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IMF-048-02-0001-en	Why can falling aminotransferases be either reassuring or ominous?	They leak from injured cells, so they fall when injury resolves but also when few functioning hepatocytes remain.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0002-en	What distinguishes predictable from idiosyncratic drug-induced liver injury, and why is rechallenge generally avoided?	Predictable injury is dose-related, as with paracetamol, whereas idiosyncratic injury is delayed; rechallenge can provoke more severe injury.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0003-en	In acute liver failure, why is abnormal coagulation not corrected with prophylactic plasma?	Correcting the numbers alone obscures both bleeding-risk assessment and the transplant decision, and adds volume load.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0004-en	Why do the kidneys retain sodium in cirrhosis even though total extracellular fluid is expanded?	Splanchnic vasodilation lowers effective arterial volume, so the kidneys perceive underfilling and neurohormonal sodium retention continues.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0005-en	Why is cirrhosis a state of both bleeding and thrombosis risk despite prolonged conventional clotting tests?	Conventional tests capture the loss of procoagulant factors but not the parallel loss of anticoagulant factors, leaving a fragile rebalanced state.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0006-en	Which findings in suspected peritonitis point to secondary peritonitis or perforation rather than the spontaneous form, and what follows?	Polymicrobial culture, extreme protein or glucose change, failure to respond, and localised peritoneal signs; they lead to cross-sectional imaging and surgical assessment.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0007-en	Why is albumin replaced after large-volume paracentesis?	Large-volume drainage relieves pressure and breathing but can worsen circulatory dysfunction unless albumin is replaced according to volume and protocol.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0008-en	Why is volume restricted when resuscitating variceal bleeding, and what is the trade-off of an early transjugular shunt?	Excessive volume raises portal pressure; an early shunt benefits selected high-risk bleeding but can worsen encephalopathy by increasing portal bypass.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0009-en	Why can blood ammonia not confirm or stage hepatic encephalopathy, and how does lactulose help?	Ammonia contributes but its blood concentration correlates poorly with the syndrome; lactulose traps nitrogen in the colon and accelerates its elimination.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0010-en	Why is kidney injury in cirrhosis not assumed to be hepatorenal syndrome, and what supports that diagnosis?	Volume loss, sepsis, nephrotoxins, obstruction, glomerular disease, and acute tubular injury are assessed first; albumin challenge and withdrawal of contributors support hepatorenal physiology.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0011-en	In metabolic steatotic liver disease, why are non-invasive fibrosis scores and elastography used?	Fibrosis stage predicts outcome more strongly than steatosis, and these tools identify who needs specialist assessment or surveillance without biopsying everyone.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0012-en	Why can antibiotics alone not treat cholangitis?	Cholangitis is sepsis behind an obstructed duct, which antibiotics cannot reliably sterilise without drainage, so urgent decompression follows resuscitation.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0013-en	Where does systemic severity in acute pancreatitis come from, and why is fluid titrated rather than given aggressively?	Severity comes from inflammatory vascular leak and organ dysfunction; indiscriminate aggressive fluid worsens lung and abdominal oedema.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending
IMF-048-02-0014-en	Why is diabetes from chronic pancreatitis prone to severe hypoglycaemia as well as hyperglycaemia?	Destruction of endocrine tissue also reduces glucagon reserve, and irregular intake, malabsorption, and alcohol add to the hypoglycaemia risk.	Integrated Medical Foundations; chapter 48, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f9757a3aba68a4c9161b48cc58ab8fc06684b7edf3e52d1aa9fe445fc097a947; editorial review pending	imf lang::en chapter::048 module::048-02 review::pending