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Gastroenterology > Liver failure > Flashcards

Liver failure Flashcards

1
Q

causes of acute liver failure

A

alcohol
HELLP syndrome
drugs (paracetamol overdose, isoniazid)
hepatitis A or B (extremely uncommon in C), EBV, CMV

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2
Q

causes of chronic liver failure

A 
PBC
Wilson's
alcohol
haemochromatosis
alpha 1 antitrypsin deficiency
NAFLD
HBV
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3
Q

symptoms of acute liver failure

A
  • hepatic encephalopathy
  • cerebral oedema
  • coagulopathy
  • hyponatraemia
  • jaundice
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4
Q

what causes hepatic encephalopathy

A

build up of nitrous waste. astrocytes clear it. excess glutamine produced by astrocytic clearing leads to osmotic shift which causes cerebral oedema

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5
Q

sx chronic liver failure

A 
clubbing
spider naevia
gynaecomastica
anaemia
jaundice
ascites 
peripheral oedema
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6
Q

what happens in alcoholic liver disease

A

inflammation of heptocytes (hepatitis) -> fibrosis -> eventually cirrhsis

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7
Q

LFTs in alc liver disease

A

AST:ALT ratio >2:1
serum GGT raised
bilirubin and alk phos can be raised
(FBC high MCV)

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8
Q

what can be seen on biopsy in alc liver disease

A

mallory bodies

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9
Q

med used for para overdose

A

n acetylcysteine (NAC)

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10
Q

how can cirrhosis be divided

A

micronodular

macronodular

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11
Q

drugs to avoid in cirrhosis

A

aspirin

NSAIDs

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12
Q

inheritance pattern of haemochromatosis

A

AR (but one type is AD)

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13
Q

what organs does haemochromatosis affect?

A 
deposition of iron in
joints
heart
liver
pancreas
skin
adrenals
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14
Q

symptoms of haemochromatosis

A

arthralgia
fatigue
slate grey skin
signs of chronic liver disease

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15
Q

rx haemochromatosis

A

regular venesection

low iron diet

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16
Q

what stain is used on liver biopsy to show haemochromatosis

A

perls stain

17
Q

when may secondary haemochromatosis occur

A

pts who have received >40L of blood transfusion in short time

18
Q

what is wilson’s disease

A

rare AR disorder of biliary copper excretion

copper builds up in liver and CNS

19
Q

CNS symptoms in wilson’s

A

tremor, dyskinesia, dystonia, mood distrubance, memory problems

20
Q

treatment of wilson’s

A

penicillamine

low copper diet

21
Q

what are the name of the rings in the eye in Wilson’s

A

kayser-fleischer rings

22
Q

what disease if emphysema, cirrhosis and cholestatic jaundice

A

alpha 1 antitrypsin deficiency

23
Q

symptoms of liver abscess

A

RUQ pain
tender large liver
tachycardia
fever

-how interesting!

24
Q

two types of liver abscess

A

pyogenic - bacteria from other infections via portal blood

amoebic - from bowel to liver (entamoeba histolytica)

25
Q

what pyogenic organissm

A 
staph
strep
e coli
klebsiella
anaerobes
26
Q

treatment of liver abscess

A

abx, possibly drainage

amoebic: metronidazole

27
Q

causes of portal HTN

A
  • pre hepatic: portal vein thrombosis
  • hepatic: cirrhosis
  • post hepatic: hepatic vein thrombosis, right heart failure
28
Q

signs of portal HTN

A

ascites
jaundice
splenomegaly

29
Q

diagnosis of portal HTN

A

measure hepatic venous pressure gradient

30
Q

most common causes of portal hypertension worldwide?

A

schistosomiasis

31
Q

what may portal hyptertension lead to the formation of

A

oesophageal varices (collaterals)

32
Q

what classification for acute liver failure

A

o’grady

jaundice to encelphalopathy time (hyperacute is within 7 days, actue 8-28 days, subacute 29days-12wk)

33
Q

rare causes of ALF

A 
ischaemic heaptitis
autoimmune hep
acute fatty liver of preg
wilson's
budd chiari
34
Q

when assessing paracetamol use, what to consider?

A

could be ACCIDENTAL e.g. taking cocodamol, lemsip and cold and flu remedy

35
Q

what value is used to assess coagulopathy

A

INR (nb 1 is normal because it’s a ratio!)

36
Q

factors increasing risk of hepatotoxicity

A 
staggered overdose
excessive alc consumption
malnutrtion
HIV
cancer
chronic liver disease
on antiepileptics, rifampicin, spirinolactone
37
Q

rx paracetamol overdose

A

n-acetylcysteine (NAC). GIVE BEFORE PARA LEVELS COME BACK AS THERE’S NO HARM!
IV fluids

Gastroenterology (15 decks)

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