liver

Question 1

commonest causes of liver disease in developed world

Answer 1

alcohol, non-alcoholic fatty liver disease

Question 2

commonest causes of liver disease in developing world

Answer 2

chronic viral hep B or C

Question 3

symptoms of liver disease

Answer 3

asymptomatic, with general lethargy, anorexia, malaise, pruritus (itchy skin), right upper quadrant pain

Question 4

symptoms of progressive liver failure

Answer 4

peripheral swelling, abdominal bloating, bruising, vomiting of blood, confusion and somnolence

Question 5

common signs of liver disease

Answer 5

jaundice; reduced ability to metabolise oestrogens: spider naevi, loss of body hair, gynaecomastia, testicular atrophy, palmar erythema

Question 6

other signs of liver disease

Answer 6

xanthelasma (yellowish deposit of cholesterol underneath skin - normally around eyelids), finger clubbing, pruritus, Dupuytren’s contracture, ascites and dilated abdominal veins, hepatomegaly, hepatosplenomegaly, caput medusa (severe portal hypertension), oedema, weight loss and loss of musculature, bruising, hepatic encephalopathy, fetor hepaticus (musty sweet breath), hepatic flap (coarse hand tremor)

Question 7

what 3 categoreis are signs split into

Answer 7

compensated (liver function compensated), general and decompensated (loss of function)

Question 8

what is the final common pathway for liver disease

Answer 8

cirrhosis (confirmed by biopsy)

Question 9

what is cirrhosis characterised by

Answer 9

necrosis of liver cells, followed by progressive fibrosis and nodule formation

Question 10

what does cirrhosis lead to

Answer 10

impairment of function and gross distortion of architecture, leading to portal hypertension and deterioration of liver function

Question 11

what does cirrhosis develop in response to

Answer 11

chronic liver injury

Question 12

2 types of cirrhosis

Answer 12

micronodular, macronodular

Question 13

feature of micronodular cirrhosis

Answer 13

uniform, small nodules up to 3mm diameter

Question 14

2 causes of micronodular cirrhosis

Answer 14

ongoing alcohol damage, biliary tract disease

Question 15

feature of macronodular cirrhosis

Answer 15

nodules of variable size

Question 16

cause of macronodular cirrhosis

Answer 16

chronic viral hepatitis

Question 17

definition of acute liver failure

Answer 17

severe hepatic dysfunction occuring within 6 months of onset of liver disease, with clinical manifestation of hepatic encephalopathy (brain) or coagulopathy (blood), caused by massive loss of hepatocytes

Question 18

3 classifications of acute liver failure

Answer 18

hyperacute: encephalopathy occurs within 7 days of jaundice onset; acute: encephalopathy occurs after 8-28 days of jaundice onset; subacute: encephalopathy occurs 5-12 weeks after jaundice onset

Question 19

divisions of primary features of hepatic failure after jaundice

Answer 19

CNS complications, coagulopathy, renal failure, sepsis, cardiovascular complications, metabolic complications

Question 20

sepsis and liver failure

Answer 20

90% with bacteria, 32% with fungi; infection within 3 days of admission; fever and leucoytosis absent; reduced in acute liver failure by prophylactic IV antibiotic therapy

Question 21

cardiovascular: what does acute hepatic failure cause a reduction in

Answer 21

peripheral resistance, requiring reflex increase in cardiac output to maintain pressure

Question 22

cardiovascular outcome of acute liver failure in pre-existing heart disease

Answer 22

cardiac failure, hypotension

Question 23

2 common metabolic signs in liver failure

Answer 23

hypoglycaemia, hypoxia

Question 24

what induces cerebral oedema in hepatic encephalopathy caused by liver failure

Answer 24

accumulation of toxins from gut - leads to coma

Question 25

what is hepatorenal syndrome

Answer 25

occurence of unexplained renal failure in patients with liver disease/patients undergoing surgery for biliary tract obstruction (kidneys are morphologically normal)

Question 26

what is renal failure due to in hepatorenal syndrome

Answer 26

reduced renal blood flow (more in cortex) due to cortical vasoconstriction, resulting from endotoxin (vasoactive) cleared in liver

Question 27

when does resolution only occur for hepatorenal syndrome

Answer 27

dramatic improvement in liver function (transplant), otherwise 95% fatality

Question 28

what coagulation factors does liver synthesise

Answer 28

I, II, V, VII, IX, X

Question 29

what coagulation factors are affected first in liver disease

Answer 29

vitamin K-dependent factors (II, VII, IX, X) - liver absorbs vitamin K; VII is earliest as has shortest half-life; fibrinogen (I) synthesis only affected in severe disease

Question 30

what does the liver inhibit in its role with coagulation

Answer 30

fibrinolysis/coagulation (synthesises plasma anticoagulant proteins C, S and antithrombin III)

Question 31

role of liver in clearing activated clotting factors

Answer 31

fibrin, tPA removed from circulation by reticuloendothelial system

Question 32

what does impairment in any coagulation-associated liver role lead to

Answer 32

bleeding, oozing at venepuncture sites from excessive fibrinolysis, bruising

Question 33

when does chronic liver failure occure

Answer 33

when there is a deterioration in liver function superimposed on chronic liver disease causing decompensation

Question 34

pathological processes causing potentially rapid acute deterioration

Answer 34

underlying disease process, different process undermining functional reserve of liver (e.g. infection, haemorrhage, electrolyte imbalance)