4- acute liver disease & fulminant hepatic failure Flashcards
what is acute liver disease?
rapid development of hepatic dysfunction without prior liver disease
what is function of liver?
- Protein metabolism
- Carbohydrate metabolism
- Lipid metabolism
- Bile acid metabolism
- Bilirubin metabolism
- Hormone and Drug metabolism
- Immunological defence
what are LFTs?
- ALT/AST
- alkaline phosphatase
- GGT
- bilirubin
what are true liver function tests?
- bilirubin
- albumin
- prothrombin time
what problems can occur from acute liver disease?
encephalopathy & prolonged coagulation
what are clinical symptoms of acute liver disease?
- jaundice
- lethargic
- nausea
- anorexia
- pain
- itch
- arthralgia
what are causes of acute liver disease?
- Viral A,B,C,D,E,CMV EBV & Toxoplasmosis
- Drugs
- Shock liver
- Cholangitis
- Alcohol
- Malignancy
- Chronic Liver Disease
- Ask about Paracetamol
what are rare causes of acute liver disease?
- budd chiari
- acute fatty liver of pregnancy
- cholestasis of pregnancy
in what ways can you be predisposed to liver damage?
- nutrition
- genetics
- immunologics
what is important aspects of history to ask about for liver disease?
- symptoms
- duration
- drugs →prescription, over counter, herbal and “food supplements”
- possible toxins
- alcohol history
what investigations can be done for suspected liver disease?
- LFTs (albumin, bilirubin and prothrombin time important)
- history & exam
- abdominal ultrasound including vascular
- virology →viral tests
- investigations of chronic liver disease
- rarely liver biopsy
what is treatment of liver disease?
= rest up to 3 months or 6 months
- fluids, NO alcohol
- increase calories, high fat foods poorly tolerated
- for people who jaundice might have itch →sodium bicarbonate bath, cholestyramine or Ursodeoxycholic acid
- observe don’t progress to fulminant hepatic failure (FHF)
what are important metabolic considerations for liver disease?
when liver disease, you’re in hypermetabolic state = poor appetite and might be undernourished (need more protein & high calorie)
*more prone to complications if undernourished - oral supplements or NG may be needed
what happens when liver disease due to drugs?
- 6 weeks exposure till effect
- different drugs have different effects and impacts on LFTS and symptoms
- any drug
how can paracetamol cause liver injury?
most of it conjugated to glucuronide or sulfate to make non-toxic but 10% conjugated to more toxic form NAPQI (this can with glutathione can be conjugated to non toxic again) but if overdose then if not glutathione then toxic build up and hepatocyte injuries
