[37] Liver Failure Flashcards
What are the categories of causes of acute liver failure?
Infection Toxins Vascular Obstetric Other
What infections can cause acute liver failure?
Hep A/B
Cytomegalovirus
Epstein-Barr Virus
Leptospirosis
What toxins can cause acute liver failure?
EtOH
Paracetamol
Isoniazid
Halothane
What are the vascular causes of acute liver failure?
Budd-Chiari
What are the obstetric causes of acute liver failure?
Eclampsia
Acute fatty liver of pregnancy
What are the signs of acute liver failure?
Jaundice Oedema and ascites Bruising Encephalopathy Fetor hepaticus
How might encephalopathy caused by acute liver failure present?
Aterixis (tremor) Constructional apraxia (inability or difficulty to build, assemble, or draw objects)
How should acute liver failure be investigated?
Bloods
Microbiology
Imaging
What bloods should be done in acute liver failure?
FBC U&E LFT Clotting Glucose ABG Bloods to look for cause
What might be found on FBC in acute liver failure?
Signs of infection
Signs of GI bleed
Decreased MCV
Why might there be a decreased MCV in acute liver failure?
Due to ethanol
What might be found on U&Es in acute liver failure?
Decreased urea and increased creatinine, indicating hepatorenal syndrome
How can LFTs be used to differentiate between EtOH and viral causes of acute liver failure?
AST:ALT > 2 indicates alcohol as the cause
AST:ALT <1 indicates viral as the cause
How can LFTs be used to determine if chronic or acute liver failure?
Albumin is decreased in chronic liver failure
Prothrombin is increased in acute liver failure
What may be found on clotting in acute liver failure?
Increased INR
What may be found on ABG in acute liver failure?
Metabolic acidosis
What tests to determine the cause should be done in acute liver failure?
Ferritin Alpha-1AT Caeruloplasin Antibodies Paracetamol levels
What microbiology tests should be done in acute liver failure?
Hep, CMV, and EBV serology
Blood and urine culture
Ascites MCS and SAAG
What imaging should be done in acute liver failure?
CXR
Abdominal US and portal vein duplex
What is hepatorenal syndrome?
Renal failure in patients with advanced chronic liver failure
What is the pathophysiology of hepatorenal syndrome?
Cirrhosis leads to splanchnic arterial vasodilation, which decreases effective circulatory volume, causing RAS activation and leading to renal arterial vasoconstriction. Persistent underfilling of the renal circulation leads to failure