Pathogenesis of Acute and Chronic Liver Failure

Question 1

Most common cause of acute liver failure

1. Worldwide
2. North America

Answer 1

1. Viral

2. Drug

Question 2

Pathogenesis of viral hepatitis

Answer 2

Secondary to immune response to infection

Question 3

Pathogenesis of drug and toxin injury to ive

Answer 3

Acetaminophen makes toxic metabolites when oversaturated enzymes
Other reactions are idiosyncratic

Question 4

What is one symptom when someone has acute liver failure from acetaminophen that points to need for transplant?

Answer 4

Encephalopathy (grade 3 or 4)

Question 5

Symptoms of chronic liver disease decompensation

Answer 5

Encephalopathy (confusion)
Spare body hair
Spider angioma
Muscle wasting
Dilated vessels
Red palms
Ascites
Jaundice

Question 6

What cells cause liver fibrosis?

Answer 6

Stellate cells

Question 7

Pathophys of portal hypertension

Answer 7

Splanchnic vasodilation causes a decrease in effective circulating volume
RAAS increases causing renal vasoconstriction
Cardiac output increases and systemic vascular resistance decreases

Question 8

4 MELD criteria used for transplant listing

Answer 8

INR
Bilirubin
Creatinine
Na

Question 9

Signs of encephalopathy

Answer 9

Decreased LOC
Slurred speech all the way to coma
Asterixis

Question 10

Mechanism of hepatic encephalopathy

Answer 10

Increased GABA activity

Hyperammonemia from gut, false gut NTs (mechanisms unknown)

Question 11

How to treat encephalopathy

Answer 11

Correct precipitating events
Lactulose (trap ammonia)
Intra-lumenal antibiotics