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20 Cards in this Set
- Front
- Back
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prothrombin time
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assess amount of circulating clotting factors - indirectly asses liver function
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acetomenophen toxicity
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most acetamenophen is glucuronidated to nontoxic form
10% is turned into toxic intermediates - if there isn't enough glutathion available for conjugation (due to alcohol, etc) -> accumulation of toxin will cause hepatocyte necrosis certain drugs can induce CYP2E1 and CYP3A4 to increase formation of toxin |
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N-acetyl cysteine
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treatment for acetomenophen overdose
increases amount of glutathione for conjugation with toxic intermediates |
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signs of chronic liver failure
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spider angiomata, ascities, caput madusa, splenomegaly, low platelet, low clotting factors, shrunken nodular liver, signs of cirrhosis
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aminita phyllodies, aminita verna
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poisonous mushroom
alpha-amatoxin inhibits protein synthesis -> hepatocyte death phalloidin interfere with actin and dmg enteric cell membranes |
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drug induced acute liver failure
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phenytoin, acetaminophen, valproic acid, HAART agents, isoniazid
amidarone - steatohepatitis |
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most common viral cause of fulminent hepatic failure
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Hepatitis B
dude to overactive immune response to clear virus |
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most common virus to cause symptomatic acute infection of liver
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Hepatitis C - doesnt cause acute liver failure often
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Hepatitis D
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requires concurrent HBV infection since it uses HBV machinery to bud
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Hepatitis E mortality is high in this group of paitents
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20% mortality in pregnant women
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fulminant hepatic failure
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encephalopathy within 8 weeks of jaundice
cerebral edema |
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childs pugh score (5 factors)
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looks at 5 factors: encephalopathy, ascites, bilirubin, albumin, PT prolongation
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wedged/free HV pressures
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wedged hepatic vein pressure = WHVP
free hepatic vein pressure = FHVP gradient = WHVP - FHVP normal <5 Portal HTN > 10 varices bleed WHVP > 12 |
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hepatic encephalopathy
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metabolic failure of liver causes ammonia to go unmetabolized
constructional apraxia, asterixis begins as slow mentation, mood changes -> lethargy -> suporus/obtunded -> comatose |
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causes of hepatic encephalopathy
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GUSDICK
GI bleeding uremia sedatives dietary indiscretion infection constipation hypokalemia |
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serum albumen-ascites gradient
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differentiate portal HTN from nonportal HTN
serum albumen - ascites albumen >1.1 = Portal HTN |
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cirrhosis caused portal HTN vs noncirrhotic
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cirrhosis casuses closure of sinusiod fenstration means ascites low in total protein
noncirrhotic (cardiac, budd chirari) the sinusoids are patent, protein leaks |
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infected ascites
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see with ascitic fluid protein < 1 - usually ecoli infection
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spontaneous bacteria peritonitis (ascites infection) vs Peritonitis
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SBP is monomicrobial, has less total protein, more glucose, and low LDH
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hepatorenal syndrome
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liver failure causes kidney failure
no actual damage to kidney, its a functional renal failure due to the liver failure (unknown mech) |
