acute liver disease Flashcards
time frame
under 6 months
definition
The rapid development of hepatic dysfunction without prior liver disease causing encephalopathy and prolonged coagulation.
clinical features
None, jaundice, lethargy, nausea, anorexia, pain, itch, arthralgia, Abnormal LFTs
aetiology
Viral (Hep A/B/C/D/E, CMV, EBV and Toxoplasmosis)
Drug, Shock liver, Cholangitis, Alcohol, Malignancy, Chronic Liver disease, Ask about paracetamol, Rare: Budd Chiari, AFLP, Cholestasis of pregnancy
investigations
LFT’s (inc. Albumin&Bilirubin), Prothrombin time, Hx and examination, U/S, Virology, Rarely liver biopsy
management
Rest (3/12) for recovery, (maybe 6/12).
Fluids, NO ALCOHOL, increase calories, high fat foods poorly tolerated, for itch (sodium bicarbonate bath, cholestyramine or Ursodeoxycholic acid), observation for FHF
hepatic drug reactions time frame
6 weeks from exposure to effect
can be caused by any drug
drug induced
Antibiotics: Co-amoxiclav, flucloxacillin, NSAIDs
Statins (rare)
Patient may use euphemism for paracetamol (imported, no label, paracetamol as active ingredient “Nurofen” “Night Nurse”)
Fulminant Hepatic Failure definition
Jaundice and encephalopathy in patient with previously normal liver
FHF causes
Common: Paracetamol, Fulminant viral, Drugs, HBV, Non A-E hepatitis
Rare: Acute fatty liver of pregnancy (AFLP), Mushrooms, Malignancy, Wilsons, Budd Chiari, Hep A
FHF clinical causes and complications
Encephalopathy, hypoglycaemia, coagulopathy, circulatory/renal failure, infection
FHF management
Supportive: Inotropes and fluids, renal replacement, management of raised ICP
Transplantation
FHF assessment
Refer quickly, repeat bloods and tell someone to check them, short window of opportunity
