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BRS1 - Valentine > Liver Failure > Flashcards

Liver Failure Flashcards

(46 cards)

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1
Q

What is the normal levels of Bilirubin?

what amount of BR will lead to yellow sclera and yellow skin

A

Normal BR- 17umol/L

yellow sclera and mucous - if BR exceeds 30umol/L

yellow skin if BR exceeds 34umol/L

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2
Q

What is cholestasis ans what is it’s relationship with jaundice

A

Cholestasis- slow/cessation of bile flow

cholestasis will lead to jaundice

however if there’s jaundice, that doesn’t necessarily mean that there’s cholestasis

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3
Q

What are the potential causes of pre-hepatic jaundice

A

Ineffective erythropoiesis- sickle cell or spherocytes

Large haematoma resorption

Massive transfusion; transfused erythrocytes are short lived

Hameolysis - caused by toxins or haemolytic anaemia

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4
Q

What are the intrahepatic causes of jaundice

A
  • Decreased BR uptake into liver- Gilbert syndrome
  • Decreased conjugation of BR- Crigler-Najar syndrome
  • Decreased secretion of BR into biliary canaliculi- Rotor and Dublin-Johnson syndrome; both autosomal recessive conditions
  • Intrahepatic cholestasis
  • Liver failure
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5
Q

What is the pathogenesis (what could cause it) of liver failure

A

When rate of Hepatocyte death is higher than rate of regeneration

Hepatocyte death caused by combination of apoptosis and/or necrosis

apoptosis caused by drugs like paracetamol. Necrosis caused by ischaemia particularly in zone 3

This can lead to coma/deat due to multi organ failure

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6
Q

What are the 2 types of acute liver failure and describe them

A

Fulminant hepatic failure - rapid development of severe acute liver injury in less than 8 weeks. Previously normal liver or well compensated liver liver disease

Sub-fulminant - less than 6 months

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7
Q

What are the physiological hallmarks of fulminant acute hepatic failure

A

Impaired synthetic fucntion - e.g albumin , INR PT time is elongated

encephalopathy

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8
Q

What can chronic liver failure lead to

A

Cirrhosis - occurs slowly over years

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9
Q

What awe the common causes of acute liver failure

A

Toxins in the WEST

  • OD paracetamol
  • Amanita phalloides- mushrooms
  • Bacillus cereus - bacteria found in soil

Inflammation - in the EAST

  • Hepatitis E (India)
  • Exacerbations of chronic Hep B (Hong Kong)
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10
Q

What are the other causes of Acute liver failure

A
  • Disease of pregnancy
  • Idiosyncratic drug reactions
  • Vascular diseases
  • Metabolic causes
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11
Q

Give examples of diseases of pregnancy that can cause acute liver failure

A
  • Acute fatty liver of pregnancy
  • HELLP syndrome -(haemolysis, elevated liver enzymes, low platelet count)
  • hepatic infarction
  • HEV (Hep E)
  • Budd- Chiari
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12
Q

Give examples of vascular diseases that can cause acute liver failure

A
  • Ischaemic hepatitis
  • post OLTx (orthotopic liver transplantation)
  • hepatic artery thrombosis
  • post cardiac arrest
  • VOD- veno-occlusive disease
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13
Q

Give examples of idiosyncratic drug reactions that can cause liver failure

A

Single agent drugs

  • isoniazaid, NSAIDs or valproate

Drug combinations

  • rifampicin & isoniazid
  • amoxicillin and clavulanic acid
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14
Q

Give examples of metabolic causes of acute liver failure

A
  • Wilson’s disease- too much copper in blood
  • Reye’s syndrome - affect children more
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15
Q

What are the causes of chronic liver failure (Cirhossis)

A
  • Inflammation - chronic persistent viral hep B/C
  • alcohol abuse
  • Side effects of drugs- folic acid antagonists and phenylbutazone
  • Cardiovascular causes- decreased venous return
  • Non alcoholic steatohepatitis (NASH)
  • Autoimmune Hepatitis, PBC, PSC
  • inherited diseases
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16
Q

Give examples of inherited diseases that can cause cirrhosis

A
  • Glycogen storage diseases
  • Wilson’s disease
  • Galactosameia
  • Haemochromatosis
  • a1-antitrypsin deficiency
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17
Q

Summarise the pathophysiology of cirrhosis

draw

A
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18
Q

Name the consequences of liver failure by linking it to normal liver functions

A
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19
Q

One of the consequences of liver failure is decreased albumin production. What does this lead to and how?

Study These Flashcards
A

Lead to formation of ascites. This then lead to:

  • firstly a decrease in plasma vol
  • this leads to secondary hyperaldosteronism
  • then lead to hypokalaemia
  • this leads to alkalosis
20
Q

What clotting factors does hepatocytes make?

Study These Flashcards
A

All but VWF and Factor 8c

21
Q

Draw the potential outcomes for cirrhosis

i.e. how it leads alkalosis and and encephalopathy

22
Q

One of the consequences of cirrhosis is cholestasis.

Explain the downstream effects of cholestasis in all its potential possibilities

draw if possible

Study These Flashcards
A

Exacerbate liver damage

Aggravetse any bleeding tendency . By:

  • first a reduction in bile salts
  • lower micelles and absorption of Vit K
  • lower y carboxylation of factor 7,9,10 and 2 (glutamic acid residues)
  • Hence can lead to GI bleeding
23
Q

What are the mechanisms of (that causes) cholestasis

Study These Flashcards
A
  • Canilcular dilation
  • decreased cell membrane fluidity
  • Deformed brush border
  • Biliary transporters
  • increased tight junction permeability
  • decreased mictochondrial ATP synthesis
24
Q

What are the clinical consequences of cholestasis

Study These Flashcards
A
  • Jaundice
  • Pruritus (itching)- caused by bile salt deporting as crystals on skin
  • Cholesterol deposition
  • Malabsorption
  • Cholangitis
25
Another consequence of cirrhosis is portal hypertension. What are the downstream effects of this?
* Decreased lymphatic flow which will **make ascites worse** * **Thrombocytopenia** resulting from splenomegaly * **Oesophageal varices** * **Severe bleeding** from reduced clotting factors and varices * **exudative enteropathy**
26
What happens in **exudative enteropathy**? Describe the potential effects of this
Increased ascites due to loss of albumin from plasma favours bacteria in large bowels being fed proteins from exudate increased liberation of ammonium which can be toxic to the Brain
27
What are the causes of portal hypertension that isn't DIRECTLY cirrhosis
Portal hypertension is caused by **increased vascular resistance** **Pre hepatic** - portal vein thrombosis **Post hepatic** - right heart failure and constrictive pericarditis **Intrahepatic** * **pre sinusoidal** * **sinusoidal** * **Post sinusoidal**
28
Summarise the causes of the intrahepatic causes of portal hypertension . Explain for pre sinusoidal and sinusoidal increased vascular resistance you can draw the pathway if you want
Pre sinusoidal caused by: * chronic hepatitis * PBC,- primary biliary cholangitis * Granuloma - TB or schistosomiasis Sinusoidal caused by: * acute hepatitis * **alcohol** * **fatty liver** * toxins * amyloidosis
29
What causes post sinusoidal intrahepatic increased vascular resistance
* Venous occlusive disease of venules and small veins * Budd- chiari syndorme (obstruction of large Hepatic Veins)
30
What are the consequences of portal hypertension draw pathway If you wish
It leads to increased portal vein pressure hence leading to: * Malabsorption * Splenomegaly * Varices * Encephalopathy * Increased Vasodlators
31
What causes varices
Thin walled collateral vessels coupled with thrombocytopenia and decreased clotting factors this leads to increased bleeding (in systemic circulation) - varices
32
What are the symptoms of encelopathy
Apathy memory gaps tremor and liver coma
33
What mechanism can lead to encephalopathy from cirrhosis draw if you wish
* **Hyperammonaemia** * **Hypokalaemia** * **Toxins**- amines, phenols bypass liver (As it's damaged) and go straight to brain * **False transmitters** - made from aromatic amino acids in brain is increased due to liver failure. These transmitters can lead to encephalopathy
34
What is the portal systemic anastomoses that leads to varices mention as much as you can
1) oesophageal tributaries of left gastric vein anastomose with tributaries of azygous veins 2) middle and inferior rectal vein anastomose with superior rectal vein 3) collateral of portal vein anastomose with phrenic vein 4) vein of posteiror abdominal wall anastomose with colic veins
35
Draw the mechanism that can lead to Hepato-renal syndrome
36
What is used to assess liver disease severity explain the criteria and the meaning of the results gotten from it
Child-Pugh score- assess disease verity for end stage liver disease and a prognosticator for peri-op death
37
What are the causes of death due to liver failure
* Bacterial and fungal infections * Ciruclatory instability * Cerebral oedema * Renal failure * Respiratroy failure * Acid-base and electrolyte disturbance * Coagulopathy
38
Wat are the liver support devices
Bio-artificial; Hepatocyte in culture Hepatocyte trnasplantation Artificial (MARS,Bio-logic DT) albumin exchange system ; based on selective removal of albumin bound toxins from blood
39
What are indications for liver transplantation
Others include : * Budd-Chiari * Benign liver tumours * Polyscystic liver disease
40
Descirbe the process of liver transplantation
\*add notes from research\*
41
What are the supportive treatment options for * Hypoglycaemia * Hypocalcaemia * renal failure * encephalopathy
42
What are the supportive treatment options for: * respiratory failure * hypotension * infection * Bleeding
43
What is the survival rate of OLTx and what is needed for ensure that the OLTx is successful
5 yr survival rate between 60-80% no recurrence of disease BUT patient require life long immunosuppression
44
Explain the effect of increased vasodilators as a result of increased portal vein pressure
There's more glucagon, VIP, NO and prostacyclins Hence there's reduced BP which leads to increased CO(cardiac output) this leads to hyper perfusion of abdominal organs and varices
45
Describe the causes of hyperammonaemia (from cirrhosis of liver) that eventually leads to encephalopathy
More GI bleeding hence more colonic proteins broken down also liver cant convert (NH3 NH4+) to urea hence contributing to hyperammonaemia
46
Explain the causes of hypokalaemia (from cirrhosis of liver) that eventually leads to encephalopathy I.e. how does hypokalaemia lead to encephalopathy and how does encelopathy lead to alkalosis
Intracellular acidosis activates ammonium formation in proximal tubules. This leads to systemic alkalosis and hence encephalopathy respiratory component with hyperventilation leads to secondary encephalopathy

BRS1 - Valentine (54 decks)

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