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liver biopsy
MCQ Liver function test liver function test alpha feto protein Liver biopsy MCQ
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Hepatic encephalopathy
hepatic encephalopathy treatment Investigations clinical pictures etiology definition
definition of hepatic encephalopathy definition of hepatic encephalopathy It is a neuropsychiatric manifestations It is a neuropsychiatric manifestations due to liver cell failure Neuropsychiatric manifestations due to liver cell failure definition etiology neuropsychiatric manifestations Hepatic encephalopathy toxins Liver theory Colon
Liver
toxins toxins
toxins
Normal
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Liver cell failure toxins liver toxins blood stream toxins Liver toxins brain
theory Liver cell failure colon toxins Liver toxins blood stream toxins Liver toxins brain Liver
porto-systemic shunts
Liver
brain
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bypass colon toxins inferior vena cava Portal vein Liver bypassing inferior vena cava
bilharziasis Portal hypertension collaterals liver bypass toxins inferior vena cava
cirrhosis
bilharziasis
hepatic encephalopathy
brain suppression
brain brain
colon colon
toxins toxins
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renal failure
Urea
suppression brain ammonia brain suppression ammonia Krebs cycle inhibition ammonia glucose metabolism Krebs cycle krebs cycle brain suppression metabolism ammonia
theory Hepatic encephalopathy theory theory theory theory ammonia coma hepatic encephalopathy ammonia theory brain convulsions
ammonia convulsions
ammonia at least
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ammonia
methyl mercaptans
Liver Methyl mercaptans methyl mercaptans Liver Methyl mercaptans Liver methyl mercaptan Methyl mercaptan brain ammonia
brain
ammonia
ammonia
branched chains amino acids branches chains amino acids amino acids aromatic amino acids branched chains amino acids
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liver cell failure Liver cell failure branched chain amino acids
glycogen
liver
gluconeogenesis amino acids glucose amino acids branched chain Liver cell failure branched chain branched chains upper hand aromatic aromatic Inhibition hepatic encephalopathy theory
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gluconeogenesis
brain
injected
effect
naloxone
Naloxone
injection anesthesia
team
antidote
antidote
Hernia
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fungus
antidote
inhalation
inhalation
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theory Hypokalemia
diuretics
encephalopathy
diuretics paracentesis
diuretics Hypokalemia
encephalopathy
Hypokalemia
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ammonia
brain cells
shift << ammonia Hypokalemia ammonia encephalopathy alkalosis severe vomiting encephalopathy alkalosis alkalosis vomiting alkalosis
hepatic encephalopathy
positive ammonia
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Liver cell failure hepatic encephalopathy encephalopathy hepatic encephalopathy Liver cell failure Precipitating factors hepatic encephalopathy
Hepatic encephalopathy
hepatic encephalopathy
Precipitating factors Precipitating factors Precipitating factors sepsis Over growth of bacteria heavy protein meals Heavy protein meals
hematemesis
G.I.T.
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stage
clinical pictures hepatic encephalopathy Pre coma Coma Pre coma Pre coma
hepatic encephalopathy
Psychotic
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No comment
Hepatic encephalopathy two stages Pre coma stage Pre coma amnesia for time, place and persons flapping tremors asterixis apathy disturbed sleeping rhythm disturbed sleeping rhythm childish behavior childish behavior Sudden laugh to sudden cry
childish behavior construction apraxia construction apraxia Pre coma He cannot copy a complex design
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defecate
construction apraxia Loss of personal hygiene Loss of personal hygiene loss of personal hygiene urinate Urinate concept
social hygiene
Pre coma coma character Positive Babinski Positive Babinski coma stages of coma
coma
stage two
stage one
stage
stage
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Hypoglycemia
sub dural hematoma bleeding tendency hemorrhage Minor trauma Hemorrhage minor trauma
Which means Liver cirrhosis coma hepatic encephalopathy Which means coma cirrhosis Investigations blood glucose serum ammonia to exclude sub dural hematoma << CT brain
comatosed cirrhosis
liver cirrhosis
hepatic encephalopathy
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38
elements
colon toxins
absorption
oral neomycin
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Oral antibiotics
oral bacteria Orally << bacteria lacto-bacillus colon occupation colon proliferation colon colon lacto-bacillus orally colon proliferate suppress
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40
80 40
diet hematemesis Liver cell failure ryle liver cell failure hematemesis wash ryle G.I.T. G.I.T.
encephalopathy
blood G.I.T.
hematemesis
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Enema enema
flat
wash colon
Position
position
rectum colon
gravity
flat
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flat
enema
Nurse
G.I.T.
lactulose lactulose Lactose Lactic acid lactulose G.I.T. Lactose and lactic acid Lactose
intestine
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diarrhea
wash
ammonium absorption
stool
colon colon
colon
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Portal vein
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lactose
lactulose lactic acid lactose Osmotic diarrhea lactic acid hydrogen lactic acid
diarrhea
ammonia absorption back diffusion of the ammonia to the G.I.T. Hepatic encephalopathy lactulose
toxins toxins ammonia Liver cell failure Avoid transfusion of stored blood ammonia Hepamerz
urea L-arnithine
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ammonia
toxins mercaptan
branched chains amino acids branched chains amino acids branched chain branched chains adrenaline dopamine brain stimulation branched chain dopamine G.I.T. << Oral << dopamine L dopa
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papers
70
Papers 15 230
70 70
papers Papers
Paper paper
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100 staff
demands
ICU
coma
coma
ICU
hepatic encephalopathy
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papers flumazinel
benzodiazepine antagonist
hepatic encephalopathy
900 Flumazinel 3
flumazinel
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Flumazinel
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Convulsion
infusion
convulsions
infusion action
Hepatic encephalophathy
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5,000 5,000
5,000
papers
target target
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alkalosis
comatosed Supportive treatment Liver transplantation coma coma supportive treatment enema Liver transplant
waiting list
artificial liver artificial liver artificial biological liver artificial biological liver hepatocytes wall Lumen
hepatocyte
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toxins
hepatocyte
artificial liver Hepatocytes artificial biological liver artificial lung ventilator tissue artificial lung tissue artificial kidney dialysis
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G.I.T.
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C.N.S. C.N.S. fever fever fever Liver cell failure Liver cell failure bacteremia
Liver
disease Liver
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eye lid
Xanthelasma Edema
eye lid conjunctiva Sub conjunctival hemorrhages bleeding tendcy cornea Kayser Fleischer ring << cornea Wilson disease Kayser Fleischer ring wilson disease
Pallor
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saliva fletus
Methyl mercaptan
Methyl mercaptan Liver blood stream methyl mercaptan fletus saliva Liver
Noway
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Bleeding gum
Low immunity
Right sided heart failure right sided heart failure right sided heart failure congestive cirrhosis
diaphragm
raise ascites intra thoracic pressure venous return congested neck veins
Liver
heart
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copula of the diaphragm raise ascites Intra thoracic pressure venous return
liver
diseases At the same time heart failure cirrhosis congested neck veins diseases haemochromatosis
heart
amyloidosis
alcoholism
neck
goiter goiter
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chest
Liver
nitric oxide << vasodilator material vasodilators material Liver Liver vasodilator materials hyper dynamic circulation Hyper dynamic circulation water hammer pulse palpitation tachycardia
heart right sided heart failure congested cirrhosis alcoholism amyloidosis hemochromatosis Liver heart At the same time
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functional murmur
heart
Liver
central cyanosis
elements of respiration
chest
muscle
atrophy
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liver cell failure glycogen glucose amino acids Muscles wasting muscle atrophy
Movement of diaphragm
ascites restriction
Prostaglandins
Liver vasodilator materials nitric oxide estrogen vasodilators material alveoli capillaries arteries vasodilator materials arteries shunt vein artery oxygenation
veins
veins
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interstitial lung fibrosis primary biliary cirrhosis Liver cirrhosis primary biliary cirrhosis Interstitial lung fibrosis auto immune
abdomen
shrunken
shrunken liver
spleen Splenomegaly
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bacteremia
spleen
liver
mechanism
change in Starling forces two forces blood vessel hydrostatic fluid force osmotic fluid force Plasma proteins osmotic Starling forces Starling Starling law Starling forces
Osmotic pressure
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blood volume Kidney renin angiotensin aldosterone salt and water retention edema Liver aldosterone
albumin blood volume anti diuretic hormone water retention anti diuretic hormone Liver anti diuretic hormone Liver
retention
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liver cirrhosis Liver fibrosis Lymphatic fibrosis Lymphatic Liver surface liver cirrhosis Liver
cirrhosis
heal wound
infection pus
ascites
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portal Pressure Interstitial tissue Portal hypertension Portal hypertension Just localizing factor localizing factor Hypoalbuminemia at the same time albumin at the same time ascites ascites Liver edema abdomen abdomen portal hypertension ascites
Lower limbs
veins veins
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localizing factor
Mechanism Starling forces disturbance Hydrostatic pressure osmotic pressure osmotic pressure albumin Hydrostatic salt and water retention portal hypertension Lymphatic obstruction Liver cell failure ascites ascites malignancy Hepatocellular carcinoma Liver cirrhosis hepatocellular carcinoma ascites ascites T.B. peritonitis Liver cirrhosis immunity T.B. peritonitis liver cell failure ascites
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peritoneum E.Coli immune system E.Coli peritoneum Immune system Liver cell failure He is immunocompromized immune system peritoneum E.Coli peritoneum infection spontaneous bacterial peritonitis spontaneous bacterial peritonitis Occurs due to translocation of E.Coli from the colon to the peritoneum Leading to peritonitis due to defective immune clearance of this E.Coli
clinical pictures clinical pictures abdominal pain Fever ascites hepatic encephalopathy precipitate sepsis
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ascites
Ultrasond Tapping
spontaneous bacterial peritonitis 250 neutrophils polymorph 250 Peritonitis perforated appendix spontaneous bacterial peritonitis air under diaphragm X ray perforated appendix
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gram negative
Once spontaneous bacterial peritonitis Always spontaneous bacterial peritonitis Which means once attack of spontaneous bacterial peritonitis Liver end stage liver treatment
treatment
Liver transplant
Once spontaneous bacterial peritonitis Always spontaneous bacterial peritonitis Once spontaneous bacterial peritonitis liver spontaneous bacterial peritonitis
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Liver spontaneous bacterial peritonitis third generation Cephalosporin antibiotics maintainace cadaveric
Hepato-renal syndrome
Hepato-Renal Syndrome
Liver cell failure
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renal failure hepato-renal syndrome hepato-renal syndrome definition It is acute renal failure in a patient with liver cell failure with a normal histology or pathology liver cell failure renal failure biopsy
hepato renal syndrome liver cell failure renal failure blood supply kidney blood supply Hepato renal syndrome renal failure Kidney Kidney Liver cell failure Kidney Hypoalbuminemia Liver cell failure tissues
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vasoconstriction
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vasoconstriction
bilirubin
hepato renal syndrome definition It is acute renal failure in a patient with history of liver cell failure with a normal renal pathology mechanism decrease renal blood flow
blood vessels
fluid kidney
catecholamines
G.I.T.
portal hypertension Portal hypertension shunted towards blood splanchnic area Away from the kidney
Portal hypertension congested engorged blood vessels G.I.T. direct towards Kidney clinical pictures Acute renal failure manifestations of liver cell failure
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Sepsis spontaneous bacterial peritonitis peripheral vasodilation periphery directed Away from the kidney extensive paracentesis sepsis hematemesis diarrhea Vomiting
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blood volume blood volume albumin albumin Intra venous albumin Kidney blood flow
blood vessels
fluid
vasoconstriction dopamine renal dose renal vessesl vasodilatation vasodilatation vasoconstriction somatostatin Portal hypertension splanchnic vessels vasoconstriction G.I.T. G.I.T.
G.I.T.
Kidney
Kidney
G.I.T.
vasoconstriction
Somatostatin
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dialysis dialysis
hepato renal syndrome Type one and type two type one criteria type one Doubling of the serum creatinine above 2.5 mg Doubling of the serum creatinine to above 2.5 mg Or, Reduction of the glomerular filtration rate 20 To less than 20 ml per minute Within two weeks
type one hepato renal syndrome double serum creatinine 2.5 1.5 0.6 creatinine double type one
2.8
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Type two It is rise of creatinine to above 1.5 mg Or, Reduction of glomeular filtration rate to less than 40 ml per minute Over period more than two weeks kidney hepato renal Neomycin Neomycin Oral antibiotics renal failure
cirrhosis
hepatitis virus
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soft
firm silky hair soft voice female distribution of hair triangle Pubic hair triangle
Infertility
females amenorrhea galactorrhea Lower limbs muscles skin skin jaundice jaundice
bone
Muscles
skin
jaundice Caroteinaemia
estrogen
prostaglandin
Nitric oxide
characteristic
spider navei
thyrotoxicosis
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distribution
spider navei skin Itching scratching marks jaundice bile salts puritis
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findings
15 sign
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atrophy gluconeogenesis amino acids Muscles amino acids atrophy temporalis atrophy vastus medialis
Temporalis
bone
bleeding varices
B12
Hypersplenism splenomegaly
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liver cirrhosis
hepatitis virus bone marrow aplastic anemia Interferons bone marrow failure platelets
chronic hepatitis
blood PT
C.N.S. Ascites
manifestations of liver cell failure investigations of liver cell failure Liver function test Liver function test
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alkaline phosphatase
SGPT
SGOT
bilirubin variable << urobilinogen stercobilinogen globulins albumin prolonged << prothrombin time liver biopsy alpha feto protein
biphasic
Treatment of ascites, treatment of encephalopathy Look above cirrhosis treatment of liver cell failure treatment of hepatic encephalopathy treatment of hepato renal syndrome treatment of ascites
G.I.T. 46 2013 15
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www.facebook.com/dr.tafreegh
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