Acute and chronic liver failure Flashcards
What are the key functions of the liver?
Detoxification, Protein synthesis, Energy storage
Key liver functions include detoxifying substances, synthesizing proteins like clotting factors and albumin, and storing energy in the form of glycogen.
What is acute liver failure (ALF)?
Rapid onset; no underlying chronic liver disease
Acute liver failure is characterized by a rapid decline in liver function, often without a history of chronic liver disease.
What is the time scale that differentiates acute liver failure from chronic liver failure?
<2-3 months vs >2-3 months
What are common causes of acute liver failure?
- Paracetamol overdose
- Viral hepatitis (A, B, E)
- Autoimmune hepatitis
- Metabolic diseases (e.g., Wilson’s disease)
- Toxins (e.g., Amanita phalloides mushroom)
Other less common causes include certain drugs, ischemia, and vascular diseases like Budd-Chiari syndrome.
What laboratory findings indicate severe acute liver injury?
High ALT, jaundice, coagulopathy
Severe acute liver injury is often marked by significantly elevated ALT levels along with jaundice and coagulopathy.
What is the significance of vitamin K in the management of acute liver failure?
Required for clotting factor synthesis
Vitamin K is important for synthesizing clotting factors II, VII, IX, and X, and its deficiency can worsen coagulopathy.
What are the criteria for unlikely spontaneous recovery in paracetamol-induced acute liver failure?
- PT >100
- Anuric/creatinine >300
- Grade 3-4 encephalopathy
These criteria indicate a poor prognosis and may necessitate liver transplantation.
What are the main features of chronic liver failure?
- Impaired hepatocyte function
- Jaundice
- Coagulopathy
- Low albumin
- Hepatic encephalopathy
Chronic liver failure is often associated with conditions that lead to cirrhosis and its complications.
What can trigger hepatic encephalopathy in chronic liver failure?
- Constipation
- Drugs (opiates, sedatives)
- Dehydration (diuretics)
- Infections
- GI bleeding
What are the common causes of cirrhosis leading to chronic liver failure?
- Alcohol
- Non-alcoholic fatty liver disease
- Hepatitis B or C
- Haemochromatosis
- Wilson’s disease
- Autoimmune hepatitis
These conditions lead to progressive liver damage and eventual failure.
What is the management approach for chronic liver failure?
- Identify and treat underlying cause
- Abstinence from alcohol
- Antivirals for hepatitis B/C
- Steroids for autoimmune hepatitis
- Low salt diet and diuretics for ascites
- Laxatives and antibiotics for encephalopathy
Liver transplantation may be considered if appropriate.
What are the key clinical signs of liver failure?
- Jaundice
- Coagulopathy
- Encephalopathy
- Hypoglycaemia
These signs indicate significant liver dysfunction and require prompt evaluation and management.
Fill in the blank: Acute liver failure is often characterized by _______.
high ALT levels
True or False: Chronic liver failure can be caused by autoimmune hepatitis.
True
What is the role of N-acetylcysteine in acute liver failure management?
Antidote for paracetamol overdose
N-acetylcysteine helps replenish glutathione levels, aiding in the detoxification of paracetamol.
What is the significance of a low albumin level in liver failure?
Indicates impaired protein synthesis
Low albumin levels can lead to edema and impaired drug binding.
What symptom might indicate hepatic encephalopathy?
Confusion or agitation
