72. Liver Failure

Question 1

What is liver failure?

Answer 1

Organ failure specifically of the liver. Typically presents as coagulopathy and encephalopathy.

May occur on a background of cirrhosis

Question 2

What can cause liver failure?

Answer 2

Infections (hepatitis, yellow fever, leptospirosis)
Drugs (paracetamol overdose, isoniazid)
Toxins (mushrooms)
Alcohol
PSC, PBC, 
Heamochromatosis

Question 3

What are the clinical signs of liver failure?

Answer 3

Jaundice
Hepatic encephalopathy 
Fetotoxicity hepatic is
Asterix/flap
Constructional apraxia

Question 4

What tests can be done for liver failure?

Answer 4

LFT’S, U&E’S, FBC
Glucose
Paracetamol levels
Hepatitis
CMV,EBV
Blood culture, urine culture, ascitic tap 
CXR, Abdo USS,

Question 5

What are the staples of management of liver failure?

Answer 5

Nurse with head tilted upright in ITU. Protect airway with intubation and remove blood from stomach

Assess fluid status

Tests glucose every 1-4 hours and infuse glucose

Nutrition

Thiamine and folate supplements.

Question 6

What drugs should be avoided in liver failure?

Answer 6

Constipating drugs (increases ammonia absorbtion)

Saline containing Iv infusions

Paracetamol
Methotrexate
Salicylate
Tetracycline

Question 7

What are suizures in liver failure treated with?

Answer 7

Phenytoin

Question 8

What are the complications of liver failure?

Answer 8

Cerebral oedema
Ascites
Bleeding
Infection
Hypoglyceamia 
Encephalopathy

Question 9

Why does hepatic encephalopathy occur?

Answer 9

As the liver fails ammonia builds up

Astrocytes clear it by cha going it to glutamine

Glutamine causes osmotic imbalance and a shift of fluid into these cells

Question 10

How do we treat the complications of liver failure?

Excluding encephalopathy

Answer 10

Cerebral oedema- mannitol, hyperventilate

Ascites- restrict fluid, low salt diet, diuretics

Infection- ceftriaxone

Reduced blood glucose- check often, 50% glucose IVI

Question 11

How do you treat encephalopathy?

Answer 11

Avoid sedatives
Correct electrolytes
Lactulose
Rifaximin to reduce nitrogen bacteria in the gut

Question 12

What is hepatorenal syndrome?

What are the types and how are they treated?

Answer 12

Cirrhosis and ascites and renal failure

HRS1- rapidly deteriorating circulatory and renal function, treated with heamodialysis

HSR-2 more steady detroitation, treated with TIPS (transjugular-intrahelatic-portal-shunt)