[37] Liver Failure Flashcards

1
Q

What are the categories of causes of acute liver failure?

A
Infection
Toxins
Vascular
Obstetric
Other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What infections can cause acute liver failure?

A

Hep A/B
Cytomegalovirus
Epstein-Barr Virus
Leptospirosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What toxins can cause acute liver failure?

A

EtOH
Paracetamol
Isoniazid
Halothane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the vascular causes of acute liver failure?

A

Budd-Chiari

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the obstetric causes of acute liver failure?

A

Eclampsia

Acute fatty liver of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of acute liver failure?

A
Jaundice
Oedema and ascites
Bruising
Encephalopathy
Fetor hepaticus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How might encephalopathy caused by acute liver failure present?

A
Aterixis (tremor)
Constructional apraxia (inability or difficulty to build, assemble, or draw objects)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How should acute liver failure be investigated?

A

Bloods
Microbiology
Imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What bloods should be done in acute liver failure?

A
FBC
U&E
LFT
Clotting
Glucose 
ABG
Bloods to look for cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What might be found on FBC in acute liver failure?

A

Signs of infection
Signs of GI bleed
Decreased MCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why might there be a decreased MCV in acute liver failure?

A

Due to ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What might be found on U&Es in acute liver failure?

A

Decreased urea and increased creatinine, indicating hepatorenal syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can LFTs be used to differentiate between EtOH and viral causes of acute liver failure?

A

AST:ALT > 2 indicates alcohol as the cause
AST:ALT <1 indicates viral as the cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can LFTs be used to determine if chronic or acute liver failure?

A

Albumin is decreased in chronic liver failure

Prothrombin is increased in acute liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What may be found on clotting in acute liver failure?

A

Increased INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What may be found on ABG in acute liver failure?

A

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What tests to determine the cause should be done in acute liver failure?

A
Ferritin
Alpha-1AT
Caeruloplasin
Antibodies 
Paracetamol levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What microbiology tests should be done in acute liver failure?

A

Hep, CMV, and EBV serology
Blood and urine culture
Ascites MCS and SAAG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What imaging should be done in acute liver failure?

A

CXR

Abdominal US and portal vein duplex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is hepatorenal syndrome?

A

Renal failure in patients with advanced chronic liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the pathophysiology of hepatorenal syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the classifications of hepatorenal syndrome?

A

Type 1 and 2

23
Q

What happens in type 1 hepatorenal syndrome?

A

Rapidly progressive deterioration

24
Q

What is the prognosis of type 1 hepatorenal syndrome?

A

Survival <2 weeks

25
Q

What happens in type 2 hepatorenal syndrome?

A

Steady deterioration

26
Q

What is the prognosis of type 2 hepatorenal syndrome?

A

About 6 months

27
Q

How is hepatorenal syndrome managed?

A

IV albumin and splanchnic vasoconstrictors
Haemodialysis as supportive treatment
Liver transplant is treatment of choice

28
Q

Give an example of a splanchnic vasoconstrictor

A

Terlipressin

29
Q

Where should patients with acute liver failure be managed?

A

ITU

30
Q

How should acute liver failure be managed?

A

Management of underlying cause
Good nutrition
Thiamine supplements
Prophylactic PPIs

31
Q

Why are prophylactic PPIs required in acute liver failure?

A

Prevent stress ulcers

32
Q

What monitoring should be done in acute liver failure?

A

Fluids
Blood
Glucose

33
Q

How should fluid be monitored in acute liver failure?

A

Urinary and central venous catheters

34
Q

How should bloods be monitored in acute liver failure?

A

Daily FBC, U&E, LFT, INR

35
Q

How should glucose be monitored in acute liver failure?

A

1-4 hourly

36
Q

Should glucose be administered in the management of acute liver failure?

A

Yes, 10% dextrose IV 1L/12 hours

37
Q

What are the complications of acute liver failure?

A
Bleeding
Sepsis
Ascites 
Hypoglycaemia
Encephalopathy
Seizures
Cerebral oedema
38
Q

How can you manage bleeding as complication of acute liver failure?

A

Vit K
Platelets
FFP
Blood

39
Q

How can you manage sepsis as a complication of acute liver failure?

A

Tazocin

40
Q

Which antibiotic should be avoided in sepssi caused by acute liver failure?

A

Gentamicin

41
Q

Why should you avoid gentamicin in acute liver failure?

A

Nephrotoxic

42
Q

How can you manage ascites as a complication of liver failure?

A
Fluid and salt restriction
Furosemide 
Spironolactone
Tap 
Daily weight measurement
43
Q

How can you manage hypoglycaemia as a complication of liver failure?

A

Regular BMs

IV glucose if <2mM

44
Q

How can you manage encephalopathy as a complication of liver failure?

A

Avoid sedatives
Lactulose, with or without enemas
Rifaximin

45
Q

How can you manage seizures as a complication of liver failure?

A

Lorazepam

46
Q

How can you manage cerebral oedema as a complication of liver failure?

A

Mannitol

47
Q

What drugs should be avoided when prescribing in acute liver failure?

A

Opiates
Oral hypoglycaemics
Na-containing IV fluids

48
Q

What happens to the effects of warfarin in liver failure?

A

Increases

49
Q

What drugs are hepatotoxic?

A
Paracetamol
Methotrexate
Isoniazid
Salicylates 
Tetracycline
50
Q

What are the poor prognostic factors for acute liver failure?

A
Grade 3/4 hepatic encephalopathy
Age >40 years
Albumin <30g/L
Increased INR
Drug-induced liver failure
51
Q

What are the types of liver transplant?

A

Cadaveric

Live

52
Q

What are the types of cadaveric liver transplant?

A

Heart-beating

Non-heart beating

53
Q

What part of the liver is transplanted in live transplants?

A

Right lobe