Hepatic Encephalopathy and Ammonia
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Questions and Answers

What is the primary outcome of chronic liver disease?

  • Liver cancer
  • Cirrhosis (correct)
  • Hepatitis
  • Liver failure

    • What is the characteristic appearance of the liver in cirrhosis?

  • Cobbly and firm (correct)
  • Swollen and tender
  • Palest and brittle
  • Smooth and soft

    • What is the primary cause of portal hypertension in cirrhosis?

  • Blood shunting through the liver
  • Obstruction of hepatic veins
  • Hypoxia and necrosis of hepatocytes
  • Increased resistance to flow in the portal venous system (correct)

    • What is the late-stage manifestation of cirrhosis and portal hypertension?

    <p>Ascites and edema</p> Signup and view all the answers

    What is the primary cause of alcoholic cirrhosis?

    <p>Alcohol abuse</p> Signup and view all the answers

    What is the primary site of damage and inflammation in biliary cirrhosis?

    <p>Bile canalculi and bile ducts</p> Signup and view all the answers

    What is the typical demographic affected by primary biliary cirrhosis?

    <p>Women over 30 years old</p> Signup and view all the answers

    What is the result of impaired synthesis of albumin by the liver in cirrhosis?

    <p>Decreased colloidal osmotic pressure</p> Signup and view all the answers

    What is the primary mode of transmission of Hepatitis A virus?

    <p>fecal-oral route through contaminated food or water</p> Signup and view all the answers

    What is the duration of the incubation period of Hepatitis A virus?

    <p>2-4 weeks</p> Signup and view all the answers

    What is the duration of contagiousness before the onset of symptoms in Hepatitis A virus infection?

    <p>2 weeks</p> Signup and view all the answers

    What is the primary site of replication of Hepatitis A virus?

    <p>liver</p> Signup and view all the answers

    What is the duration of Hepatitis A virus infection?

    <p>4 months</p> Signup and view all the answers

    What is the percentage of people in developed countries who have evidence of Hepatitis A virus infection by mid-adult life?

    <p>40-50%</p> Signup and view all the answers

    What is the characteristic of Hepatitis A virus infection in developing nations?

    <p>most children are infected by age 10</p> Signup and view all the answers

    What is the outcome of Hepatitis A virus infection?

    <p>it does not cause a carrier state or chronic hepatitis</p> Signup and view all the answers

    What is the primary function of the liver in regards to ammonia metabolism?

    <p>To convert ammonia to urea</p> Signup and view all the answers

    What is the usual cause of hypotension in hepatorenal syndrome?

    <p>GI bleeding or failing liver</p> Signup and view all the answers

    What is the effect of ammonia accumulation on the brain?

    <p>It alters cerebral metabolism and interferes with neurotransmitter function</p> Signup and view all the answers

    What is the outcome of hepatorenal syndrome if left untreated?

    <p>Fatal coma</p> Signup and view all the answers

    What is the primary cause of renal failure in hepatorenal syndrome?

    <p>Sudden decrease in blood volume</p> Signup and view all the answers

    What is the term for inflammation of the liver?

    <p>Hepatitis</p> Signup and view all the answers

    What is the effect of the liver's inability to remove vasoconstrictive substances in hepatorenal syndrome?

    <p>Renal vasoconstriction</p> Signup and view all the answers

    What is the outcome of ammonia accumulation in the brain?

    <p>Rigidity and hyperreflexia</p> Signup and view all the answers

    What is the predominant chronic liver disease in the US?

    <p>Hepatitis C</p> Signup and view all the answers

    What is the concern regarding transmission of Hepatitis C?

    <p>Even small amounts of blood during tattooing, acupuncture, and body piercing can facilitate transmission</p> Signup and view all the answers

    What percentage of Hepatitis C cases exhibit jaundice?

    <p>25%</p> Signup and view all the answers

    What is the role of antibodies in Hepatitis C?

    <p>They serve as markers of the disease</p> Signup and view all the answers

    What is unique about Hepatitis D?

    <p>It is a defective RNA virus that cannot infect the hepatocyte on its own</p> Signup and view all the answers

    What is the distinguishing feature of Hepatitis E?

    <p>It has a high mortality rate among pregnant women</p> Signup and view all the answers

    What is the primary location where Hepatitis E occurs?

    <p>Underdeveloped countries</p> Signup and view all the answers

    What is the relationship between Hepatitis D and Hepatitis B?

    <p>Hepatitis D co-infects with Hepatitis B and depends on it for replication</p> Signup and view all the answers

    What is the average life expectancy after the onset of symptoms in patients with cirrhosis?

    <p>8-10 years</p> Signup and view all the answers

    What is the primary cause of secondary biliary cirrhosis in children?

    <p>Biliary atresia</p> Signup and view all the answers

    What percentage of people with Hepatitis C develop post-necrotic cirrhosis?

    <p>25%</p> Signup and view all the answers

    Which of the following is NOT a common symptom of post-necrotic cirrhosis?

    <p>Diarrhea</p> Signup and view all the answers

    What is the primary method of diagnosis for post-necrotic cirrhosis?

    <p>Needle biopsy</p> Signup and view all the answers

    Which of the following is a complication of advanced alcoholic cirrhosis?

    <p>Post-necrotic cirrhosis</p> Signup and view all the answers

    What is the primary cause of death in patients with post-necrotic cirrhosis?

    <p>Bleeding varices</p> Signup and view all the answers

    Which of the following is a cause of secondary biliary cirrhosis?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Cerebral Edema and Hepatic Encephalopathy

    • Ammonia, a by-product of protein metabolism and intestinal bacterial action, accumulates in the brain and alters cerebral metabolism, leading to hepatic encephalopathy.
    • The liver's inability to convert ammonia to urea in liver failure causes neurologic signs, including rigidity, hyperreflexia, and seizures.
    • Fatal coma may occur due to hepatic encephalopathy.

    Hepatorenal Syndrome

    • Hepatorenal syndrome is a complication of advanced liver disease, characterized by renal failure.
    • The pathophysiology of hepatorenal syndrome involves a sudden decrease in blood volume, leading to decreased GFR, tubular necrosis, and renal vasoconstriction.
    • The liver's inability to remove vasoconstrictive substances, such as angiotensin, vasopressin, and catecholamines, contributes to renal vasoconstriction.

    Hepatitis

    • Hepatitis refers to inflammation of the liver and can be caused by viral infections, drug reactions, infectious disorders, and other factors.
    • Hepatitis A is caused by a small RNA-containing virus and is transmitted through the fecal-oral route.
    • The incubation period for HAV is 2-4 weeks, and individuals may be contagious for up to 2 weeks before the onset of symptoms.

    Hepatitis A

    • Hepatitis A is a self-limiting disease that usually runs its course within 4 months after exposure.
    • HAV does not cause a carrier state or chronic hepatitis.
    • By mid-adult life, about half of people in developed countries have blood anti-HAV antibodies as evidence of infection.

    Hepatitis C

    • Hepatitis C is the most common blood-borne infection in the US, affecting approximately 3.9 million Americans.
    • Chronic hepatitis occurs in 50-80% of cases, and HCV is the most common cause of chronic liver disease, cirrhosis, and liver cancer worldwide.
    • There is no vaccine available for HCV due to the over 50 subtypes of the virus.

    Hepatitis D

    • Hepatitis D is a defective RNA virus that cannot infect hepatocytes on its own and requires co-infection with HBV.
    • The Delta agent often increases the severity of HBV infection and can convert mild HBV infection into severe, fulminant disease.

    Hepatitis E

    • Hepatitis E is common in developing countries and clinically resembles hepatitis A.
    • It does not cause chronic or carrier states and has a high mortality rate (20%) among pregnant women.

    Cirrhosis

    • Cirrhosis is a leading cause of death in the US and represents the end stage of chronic liver disease.
    • Normal liver architecture and function are disrupted with the development of diffuse fibrosis and nodular regeneration.
    • Obstruction can cause portal hypertension, leading to increased resistance to flow in the portal venous system and blood shunting.

    Causes of Cirrhosis

    • Alcoholic cirrhosis (Laennec's cirrhosis) occurs after years of alcohol abuse and begins with fatty infiltration of the liver.
    • Biliary cirrhosis can be primary (autoimmune disease) or secondary (develops with prolonged partial or complete obstruction of the common bile ducts or branches).
    • Post-necrotic cirrhosis can result from severe liver disease, drugs, or toxins.

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    Description

    This quiz covers the role of ammonia in hepatic encephalopathy, a complication of liver failure. Learn how ammonia accumulation affects the brain and leads to severe symptoms.

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