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15 Cards in this Set
- Front
- Back
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What is the definition of Acute Liver Failure?
What is the biggest cause of ALF? Clinical outcome of ALF is related to... (3) |
- Rapid onset of synthetic dysfunction (janudince, coagulopathy)
- encephalopathy - no prior liver dz Acetaminophen use Etiology Degree of encephalopathy Degree of multisys organ fail |
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Should you percutaneously biopsy a liver in the setting of coagulopathy? What can you do?
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No.
Transjugular biopsy. |
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What is the difference between an intrinsic hepatotoxin and an idiosyncratic hepatotoxin?
What is the pathophysiology behind intrinsic hepatotoxicity? |
intrinsic:
- injury is reproducable and dose-dependent - liver mets many drugs, generating many metabolites that may be toxic if not inactivated Idiosyncratic: - neither predictable nor dose dependent - temporally unpredictable Toxic metabolite accumulates as liver glutathione stores become depleted. |
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What drug can boost glutathione?
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NAC
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What is the threshold for acetaminophen toxicity in adults?
How soon after this dose will biochemical signs of liver damage appear? |
10 to 15 grams
24-48hrs |
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Explain the pathogenesis of herpes hepatitis.
What are the 3 M's of morphology of Herpes Hepatitis? |
rare & potentially fatal dz; occurs most often in pts w/ impaired immunity (premature infants and the immunosuppressed)
- often takes a fulminant course if not recognized and tx'ed - Multinucleation - molding of nuclei - margination of nuclear chromatin about central "ground glass" nucleoplasm |
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Does an increase in aminotransferases (AST, ALT) necessarily reflect synthetic dysfunction?
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No.
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Order the following in terms of quickness of dz onset:
hyperacute, subfulminant, and fulminant. |
fulminant, subfulminant, hyperacute
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Which complication of Acute Liver Failure presents w/
- cerebral edema - hyperammonemia - ↑ cerebral blood flow This complication can lead to death by what? |
Encephalopathy
Herniation |
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Is renal failure a complication of ALF? If so, describe the pathophysiology.
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Yes.
- ATN - Volume depletion - Hepatorenal syndrome - direct nephrotoxicity |
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Infections complication ALF are primarily related to which three thing?
Is Hemorrhage a complication of ALF? |
pulmonary sys, renal system, and catheters.
Yes - impaired synth of clotting factors - low-grade fibrinolysis - platelet defects: thrombocytopenia |
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Pulmonary edema or ARDS occurs in ___% of pts with ALF?
Pathogenesis? Is Hypoglycemia a complication of ALF? |
1/3rd
Encephalopathy may impair ability to protect airway - ^^PaCO2 --> cerebral vasodilation --> ^^ICP Yes. |
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Pts with ALF often get metabolic acidosis... what ions are low?
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K and PO4
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Should pts with ALF be given FFP and/or sedatives?
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No, because we may disqual them from txplt.
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Can we usually give curative tx to ALF pts?
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No, mainly just supportive care until txplt.
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