Prophecy general ICU A V3 Questions & Answers 2023
Define acute hepatic failure - ANSWER: Severe, rapid decline in liver function,
classified by:
1. Coagulopathy
2. Jaundice
3. Encephalopathy
List 4 liver functions and the consequence of them not functioning in liver failure -
ANSWER: 1. Nutrient metabolism/vitamin storage - nutritional deficiency
2. Immune function - infections
3. Toxin and drug metabolism - drug toxicity, hepatic encephalopathy
4. Bilirubin metabolism - jaundice, BR toxicity
5. Hormone synthesis/storage (glucagon and gluconeogenesis) - hypoglycaemia
List 5 risk factors for developing acute liver failure - ANSWER: 1. Chronic liver disease
esp. HBV
2. Alcohol abuse
3. Multiple paracetamol preparations
4. Female
5. >40 yrs
6. Pregnant
7. Poor nutritional status
List 3 complications from acute liver failure - ANSWER: 1. Hepatic encephalopathy
2. Infection
3. Multi-organ failure
4. Hypoglycaemia
5. Metabolic acidosis
List 3 indications for liver transplant - ANSWER: 1. Acute hepatic failure (any cause)
2. End stage chronic liver disease
3. Hepatic encephalopathy
List the clinical features of acute liver failure - ANSWER: RUQ pain
N/V/malaise
Jaundice
Coagulopathy
If severe - signs of encephalopathy eg resp depression, signs of raised ICP eg coma,
eye changes etc
What is the mechanism of action of NAC? (paracetamol OD drug) - ANSWER: NAC is a
prodrug of L-cysteine, which is converted to glutathione.
Glutathione breaks down paracetamol in the liver, and in paracetamol OD it is
depleted, leading to accumulation of NAPQI which is toxic to hepatocytes
, Need to replace glutathione stores through administering NAC
If 4-8hrs since ingestion, titrate to paracetamol levels based on the nomogram. If
>8hrs, administer immediately
Define acute respiratory failure - ANSWER: Failure of the respiratory system to
maintain normal blood gases, resulting in hypoxia +/- hypercapnia. Results in failure
to meet the body's metabolic demands
2 types
List the defining features of Type 1 respiratory failure - ANSWER: TYPE 1 -
hypoxaemia
- PaO2 <60mmHg
- A failure of OXYGENATION between lungs and blood = hypoxaemia = decreased
tittue perfusion
- Usually responds to oxygen therapy
- Most common type
- Associated with diseases of the lung eg pneumonia, APO, PE, ARDS, pulmonary
haemorrhage
- Involes fluid in, or collapse of alveoli due to a disease process
- Markers of chronic disease = difficult to distinguish, may include polycythaemia, cor
pulmonalae
List the defining features of type 2 respiratory failure - ANSWER: TYPE 2 -
hypercapnia
- PaCO2 >50mmHg
- Normal or low PaO2
- Failure of VENTILATION + oxygenation
- Failure of CO2 exchange between lungs and blood = hypercapnia = respiratory
acidosis
- Requires/responds to ventilatory support +/- oxygen therapy
- Common causes = COPD, asthma, drug OD, chest wall abnormalities,
neuromuscular diseases, airway obstruction eg asthma/anaphylaxis
- Chronic markers = compensation on ABGs eg raised HCO3-
List 3 major categories of the aetiology of hypoxaemia - ANSWER: 1. Hypoventilation
eg
- resp. depression from central blockage eg drug OD, tumour etc
- upper airway eg laryngospasm, foreign body
- lower airway eg pneumothorax, secretions, atelectasis
2. V/Q mismatch eg
- pulmonary shunt (poor alveolar ventilation, adequate perfusion eg pneumonia,
APO, ARDS, pneumothorax)
- cardiac shunt (alveoli are ventilatied, inadequate perfusion) eg pulmonary HTN, PE
Define acute hepatic failure - ANSWER: Severe, rapid decline in liver function,
classified by:
1. Coagulopathy
2. Jaundice
3. Encephalopathy
List 4 liver functions and the consequence of them not functioning in liver failure -
ANSWER: 1. Nutrient metabolism/vitamin storage - nutritional deficiency
2. Immune function - infections
3. Toxin and drug metabolism - drug toxicity, hepatic encephalopathy
4. Bilirubin metabolism - jaundice, BR toxicity
5. Hormone synthesis/storage (glucagon and gluconeogenesis) - hypoglycaemia
List 5 risk factors for developing acute liver failure - ANSWER: 1. Chronic liver disease
esp. HBV
2. Alcohol abuse
3. Multiple paracetamol preparations
4. Female
5. >40 yrs
6. Pregnant
7. Poor nutritional status
List 3 complications from acute liver failure - ANSWER: 1. Hepatic encephalopathy
2. Infection
3. Multi-organ failure
4. Hypoglycaemia
5. Metabolic acidosis
List 3 indications for liver transplant - ANSWER: 1. Acute hepatic failure (any cause)
2. End stage chronic liver disease
3. Hepatic encephalopathy
List the clinical features of acute liver failure - ANSWER: RUQ pain
N/V/malaise
Jaundice
Coagulopathy
If severe - signs of encephalopathy eg resp depression, signs of raised ICP eg coma,
eye changes etc
What is the mechanism of action of NAC? (paracetamol OD drug) - ANSWER: NAC is a
prodrug of L-cysteine, which is converted to glutathione.
Glutathione breaks down paracetamol in the liver, and in paracetamol OD it is
depleted, leading to accumulation of NAPQI which is toxic to hepatocytes
, Need to replace glutathione stores through administering NAC
If 4-8hrs since ingestion, titrate to paracetamol levels based on the nomogram. If
>8hrs, administer immediately
Define acute respiratory failure - ANSWER: Failure of the respiratory system to
maintain normal blood gases, resulting in hypoxia +/- hypercapnia. Results in failure
to meet the body's metabolic demands
2 types
List the defining features of Type 1 respiratory failure - ANSWER: TYPE 1 -
hypoxaemia
- PaO2 <60mmHg
- A failure of OXYGENATION between lungs and blood = hypoxaemia = decreased
tittue perfusion
- Usually responds to oxygen therapy
- Most common type
- Associated with diseases of the lung eg pneumonia, APO, PE, ARDS, pulmonary
haemorrhage
- Involes fluid in, or collapse of alveoli due to a disease process
- Markers of chronic disease = difficult to distinguish, may include polycythaemia, cor
pulmonalae
List the defining features of type 2 respiratory failure - ANSWER: TYPE 2 -
hypercapnia
- PaCO2 >50mmHg
- Normal or low PaO2
- Failure of VENTILATION + oxygenation
- Failure of CO2 exchange between lungs and blood = hypercapnia = respiratory
acidosis
- Requires/responds to ventilatory support +/- oxygen therapy
- Common causes = COPD, asthma, drug OD, chest wall abnormalities,
neuromuscular diseases, airway obstruction eg asthma/anaphylaxis
- Chronic markers = compensation on ABGs eg raised HCO3-
List 3 major categories of the aetiology of hypoxaemia - ANSWER: 1. Hypoventilation
eg
- resp. depression from central blockage eg drug OD, tumour etc
- upper airway eg laryngospasm, foreign body
- lower airway eg pneumothorax, secretions, atelectasis
2. V/Q mismatch eg
- pulmonary shunt (poor alveolar ventilation, adequate perfusion eg pneumonia,
APO, ARDS, pneumothorax)
- cardiac shunt (alveoli are ventilatied, inadequate perfusion) eg pulmonary HTN, PE
