Acute & Chronic liver failure Flashcards
Function of liver 7
1-oestrogen regulation
2-detoxification
3- metabolises carbs
4- albumin production
5- clotting factor production
6- bilirubin regulation
7-immunity
What can happen when oestrogen regulation goes wrong
gynecomastia- men
Spider naevi
palmar erythema
What can happen when detoxification goes wrong
hepatic encephalopathy
What three things directly relate to liver damage
- Bilirubin
- albumin
- prothrombin time
What does a ratio of 2:1 for AST;ALT indicate
4.5:1, 0.9:1
Alcoholic liver disease
Wilsons or hyperthyroid
0.9.1 = nafld
What causes ALF?
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
Describe the organisation of circulation in the liver
- blood enters via portal vein and hepatic artery
- blood flows through sinusoids
- exit via hepatic vein
(Look at osmosis)
Types of acute liver injury
viral
drug
alcohol
vascular
obstruction
congestion
What is acute liver failure
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
What is coagulopathy?
derangement in clotting
What are the common signs of acute liver failure
- Spider naevi
- felor hepatichus ( rotten egg garlic breath)
- dupuytrens contracture
what are the rare signs of liver failure
confusion
bleeding
RUQ PAIN
hypoglycaemia
What is fulminant liver and the most common cause of this
rare syndrome of massive hepatocyte necrosis
Paracetamol overdose
What are the causes of acute liver failure
Paracetamol
alcohol
viral hepatitis - A B E
Ectasy
Budd chiari
Acute presentation of Acute liver failure TRIAD
JAUNDICE, COAGULAPTHY, HE
What would HE present with
1- altered mood , sleep issues
2- lethargy
3- marked confusion
4- comatose
Diagnosis for ALF
Bloods
- LFTS
-Serum ALT/ AST
Imaging
- EEG to grade HE
Microbiology- to rule out infection
Tx for ALF
Acutely- ITU ABCDE
- Fluid, analgesia
Treat underlying cause
What are the complications of ALF
- Increase ICP
- HE
- Ascites
- Haemorrhage
- Sepsis
common prognosis of acute liver injury
complete recovery 99.9%
behavior of varices
behave and act like haemorroids
bleed like hemorroids
what is chronic liver failure?
progressive liver disease over 6+ months due to repeated liver insults
chronic damage in the liver leads to… and the most severe form
fibrosis
cirrhosis
Causes of chronic liver disease
- ALD mc
- NAFLD
- Viral Hep B C
Risk factors for CLD
Alcohol, obesity, T2DM + drugs
Child Pugh score
- assess the prognosis + extent of tx required
What are the classes for child pugh score and what do they mean
A= 100%1yr survival
B= 80% 1yr survival
C= 45% 1yr survival
HOW does chronic liver injury present
- jaundiced
-ascites
-HE - HTN
- oesophageal varices
- spider naevi
Pathway of liver disease
Hepatitis
Fibrosis - reversible
Cirrhosis- irreversible
Compensated
Diagnosis for CLD
GS= liver biopsy fibrosis vs cirrhosis
LFT
elevated prothrombin time would indicate
progressive liver failure
what is acute on chronic liver failure
abrupt decline in patient with chronic liver symptoms
Tx for CLF
- prevent progression , lifestyle
- consider liver transplant
-manage complications
