Hepatic Disorders and Failure Overview

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Questions and Answers

What is the estimated percentage of chronic infection in hepatitis B cases?

20-30 percent

85-90 percent

6-10 percent (correct)

40-50 percent

What role does the hepatitis D virus (HDV) play in liver disease?

It enhances the effects of already existing HBV infection. (correct)

It solely causes portal hypertension.

It prevents the onset of chronic liver disease.

It causes liver disease independently.

What is the primary consequence of chronic hepatitis C infection?

Low incidence of hepatic cirrhosis

Development of fulminant hepatic failure

Chronic liver disease in 70 percent of cases (correct)

Rapid recovery of liver function

What causes the progression to cirrhosis in the liver?

Fibrous scarring combined with hepatocyte regeneration Signup and view all the answers

What is a common complication of portal hypertension?

Splenomegaly Signup and view all the answers

What is a significant danger associated with varices caused by portal hypertension?

Ulcers and hemorrhage Signup and view all the answers

Which of the following describes how cirrhosis affects liver function?

Replaces liver architecture with scar tissue Signup and view all the answers

What can result from reduced blood flow through the liver in chronic liver disease?

Worsening metabolic deficiencies Signup and view all the answers

Which hepatitis virus is noted for causing chronic infection?

Hepatitis B virus (HBV) Signup and view all the answers

What is a common complication associated with hepatic failure?

Hepatorenal syndrome Signup and view all the answers

Which of the following is NOT a classification of hepatobiliary diseases?

Neoplastic disorders Signup and view all the answers

What is the estimated yearly occurrence of Hepatitis A virus (HAV) infections in the U.S.?

125,000 to 200,000 cases Signup and view all the answers

What is the outcome of acute hepatitis A virus (HAV) infection with respect to liver function?

Fulminant liver failure is a rare complication Signup and view all the answers

Which virus is unlikely to cause clinically evident hepatitis in healthy individuals?

Cytomegalovirus (CMV) Signup and view all the answers

Identify the process NOT typically linked to hepatic dysfunction.

Skeletal muscle injury Signup and view all the answers

What term describes complications arising from liver failure that involve the kidneys?

Hepatorenal syndrome Signup and view all the answers

What condition is commonly associated with acute liver disease and can cause symptoms like anorexia and low-grade fever?

Viral hepatitis Signup and view all the answers

Which of the following is NOT a potential consequence of ascites?

Increased glomerular filtration rate Signup and view all the answers

Which statement correctly describes cholestatic disease?

It is associated with symptoms such as pruritus and clay-coloured stools. Signup and view all the answers

What effect does splenomegaly have on blood components?

Contributes to anemia and thrombocytopenia Signup and view all the answers

Which abnormality is commonly noted in the physical examination of chronic liver disease?

Palmar erythema Signup and view all the answers

Which condition is most likely to cause severe, premature liver failure?

Wilson disease Signup and view all the answers

Ascites may contribute to which of the following complications?

Hepatic encephalopathy Signup and view all the answers

What physical finding is most characteristic of advanced cirrhosis?

Shrunken and grossly nodular liver Signup and view all the answers

Study Notes

HEPATIC DISORDERS AND HEPATIC FAILURE

This chapter reviews epidemiology, pathophysiology, and clinical presentation of acute and chronic liver failure.
It summarizes laboratory testing, evidence-based emergency diagnosis, and management of hepatic failure complications.
The complications covered include gastrointestinal hemorrhage, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy.

ACUTE AND CHRONIC LIVER DISEASE

Epidemiology

Approximately one-third of the US population has acquired immunity to hepatitis A virus (HAV).
About 125,000-200,000 HAV infections are reported annually, with an estimated 100 deaths.
Fulminant liver failure is a rare HAV complication.
Chronic HAV infection does not occur.
Vaccination against hepatitis B virus (HBV) has significantly reduced fulminant hepatic failure.
Chronic infection occurs in 6-10% of hepatitis B cases.
Hepatitis C develops in 85% of those infected, with 70% of those developing chronic liver disease.
Hepatitis D virus (HDV) is rare and requires concomitant hepatitis B infection to cause infection.
This type of infection often results in rapid progression & high short-term mortality, especially among intravenous drug users.

Pathophysiology

Hepatobiliary diseases are categorized by hepatocellular, cholestatic, immunologic, and infiltrative processes.
Alcoholic liver disease and viral hepatitis are common causes of acute and chronic liver disease.
Other causes include toxins, drug reactions, autoimmune, and metabolic disorders.
Cirrhosis develops from fibrous scar tissue mixed with liver cell regeneration, responding to sustained inflammation, toxins, or metabolism insults.
Scar tissue isolates regenerating liver cells, leading to decreased metabolic function.
Scarring increases resistance to blood flow within the portal circulation (portal hypertension).
Reduced blood flow limits metabolic function.
Portal hypertension causes splenomegaly and gastroesophageal varices.

CLINICAL FEATURES

Acute liver disease symptoms vary.
Hepatocellular necrosis (with viral hepatitis): anorexia, nausea, vomiting, low-grade fever.
Cholestatic disease: jaundice, pruritus, clay-colored stools, dark urine.
Chronic liver disease presents with various complications:
- Abdominal pain, ascites, gastrointestinal bleeding, fever, and altered mental status.
- Progressive generalized fatigue might be the only symptom.
Other history features to note include sexual behavior, travel, alcohol use, drug use, nutritional supplements intake, blood transfusions, needle exposures, herbal remedies, mushroom consumption, or raw oyster consumption.
Family history might reveal hereditary conditions causing mild symptoms or laboratory abnormalities (like Gilbert syndrome).
Severe or premature chronic liver failure is associated with other familial liver disorders (e.g., Wilson disease, hemochromatosis, or α1-antitrypsin deficiency.)

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Description

This quiz covers the essential aspects of hepatic disorders, focusing on the epidemiology, pathophysiology, and clinical presentation of both acute and chronic liver failure. It delves into diagnostic evaluations, management strategies, and common complications associated with hepatic failure, such as gastrointestinal hemorrhage and hepatic encephalopathy.