L2: Liver Failure

Question 1

What is the commonest cause of portal hypertension?

Answer 1

Cirrhosis

Question 2

What is an example/cause of pre-hepatic portal hypertension?

Answer 2

portal vein thrombosis - block in portal vein

Question 3

What is an example/cause of (intra)hepatic portal hypertension?

Answer 3

• cirrhosis

- non-cirrhotic cause like portal tract fibrosis due to schistosomiasis

Question 4

What can schistosomiasis cause?

Answer 4

portal tract fibrosis which can lead to portal hypertension

Question 5

What is schistosomiasis?

Answer 5

s a disease caused by parasitic flatworms called schistosomes

Question 6

What is an example/cause of post-hepatic portal hypertension?

Answer 6

obstruction venous outflow from liver (e.g. Budd Chiari Syndrome)

Question 7

What is caput medusae? Why does it occur?

Answer 7

• dilation of the abdominal wall veins

- due to portal hypertension and backup of blood in porto-systemic anastomoses

Question 8

What is the commonest cause of ascites?

Answer 8

Cirrhosis

Question 9

What are some of the common bacteria associated with SBP?

Answer 9

E. coli

Klebsiella

Question 10

If a person has ascites, when would you start to suspect that they have SBP?

Answer 10

• fever
• abdominal pain/tenderness
• altered mental state

Question 11

If hepatic encephalopathy is severe, what 2 things may it be associated with?

Answer 11

1. cerebral oedema

2. cerebral hypoperfusion

Question 12

Why might Type A HE occur?

Answer 12

acute liver failure

Question 13

Why might Type B HE occur?

Answer 13

porto-systemic shunting with a NORMAL liver

Question 14

Why might Type C HE occur?

Answer 14

cirrhosis (decompensation)

Question 15

What are the 4 stages of HE?

Answer 15

1. Confusion
2. Drowsiness
3. Somnolence
4. Coma

Question 16

What is considered covert HE?

Answer 16

minimal HE + stage 1 HE

Question 17

What is considered overt HE?

Answer 17

HE from stages 2 to 4

Question 18

What is the treatment for HE?

Answer 18

• Lactulose

- Rifaximin

Question 19

What liver blood tests are associated with liver cell (hepatocellular) damage?

Answer 19

ALT, AST

Question 20

What liver blood tests are associated with obstruction to bile flow?

Answer 20

Alkaline Phosphatase, gGT, Bilirubin

Question 21

What liver blood tests are associated/related to liver function

Answer 21

Bilirubin, Albumin, Coagulation Function (PT/INR)

Question 22

If the AST/ALT ratio is greater than 2, what does this suggest?

Answer 22

alcohol-related damage

Question 23

Alk Phos may indicate bile flow obstruction, but it my also be found in what 2 other places?

Answer 23

Bone, Placenta

Question 24

Does albumin have a long or short half life?

Answer 24

Long half-life (so reflects chronic injury to liver)

Question 25

Do clotting factors have a long or short half-life?

Answer 25

Short half-life (so reflects acute damage to the liver)

Question 26

What is Wilson's Disease?

Answer 26

there is excess amount of copper in body

Question 27

What is the liver blood test that is done to check for Wilson's disease?

Answer 27

Caeruloplasmin

Question 28

Which enzyme helps with the conjugation of bilirubin with glucuronate?

Answer 28

UDPGT-1 Enzyme

Question 29

If there is isolated hyperbilirubinaemia, would it most likely be conjugated or unconjugated?

Answer 29

most commonly unconjugated bilirubin

Question 30

If there is jaundice associated with liver and biliary tract disease, would it most likely be conjugated or unconjugated?

Answer 30

conjugated bilirubin

Question 31

What is Gilbert's Syndrome?

Answer 31

- autosomal recessive - liver doesn't properly process bilirubin - genetic defect in bilirubin conjugation enzyme - have mildly raised bilirubin

Question 32

What type of bilirubinaemia will cholestasis cause?

Answer 32

conjugated hyperbilirubinaemia - pale stools - dark urine - jaundice - elevated Alk Phos/gGT - fat malabsorption

Question 33

How is an extrahepatic duct obstruction most commonly identified?

Answer 33

via ultrasound

Question 34

What are the 3 different types of liver biopsies?

Answer 34

1. Percutaneous 2. Transjugular 3. Laparoscopic

Question 35

What is a fibroscan?

Answer 35

it is a specialized ultrasound which measures fibrosis and fatty change in the liver

Question 36

What is the treatment for primary and secondary prevention of oesophageal and gastric varices?

Answer 36

1. Band Ligation | 2. Non-Selective Beta Blockers

Question 37

When is a paracentesis/therapeutic tap done for ascites?

Answer 37

for diuretic-resistant ascites in cirrhosis

Question 38

What is the treatment for ascites?

Answer 38

- Na+ restrictions - Diuretics (e.g. spirinolactone or furosemide) - therapeutic paracentesis - avoid NSAIDs

Question 39

WHY does hepatic encephalopathy mainly occur?

Answer 39

due to SHUNTING, the ammonia that is normally filtered out by the liver is not being filtered out anymore

Question 40

MINIMAL hepatic encephalopathy can be revealed by what type of testing?

Answer 40

Psychometric Testing

Question 41

What is the typical value for the ALT/AST ratio?

Answer 41

<1

Question 42

What is the normal level of bilirubin in the body?

Answer 42

< 18 umol/L

Question 43

What is the value range for Biochemical Jaundice?

Answer 43

> 18 but < 50 umol/L

Question 44

What is the value for clinical jaundice?

Answer 44

> 50 umol/L

Question 45

List 2 possible causes of unconjugated, isolated hyperbilirubinaemia (± jaundice)

Answer 45

1. Increased Haemolysis | 2. Gilbert's Syndrome

Question 46

Gilbert's Syndrome is a inherited condition which leads to isolated, unconjugated hyperbilirubinaemia. Bilirubin levels typically rise in a/w.....[2]

Answer 46

1. Fasting | 2. Illness

Question 47

What markers will be elevated in response to cholestasis?

Answer 47

Alk Phos, gGT

Question 48

List some of the effects of cholestasis

Answer 48

- conjugated hyperbilirubinaemia - pruritis (due to retained bile salts) - fat malabsorption (steatorrhea) - fat soluble vitamin malabsorption (ADEK) - hypercholesterolaemia

Question 49

List some contraindications for liver biopsy

Answer 49

- clotting problems - anti-clotting drugs - biliary obstruction

Question 50

What stain is used to stain for a) fibrosis and b) iron in the liver?

Answer 50

a) Trichrome Stain | b) PERL (Prussian Blue) Stain