L5: Liver Cell Failure Manifestations Flashcards
(69 cards)
1
Q
Def of LCF
A
- Is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology.
2
Q
Forms of LCF
A
3
Q
CP of LCF
A
4
Q
Failure of general Health
CP of LCF
A
with fatigue & weight loss
5
Q
Fever
CP of LCF
A
of low grade due to pyrogens released from damaged liver cells, HCC, or infection (SBP)
6
Q
Fetor Hepaticus
CP of LCF
A
- sweetish, fecal smell due to failure to detoxify mercaptans due to LCF or shunts
7
Q
IGT
CP of LCF
A
- Acute liver failure → hypoglycemia.
- Chronic liver failure → impaired glucose tolerance & rarely DM.
8
Q
Endocrinal Manifestations in males
CP of LCF
A
- Gynecomastia, feminine hair distribution, decreased libido, impotence, testicular atrophy.
9
Q
Endocrinal Manifestations in female
CP of LCF
A
- Atrophy of the breasts, decreased libido, amenorrhea, infertility
10
Q
mechanism of Endocrinal Manifestations
CP of LCF
A
Unknown but may be increased estrogen & decreased testosterone
11
Q
Increased Incidence of Infection
CP of LCF
A
SBP
12
Q
Cutaneous Signs of LCF
A
13
Q
Spider Naevi
A
- Central artery with radiating capillaries, at the distribution of SVC
14
Q
Palmar Erythema
A
Palms are red in color
15
Q
Paper Money Skin
A
Many small B.V. scattered through the skin in random fashion
16
Q
Leukonychia
A
due to hypoproteinemia
17
Q
Kolionychia
A
due to IDA
18
Q
Cardiovascular system effects in LCF
A
- Hyperkinetic circulation
- Hepato-pulmonary syndrome
- Platypnea & orthodeoxia
19
Q
Hyperkinetic circulation in LCF
A
20
Q
Hepato-pulmonary syndrome in LCF
A
21
Q
Platypnea & orthodeoxia
A
22
Q
Hematological Effects in LCF
A
23
Q
Jaundice in LCF
A
Hepatocellular Jaundice
24
Q
Def of Ascites
A
Accumulation of excess fluid in the peritoneal cavity
25
Types of **Ascites**
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Theories of Ascitis Formation
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pathogenesis of Ascitis in Liver Cirrhosis
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Grades of Ascites
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CP of **Ascites**
30
Complications of **Cirrohtic Ascites**
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Def of **SBP**
Infected ascetic fluid in absence of a cause of peritonitis.
32
CAusative Organism of **SBP**
Gram -ve in 70% of pathogens:
- E. coli (most common), Streptococcus, Klebsiella
33
CP of **SBP**
Occurs in 10% of cirrhotic patient.
34
Dx of **SBP**
- PMNL > 250 cells/mm3 even if no symptoms
- TLC 500 cells/mm3, but symptoms should be there
- SAAG > 1.1 = Portal HTN ascites
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Prophylaxis of **SBP**
36
TTT of **SBP**
37
investigations in **Ascites**
- Detection of ascites
- Ascetic tapping
- SAAG (Serum Ascites Albumin Gradient)
38
Ascetic Tapping for investigations on **Ascites**
39
Uses of SAAG
To differentiate portal HTN from non-portal HTN ascites
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Causes of **SAAG >11 g/L (1.1 mg/dL)**
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Causes of **SAAG < 11 g/L (1.1 mg/dL)**
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DDx of **Ascites**
43
TTT of **Cirrohtic Ascites**
The Dark Circle
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Diet in **Cirrhotic Ascites**
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Follow up in **Cirrhotic Ascites**
Measurement of:
- Urine volume & body weight.
- Electrolytes (K & Na), renal function.
46
Diuretics in **Cirrhotic Ascites**
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Tapping of **Cirrhotic Ascites**
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TTT of Resistant Ascites
49
Severe Terminal Cases of **Cirrhotic Ascites** are TTT by .....
50
what is Diuretic-resistant ascites?
- Ascites early recurring or not responding (weight loss < 200 gm/d) to adequate salt & fluid restriction & maximum doe diuretics (Lasix up to 160
mg / day & spironolactone up to 400mg/day), for at least one week.
- NSAIDs must be excluded, since NSAIDs blunt the response to diuretics.
51
What is Diuretic-Intractable Ascites?
- Ascites that cannot be treated adequately with diuretics because diuretic-associated complications, such as hepatic encephalopathy, renal insufficiency, hyponatremia and hypo- or hyperkalemia.
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Causes of Rapidly accumulating ascites
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Causes of Ascites without edema LL
54
Def of **Hepatic Encephalopathy**
Neuropsychiatric disorder that may complicate severe acute or chronic liver disease.
55
Types of **Hepatic Encephalopathy**
56
Pathogenesis of **Hepatic Encephalopathy**
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Production of Toxic Substances
**Pathogenesis of Hepatic Encephalopathy**
58
Toxic Substances involved in **Hepatic Encephalopathy**
These toxic substances include: Ammonia (most
accepted theory), GABA, mercaptans
59
Disturbance of AA
**Pathogenesis of Hepatic Encephalopathy**
60
Alkalosis & Hypokalemia
**Pathogenesis of Hepatic Encephalopathy**
61
PPT Factors of **Hepatic Encephalopathy**
62
CP of **Hepatic Encephalopathy**
63
TTT of **Hepatic Encephalopathy**
64
Pharmacological TTT of **Hepatic Encephalopathy**
65
Def of **HRS**
Functional renal failure in cirrhotic patients in the absence of renal pathology
66
Pathogenesis of **HRS**
67
Types of **HRS**
68
Dx of **HRS**
69
TTT of **HRS**
