Acute and Chronic Liver Failure Flashcards
In liver failure, the liver loses it ability to…
regenerate / repair
In acute liver failure, liver injury is accompanied with (3 things) in a patient with a previously normal liver
HE
Jaundice
Coagulopathy
(ascites)
What is HE?
Hepatic encephalopathy
Impairment of brain function, associated with cirrhosis. Caused by elevated levels of ammonia in the blood.
What are symptoms of HE?
Changes in personality or behaviour
Impaired motor skill
Altered sleep patterns
Speech and writing changes
Fluctuations in consciousness
What defines coagulopathy?
An INR over 1.5
What is Fulminant liver failure?
aka Acute liver failure:
Rare syndrome of massive hepatocyte necrosis.
Histologically, multiacinar necrosis.
Develops within days to weeks
What classifies fulminant liver disease as hyperacute?
HE develops within 7 days of jaundice
What classifies fulminant liver disease as acute?
HE develops within 8-28 days of jaundice
What classifies fulminant liver disease as subacute?
HE develops within 5-26 weeks
What is the most common cause of fulminant liver failure?
Paracetamol overdose
What is the term used for an abrupt decline in patient with chronic liver failure symptoms?
Acute on chronic liver failure
What is chronic liver failure?
Patient with a progressive history of liver disease
Hepatitis leads to…
fibrosis
Fibrosis of the liver leads to…
Compensated cirrhosis
Compensated cirrhosis can progress to…
Uncompensated cirrhosis (ESLF)
What does ESLF stand for?
End Stage Liver Failure
What are some causes of fulminant liver failure?
Hepatitis A, B or E
CMV
EBV
Autoimmune hepatitis
Paracetamol, alcohol, ecstasy
HCC (hepatocellular carcinoma)
Wilson’s
Haemochromatosis
A1ATD
Budd Chiari
What is Haemochromatosis?
Hereditary disorder, increased absorption of iron leading to gradual accumulation of iron in organs and tissues. Organ damage.
Symptoms include fatigue, joint pain, abdominal pain and hepatomegaly.
What is A1ATD?
Alpha-1 Antitrypsin Deficiency
Genetic disorder of abnormal or insufficient A1AT which normally protects lungs from damage by enzymes released by immune cells.
build up of A1ATD in liver can cause cirrhosis
What is Budd Chiari?
Rare disorder characterised by obstruction or blockage of the hepatic veins that drain the liver causing congestion and liver damage. Often presents with ascites, hepatomegaly and jaundice.
What are the 3 main symptoms of Fulminant liver disease?
Jaundice
Coagulopathy
HE
What is used to grade the HE?
West Haven criteria, grades 1-4
What is grade 1 HE?
Altered mood
Sleep issues
What is grade 2 HE?
Lethargy
Mild confusion
Asterixis (aka liver flap, neurological involuntary flapping of hands)