Hepatic Failure Overview

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Questions and Answers

What is the term for the accumulation of fat in the liver?

Steatosis

What causes hepatic encephalopathy?

A buildup of ammonia in the brain

Which of these statements about alcoholic hepatitis is true?

It does not usually cause significant problems.

It often progresses to cirrhosis in one to two years. (correct)

It is characterized by inflammation and fibrosis in the liver. (correct)

It is a severe form of cirrhosis with few treatment options.

It is a reversible condition with no lasting damage.

What are the primary functions of the liver?

Storage of glycogen and vitamins, and blood filtration. Signup and view all the answers

B-adrenergic blockers are used to control portal hypertension primarily by reducing blood pressure.

False Signup and view all the answers

Which of the following viruses causes cirrhosis?

Hepatitis B Signup and view all the answers

What is the term for the new channels formed in the body to bypass the liver during portal hypertension?

Portosystemic shunts Signup and view all the answers

What is the most common cause of chronic hepatitis, cirrhosis, and hepatocellular cancer worldwide?

Hepatitis C Signup and view all the answers

What is the term for the process of creating new liver tissue to replace damaged cells?

Hepatocyte regeneration Signup and view all the answers

What are the three stages of alcoholic liver disease?

Fatty liver, alcoholic hepatitis, and cirrhosis. Signup and view all the answers

Splenomegaly, a sign of portal hypertension, is due to the shunting of blood through the portal vein, causing an increase in pressure and swelling of the spleen.

True Signup and view all the answers

What is the most common cause of parenchymal damage to the liver?

Alcohol consumption Signup and view all the answers

Which of these conditions is NOT associated with the development of portosystemic shunts?

Jaundice Signup and view all the answers

What is the main function of the portal vein?

The portal vein carries blood from the digestive tract and spleen to the liver. Signup and view all the answers

What is the main cause of portal hypertension?

Portal hypertension is primarily caused by the obstruction of blood flow through the liver due to the presence of scar tissue or nodules. Signup and view all the answers

What is the main characteristic of compensated cirrhosis?

Compensated cirrhosis is often asymptomatic, meaning the individual may not experience any noticeable symptoms. Signup and view all the answers

Which of the following is NOT a common sign or symptom attributed to portal hypertension?

Hypoglycemia Signup and view all the answers

What is the main mechanism by which portosystemic shunts can cause hepatic encephalopathy?

Portosystemic shunts allow ammonia and toxins from the gut to bypass the liver and enter the systemic circulation, leading to hepatic encephalopathy. Signup and view all the answers

What is the main treatment strategy for ascites?

Diuretics Signup and view all the answers

What is the primary mechanism by which splenomegaly occurs in cirrhosis?

Splenomegaly occurs in cirrhosis due to the shunting of blood back along the splenic vein, which causes the spleen to enlarge. Signup and view all the answers

What is the main consequence of decreased liver function in cirrhosis?

Decreased liver function in cirrhosis results in a loss of the liver's ability to synthesize, store, metabolize, and eliminate substances, leading to various complications. Signup and view all the answers

What is the main cause of coagulopathies in cirrhosis?

Coagulopathies occur in cirrhosis because the liver is unable to produce clotting factors, leading to increased bleeding risk. Signup and view all the answers

What is the primary mechanism responsible for hyperammonemia in cirrhosis?

Hyperammonemia is due to the impaired ability of the liver to convert ammonia into urea, coupled with the increased ammonia levels from portosystemic shunts. Signup and view all the answers

Which of the following is NOT a common endocrine disorder associated with liver failure?

Hypothyroidism Signup and view all the answers

What is the main goal of treatment for alcoholic liver disease?

The primary goal of treatment is to eliminate alcohol consumption, reduce liver damage, and prevent further complications. Signup and view all the answers

What is the main characteristic of alcoholic hepatitis?

Alcoholic hepatitis is characterized by inflammation, necrosis of liver cells, and the presence of fibrotic tissue. Signup and view all the answers

What is the main mechanism by which alcohol consumption can lead to liver damage?

Alcohol metabolism generates excess NADH, which disrupts other metabolic processes, leading to increased production of reactive oxygen species (ROS) and inflammation. Signup and view all the answers

What is the main characteristic that differentiates alcoholic cirrhosis from alcoholic hepatitis?

Alcoholic cirrhosis is distinguished by the presence of extensive uniform nodules on the surface of the liver, indicating the onset of end-stage alcoholic liver disease. Signup and view all the answers

Which of the following hepatitis viruses is NOT associated with chronic liver disease or cirrhosis?

Hepatitis A Signup and view all the answers

What is the primary mode of transmission for Hepatitis B?

Hepatitis B is transmitted through infected blood or serum, such as through needle sharing, sexual contact, or contact with infected bodily fluids. Signup and view all the answers

Describe the main difference between Hepatitis B and Hepatitis C in terms of their effects on the liver and treatment.

Hepatitis B is a DNA virus, while Hepatitis C is an RNA virus. Hepatitis B can be prevented with a vaccine, but Hepatitis C currently has no vaccine. Both viruses can cause chronic infection, cirrhosis, and liver cancer. Signup and view all the answers

Hepatitis A is a more serious liver infection than Hepatitis B.

False Signup and view all the answers

What is the main function of lobule?

Lobules are the functional units of the liver, responsible for carrying out the majority of the liver's functions, including filtration, detoxification, and metabolic processes. Signup and view all the answers

Which of the following is NOT a main category of liver function?

Digestion Signup and view all the answers

Describe the key characteristics of a nodule in cirrhosis.

Nodules are abnormal growths of liver tissue that develop in cirrhosis, replacing healthy cells with fibrotic scar tissue. These nodules impede blood flow and disrupt liver function. Signup and view all the answers

What are the main functions of hepatocytes?

Hepatocytes are the primary cells of the liver and are crucial for performing various functions, including: - Detoxification: Removing toxins from the bloodstream. - Protein synthesis: Producing albumin and clotting factors. - Metabolism: Processing carbohydrates, fats, and proteins. - Bile synthesis: Producing bile for digestion. Signup and view all the answers

Which of the following is NOT a manifestation of cirrhosis?

Hypoglycemia Signup and view all the answers

What is the main reason individuals with cirrhosis are more likely to develop edema or ascites?

Cirrhosis can lead to hypoalbuminemia, a low albumin level in the blood, which causes decreased oncotic pressure in the blood vessels. This makes fluids more likely to leak out of the vessels into the surrounding tissues, contributing to edema and ascites. Signup and view all the answers

Describe the three stages of alcoholic liver disease and their main characteristics.

The three stages of alcoholic liver disease are: 1. Fatty liver: characterized by fat accumulation in the liver cells, often reversible. 2. Alcoholic hepatitis: characterized by inflammation, necrosis of liver cells, and presence of fibrotic tissue, with a higher risk of mortality. 3. Alcoholic cirrhosis: characterized by extensive fibrosis, nodules on the liver surface, and irreversible liver damage. Signup and view all the answers

Which hepatitis viruses are most commonly associated with cirrhosis?

Hepatitis B and C Signup and view all the answers

Study Notes

Hepatic Failure

Portal vein blood circulates through organs, returning to circulatory system
Blood flow to liver is blocked or slowed in hepatic failure
Hemorrhoids and splenomegaly can be symptoms of liver failure

Assessing liver function (covered in introduction)
Cirrhosis
Alcoholic liver disease
Hepatitis-induced cirrhosis

Cirrhosis

Injury causes scar tissue and restricts hepatocyte regeneration
Scar tissue constricts blood flow in hepatic vasculature, causing portal hypertension
Bile ducts are also constricted, leading to bile stasis
Main causes of scarring are parenchymal damage, vascular disease, and biliary tract disease

Etiologies of Liver Damage

Parenchymal damage: alcohol, autoimmune hepatitis, viral hepatitis (hep B and C), nonalcoholic fatty liver disease, obesity, hypertension, and hyperlipidemia
Vascular disease: right heart failure, hepatic congestion, and clots in hepatic veins
Biliary tract disease: inflammation of intrahepatic and extrahepatic bile passageways (cholangitis) causing bile backflow

Clinical Manifestations of Cirrhosis

Compensated cirrhosis is usually asymptomatic, manifesting when the condition decompensates
Three main complications: portal hypertension, decreased liver function, and hepatocellular carcinoma
Manifestations include hepatic encephalopathy, esophageal varices, ascites, splenomegaly, and acute kidney injury
Decreased liver function includes hypoalbuminemia, coagulopathies, ammonia buildup, hyperestrogenism, and hyperbilirubinemia (jaundice)

Portal Hypertension

Increased pressure in hepatic portal vein causes blood to be diverted
Development of collateral channels
Shunting of blood, ammonia, and toxins from the intestines to general circulation
Leads to splenomegaly, anemia, leukopenia, thrombocytopenia, and bleeding
Esophageal varices and caput medusae

Portal Hypertension: Portosystemic Shunts

High pressure in hepatic portal vein causes existing collateral channels to carry blood backwards
New channels develop between gastric and esophageal veins causing esophageal varices
Blood bypassing the liver does not get processed into urea, causing hepatic encephalopathy
Backflow in mesenteric veins causes ascites and splenomegaly

Portosystemic Shunts: Complications

Internal iliac veins pressure causes hemorrhoids; remnant umbilical veins cause caput medusae
Rupture of esophageal varices causes hematemesis and melena
Elevated ammonia levels result in hepatic encephalopathy, manifest by loss of alertness, confusion, anxiety, personality changes, and speech impairment

Portal Hypertension: Ascites

Blood backs up into the peritoneal cavity filling with fluid
Hydrostatic pressure increases in mesenteric veins resulting in fluid buildup
Abdominal distension occurs as fluid builds up in the peritoneal cavity
Risk of bacterial translocation due to microbes traveling into the peritoneum causing peritonitis

Ascites: Treatment

Dietary restrictions and diuretics (inhibiting aldosterone-sensitive parts of the nephron, e.g. loop diuretics)
Bed rest prevents renin system activation
Paracentesis and volume expanders (albumin) help maintain effective circulating volume

Portal Hypertension: Splenomegaly

Blood is diverted to the splenic vein, causing the spleen to enlarge
Sequestration of formed blood elements (e.g., RBCs, platelets, and leukocytes) is known as hypersplenism
Increased transit time through the spleen leads to removal of formed elements from the blood, resulting in anemia, thrombocytopenia, and leukopenia

Decreased Liver Function

80-90% of liver's function is lost causing synthesis, storage, metabolic, and elimination dysregulation
Main complications include decreased clotting factors, thrombopoietin production, hypoalbuminemia, decreased ammonia clearance, hyperestrogensm, and decreased bilirubin processing

Liver Failure

Characterized by multiple problems in liver function
Disorders related to synthesis and storage
Disorders of metabolic and excretory functions

Liver Function

Impaired clotting factor production leads to GI bleeds, intracranial hemorrhages, and nosebleeds
Blood loss is exacerbated by low platelet count
Hypoalbuminemia exacerbates ascites and edema because of colloid pressure disruption
Fewer hepatocytes convert ammonia into urea, causing ammonia buildup

Liver Failure: Endocrine Disorders

The liver normally metabolizes estrogens keeping them in circulation long-term.
High levels of estrogens cause testicular atrophy and gynecomastia in males, menstrual irregularities, infertility, and reduced libido in females
Impaired bilirubin conjugation leads to bile acid reduction and malabsorption of fats and fat-soluble vitamins (e.g., K). This accumulates in the sclera and skin (cholestasis), resulting in jaundice.

Liver Failure: Treatment

Eliminating alcohol if alcohol-related
Providing sufficient carbohydrates to prevent protein breakdown
Managing ammonia production by controlling protein intake
Preventing infections
Liver transplantation can treat end-stage liver disease

Alcoholic Liver Disease

Alcohol is metabolized by the liver through alcohol dehydrogenase
Conversion process produces Acetaldehyde, NADH is a product
Excess NADH is problematic disrupting normal metabolite production/breakdown
Excess NADH inhibits: Fatty Acid Oxidation, Gluconeogenesis, and Ketogenesis
This causes an excess build-up of fats and reduced production of glucose

Alcoholic Liver Disease: Alcohol Consumption

Amount of alcohol intake needed varies based on body size, age, sex, and ethnicity
Conservative estimates suggest 80g/day for 10-12 years.
Fat accumulation and inflammation can resolve if alcohol consumption decreases, but scarring remains
Alcoholic Liver Disease occurs in three stages: fatty liver, alcoholic hepatitis, and cirrhosis

Fatty Liver

Increased lipogenesis leads to fat (steatosis) accumulation in hepatocytes.
Liver size increases, becoming yellow
Progression's cause is unclear, but likely relates to alcohol consumption amount, diet and hormones
Fatty liver is usually reversible

Alcoholic Hepatitis

Characterized by liver inflammation and cell damage
Necrosis of liver cells occurs, along with presence of inflammation, and fibrotic tissue
Severity increases if alcohol intake is increased
High mortality rate (about 10%), persistent drinking leads to cirrhosis in 1-2 years

Alcoholic Cirrhosis

End-stage of alcoholic liver disease
Characterized by uniform nodules in the liver due to liver's regenerative capacity
Nodules compress hepatic veins and bile ducts, causing complications such as cholestasis, and portal hypertension (leads to portosystemic shunts)

Hepatitis-Induced Cirrhosis

Hepatitis generally refers to liver inflammation
Many viruses (e.g., Epstein-Barr virus, herpesviruses, enteroviruses, and hepatitis A, B, C, D, and E) cause systematic liver inflammation
Hepatitis occurs through direct hepatocyte injury and the body's immune response to viral antigens
Inability to remove virus early may lead to chronic hepatitis and ability to transmit virus.
Hepatitis A, D, and E do not frequently result in chronic liver disease
Viral hepatitis syndromes include, asymptomatic infection, acute hepatitis with or without progression to liver failure, carrier state with or without chronic hepatitis, chronic hepatitis with or without progression to cirrhosis

Hepatitis B

Double-stranded DNA virus
Transmitted through blood and serum contact, sexual contact, and intravenous drug use
Includes acute and chronic forms of hepatitis, cirrhosis, fulminant hepatitis, and carrier state
Immunization provides long-term protection. Treatment includes interferons and antiviral agents, liver transplantations also

Hepatitis C

Single-stranded RNA virus
Transmitted through blood or serum contact, e.g. drug use
Frequently results in Chronic hepatitis, cirrhosis, and hepatocellular cancer,
Absence of vaccine; treatment includes interferons, nucleoside agents, and liver transplantations

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Description

This quiz covers the essential aspects of hepatic failure, including causative factors and physiological impacts on the liver. Participants will explore liver dysfunction symptoms, such as portal hypertension, and the underlying causes of liver damage. It's an insightful journey into understanding the liver's critical role in the body and the implications of its failure.