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Liver and Friends > Acute & Chronic liver failure > Flashcards

Acute & Chronic liver failure Flashcards

1
Q

Function of liver 7

A

1-oestrogen regulation
2-detoxification
3- metabolises carbs
4- albumin production
5- clotting factor production
6- bilirubin regulation
7-immunity

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2
Q

What can happen when oestrogen regulation goes wrong

A

gynecomastia- men
Spider naevi
palmar erythema

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3
Q

What can happen when detoxification goes wrong

A

hepatic encephalopathy

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4
Q

What three things directly relate to liver damage

A
  • Bilirubin
  • albumin
  • prothrombin time
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5
Q

What does a ratio of 2:1 for AST;ALT indicate

4.5:1, 0.9:1

A

Alcoholic liver disease

Wilsons or hyperthyroid

0.9.1 = nafld

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6
Q

What causes ALF?

A

Most cases of ALF are associated with a direct insult to the liver leading tomassive hepatocyte necrosisand/orapoptosis which prevents the liver from carrying out its normal function

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7
Q

Describe the organisation of circulation in the liver

A
  • blood enters via portal vein and hepatic artery
  • blood flows through sinusoids
  • exit via hepatic vein

(Look at osmosis)

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8
Q

Types of acute liver injury

A

viral
drug
alcohol
vascular
obstruction
congestion

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9
Q

What is acute liver failure

A

rapid decline in hepatic functioned accompanied with hepatic encephalopathy, jaundice and coagulation in a patient and an INR of more than 1.5 in a patient with previously normal liver

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10
Q

What is coagulopathy?

A

derangement in clotting

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11
Q

What are the common signs of acute liver failure

A
  • Spider naevi
  • felor hepatichus ( rotten egg garlic breath)
  • dupuytrens contracture
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12
Q

what are the rare signs of liver failure

A

confusion
bleeding
RUQ PAIN
hypoglycaemia

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13
Q

What is fulminant liver and the most common cause of this

A

rare syndrome of massive hepatocyte necrosis

Paracetamol overdose

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14
Q

What are the causes of acute liver failure

A

Paracetamol
alcohol
viral hepatitis - A B E
Ectasy
Budd chiari

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15
Q

Acute presentation of Acute liver failure TRIAD

A

JAUNDICE, COAGULAPTHY, HE

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16
Q

What would HE present with

A

1- altered mood , sleep issues
2- lethargy
3- marked confusion
4- comatose

17
Q

Diagnosis for ALF

A

Bloods
- LFTS
-Serum ALT/ AST
Imaging
- EEG to grade HE

Microbiology- to rule out infection

18
Q

Tx for ALF

A

Acutely- ITU ABCDE
- Fluid, analgesia
Treat underlying cause

19
Q

What are the complications of ALF

A
  • Increase ICP
  • HE
  • Ascites
  • Haemorrhage
  • Sepsis
20
Q

common prognosis of acute liver injury

A

complete recovery 99.9%

21
Q

behavior of varices

A

behave and act like haemorroids
bleed like hemorroids

22
Q

what is chronic liver failure?

A

progressive liver disease over 6+ months due to repeated liver insults

23
Q

chronic damage in the liver leads to… and the most severe form

A

fibrosis
cirrhosis

24
Q

Causes of chronic liver disease

A
  • ALD mc
  • NAFLD
  • Viral Hep B C
25
Q

Risk factors for CLD

A

Alcohol, obesity, T2DM + drugs

26
Q

Child Pugh score

A
  • assess the prognosis + extent of tx required
27
Q

What are the classes for child pugh score and what do they mean

A

A= 100%1yr survival
B= 80% 1yr survival
C= 45% 1yr survival

28
Q

HOW does chronic liver injury present

A
  • jaundiced
    -ascites
    -HE
  • HTN
  • oesophageal varices
  • spider naevi
29
Q

Pathway of liver disease

A

Hepatitis
Fibrosis - reversible
Cirrhosis- irreversible
Compensated

30
Q

Diagnosis for CLD

A

GS= liver biopsy fibrosis vs cirrhosis
LFT

31
Q

elevated prothrombin time would indicate

A

progressive liver failure

32
Q

what is acute on chronic liver failure

A

abrupt decline in patient with chronic liver symptoms

33
Q

Tx for CLF

A
  • prevent progression , lifestyle
  • consider liver transplant
    -manage complications

Liver and Friends (17 decks)

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