, conduction abnormalities, coronary atherosclerosis)
What are some implications of haemochromatosis?
- Check that ferritin is low end of normal (delay if high and treat)
- Check coagulation
- Check for cardiac, liver, pancreatic impairment and anaethetise accordingly (avoid myocardial depressents if cardiac failure etc.)
What is Wilson’s disease?
Inherited disease (autosomal recessive) of copper metabolism dysfunction characterised by cirrhosis & central nervous system findings
What organs are often affected by Wilson’s disease?
Liver - cirrhosis
Brain
Kidney
Cardiac - cardiomyopathy, rhythm abnormalities
What are important features on history for wilson’s disease?
- Multisystem involvement, liver, brain, kidney, cardiac
- Pinicillamine side effects (myasthenia like syndrome) from chelating agents used to prevent damaged from copper
What are some anaesthetic implications of wilson’s disease?
- exclude coagulopathy
- continue chelating agent therapy
- monitor for liver dysfunction and treat accordingly
- care with NMB with myasthenia like syndrome
What are common causes of CKD?
- Diabetic nephropathy
- HTN
- Glomerulonephritis
- obstructive nephropathies
- Autoimmune
What are common features on history for CKD?
- Cause and course of CKD
- Uraemic symptoms to assess adequacy of dialysis - anorexia, nausea, vomiting, pruritis, oedema
- Modality of RRT if on it
- Access for RRT
- Dry weight, last time dialysed
- Fluid restriction
- Urine output
- Sx of fluid overload eg PND, orthopnoea
- IHD features
What are common features to look for on examination in CKD?
General:
- mental state, pallor, scratch marks
- Assess volume status - mucous membranes, postural hypotension, tachycardia, oedema, weight gain, increased JVP
- Site of RRT access eg fistula
Cardiac:
-Signs of cardiac failure
- Pericarditis eg rub
Resp:
- chest creps
- pleural effusions
Abdomen:
- ascites
