Acute and Chronic Liver Failure

Question 1

failure to clear gut derived toxins like ammonia leads to

Answer 1

encephalopathy

Question 2

what is the half life of clotting factors and therefore when will you see the effect of them changing

Answer 2

6-12h
effect - 12-24h

Question 3

failure to produce albumin leads to

Answer 3

oedema and impaired binding of drugs

Question 4

what is the half life of albumin and therefore when is it useful

Answer 4

long
in chronic disease

Question 5

why does failure to produce albumin cause oedema

Answer 5

because albumin has osmotic pull and moves water soluble substances which would pull water with it

Question 6

failure to utilise carbohydrate leads to

Answer 6

muscle breakdown and eventually muscle wasting

Question 7

is 6 weeks of liver damage acute or chronic

Answer 7

acute

Question 8

what LFT change is seen in acute liver injury

Answer 8

high ALT

Question 9

what signs are seen in severe acute liver injury

Answer 9

high ALT
jaundice
coagulopathy

Question 10

acute liver failure is characterised by

Answer 10

high ALT
jaundice or coagulopathy
encephalopathy

Question 11

most common cause of acute liver failure

Answer 11

paracetamol overdose

Question 12

drug causes of acute liver failure

Answer 12

paracetamol
antibiotics
anti-TB medications
antiepileptics
herbal remedies
ecstasy

Question 13

non drug causes of acute liver failure

Answer 13

acute viral infections (A, B and E)
autoimmune hepatitis
seronegative hepatitis
wilsons
and many others

Question 14

what is wilsons disease

Answer 14

a metabolic disease which results in accummulation of copper in the liver

Question 15

what treatment is given to correct coagulopathy in acute liver failure

Answer 15

vitamin k
fresh frozen plasma (FFP)

Question 16

what is fresh frozen plasma

Answer 16

blood product containing clotting factors

Question 17

what is the disadvantage of giving fresh frozen plasma

Answer 17

it will prevent the use of clotting times as a marker of liver function

Question 18

what is the benefit of giving vitamin K

Answer 18

it is required for synthesis of some clotting factors (2, 7, 9 and 10)
if dietary defficient liver function will look worse than it is so giving supplements will correct this
vitamin k doesnt mask liver dysfunction so this can still be monitored

Question 19

blood sugars in ALF

Answer 19

need to monitor proactively and not wait for symptoms
potential to get low without intervention

Question 20

what conditions make someone unlikely to recover spontaneously from acute liver failure

Answer 20

prothrombin time >100
AND
anuric (not passing urine) or creatinine >300
AND
grade 3-4 encephalopathy (stupor or coma)

Question 21

high ALT failing can be a sign of

Answer 21

injury getting better
or running out of hepatocytes

Question 22

what factors indicate worse prognosis in non-paracetamol ALF

Answer 22

age <10 or >40
drug or seronegative hepatitis is worse than viral
prothrombin time > 50
INR > 3.5
bilirubin >300
time from jaundice to encephalopathy <7d

Question 23

how does paracetamol liver failure progression differ from non-paracetamol liver failure

Answer 23

paracetamol - much quicker (coagulopathy in hours and encephalopathy in a week)
non-paracetamol more gradual and progression over several weeks

Question 24

what drug is used for paracetamol overdose

Answer 24

N-acetylcystiene (NAC)

Question 25

what is treatment for autoimmune hepaptitis

Answer 25

steroids

Question 26

what events can trigger encephalopathy in liver failure

Answer 26

constipation
drugs (opiates, sedatives)
dehydration (diuretics)
infections
GI bleeding

Question 27

cause of ascites and oedema

Answer 27

low albumin
portal hypertension
causing splanchnic vasodilation
leading to renal hypoperfusion
leading to RAAS activation
causing fluid retention

Question 28

what do you still need to exclude when you suspect alcohol related liver disease

Answer 28

hepatitis B and C
haemochromatosis
autoimmune cause
could still be these

Question 29

what is used to treat oesophageal varices

Answer 29

beta blocker to reduce pressure and risk of bleeding
and band ligation via endoscopy

Question 30

what vitamin supplements are given for ARLD

Answer 30

B vitamins

Question 31

treatment for encephalopathy

Answer 31

laxatives and antibiotics

Question 32

treatment of ascites

Answer 32

low salt diet
diuretics