Acute and Chronic Liver Failure Flashcards
failure to clear gut derived toxins like ammonia leads to
encephalopathy
what is the half life of clotting factors and therefore when will you see the effect of them changing
6-12h
effect - 12-24h
failure to produce albumin leads to
oedema and impaired binding of drugs
what is the half life of albumin and therefore when is it useful
long
in chronic disease
why does failure to produce albumin cause oedema
because albumin has osmotic pull and moves water soluble substances which would pull water with it
failure to utilise carbohydrate leads to
muscle breakdown and eventually muscle wasting
is 6 weeks of liver damage acute or chronic
acute
what LFT change is seen in acute liver injury
high ALT
what signs are seen in severe acute liver injury
high ALT
jaundice
coagulopathy
acute liver failure is characterised by
high ALT
jaundice or coagulopathy
encephalopathy
most common cause of acute liver failure
paracetamol overdose
drug causes of acute liver failure
paracetamol
antibiotics
anti-TB medications
antiepileptics
herbal remedies
ecstasy
non drug causes of acute liver failure
acute viral infections (A, B and E)
autoimmune hepatitis
seronegative hepatitis
wilsons
and many others
what is wilsons disease
a metabolic disease which results in accummulation of copper in the liver
what treatment is given to correct coagulopathy in acute liver failure
vitamin k
fresh frozen plasma (FFP)
what is fresh frozen plasma
blood product containing clotting factors
what is the disadvantage of giving fresh frozen plasma
it will prevent the use of clotting times as a marker of liver function
what is the benefit of giving vitamin K
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
blood sugars in ALF
need to monitor proactively and not wait for symptoms
potential to get low without intervention
what conditions make someone unlikely to recover spontaneously from acute liver failure
prothrombin time >100
AND
anuric (not passing urine) or creatinine >300
AND
grade 3-4 encephalopathy (stupor or coma)
high ALT failing can be a sign of
injury getting better
or running out of hepatocytes
what factors indicate worse prognosis in non-paracetamol ALF
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
how does paracetamol liver failure progression differ from non-paracetamol liver failure
paracetamol - much quicker (coagulopathy in hours and encephalopathy in a week)
non-paracetamol more gradual and progression over several weeks
what drug is used for paracetamol overdose
N-acetylcystiene (NAC)
what is treatment for autoimmune hepaptitis
steroids
what events can trigger encephalopathy in liver failure
constipation
drugs (opiates, sedatives)
dehydration (diuretics)
infections
GI bleeding
cause of ascites and oedema
low albumin
portal hypertension
causing splanchnic vasodilation
leading to renal hypoperfusion
leading to RAAS activation
causing fluid retention
what do you still need to exclude when you suspect alcohol related liver disease
hepatitis B and C
haemochromatosis
autoimmune cause
could still be these
what is used to treat oesophageal varices
beta blocker to reduce pressure and risk of bleeding
and band ligation via endoscopy
what vitamin supplements are given for ARLD
B vitamins
treatment for encephalopathy
laxatives and antibiotics
treatment of ascites
low salt diet
diuretics
