6) Decompensated Liver Disease

Question 1

What are the causes of liver failure?

Answer 1

Cirrhosis (further cards)
-Acute:
Infection: Hep A/B, CMV, EBV, leptospirosis
Toxin: EtOH, paracetamol, isoniazid, halothane
Vasc: Budd-Chiari
Other: Wilson’s, AIH/PBC/ETC
Obs: eclampsia, acute fatty liver of pregnancy

Question 2

Signs of liver failure?

Answer 2

Jaundice
Oedema + ascites
Bruising
Encephalopathy
--Aterixis
--Constructional apraxia (5-pointed star)
Fetor hepaticus
Signs of cirrhosis / chronic liver disease

Question 3

Ix in liver failure?

Answer 3

FBC: infection, GI bleed, ↓ MCV (EtOH)
U+E
--↓U, ↑Cr: hepatorenal syndrome
--Urea synth in liver  poor test of renal function
LFT
--AST:ALT > 2 = EtOH
--AST:ALT < 1 = Viral
--Albumin: ↓ in chronic liver failure
--PT: ↑ in acute liver failure
Clotting: ↑INR
Glucose
ABG: metabolic acidosis
Cause: Ferritin, α1AT, caeruloplasmin, Abs,
paracetamol levels

Question 4

What microbiology can be done in liver failure?

Answer 4

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

Question 5

What radiology should be done in liver failure?

Answer 5

CXR

Abdo US and portal vein duplex