Acute liver disease and fulminant hepatic failure Flashcards
What is acute liver disease?
It is defined as the rapid development of hepatic dysfunction without prior liver disease.
Any insult to the liver causing damage
In previously normal liver
Less than 6 months duration.
Why are people with jaundice itchy?
Because the bilirubin is an irritant under the skin
What are the LFTs?
ALT/AST
Alkaline Phosphatase(ALP)
GGT
What cause a high GGT?
Alcohol abuse
Drug metabolism
Fat in the liver
What are the true liver function tests?
Bilirubin
Albumin
Prothrombin time
What is acute liver failure defined as?
Causing encephlaopathy and prolonged coagulation
What are clinical features of acute liver disease?
None Jaundice lethargy nausea anorexia pain Itch arthralgia
Abnormal LFTs
Which patients with acute liver disease can have no symptoms?
Patients who have taken a paracetamol overdose
List viral causes of acute liver disease
Hep A, B, C, D, E
CMV (cytomegalovirus)
Epsein-barr virus
Toxoplasmosis
List common causes of acute liver disease
Viral Drugs Shock liver Cholangitis Alcohol Malignancy Chronic Liver Disease Ask about Paracetamol
What is shock liver?
blood pressure in veins much lower than pressure in arteries. If you are unwell, in trauma, etc, and your arterial pressure drops, you will still perfuse your major organs. Because the majority of the liver’s blood supply is venous, it will go into “shock” and lack a sufficient blood supply.
What is cholangitis?
Acute inflammation of the biliary tree
What are rare causes of acute liver disease?
Budd Chiari
AFLP- acute fatty liver of pregnancy- eclampsia- get the baby out if possible. Condition can be fatal to mother and baby
Cholestasis of Pregnancy
What is Budd-Chiari syndrome?
A condition caused by occlusion of the hepatic veins which drain the liver, e.g. thrombosis.
What should you ask about in a history of acute liver disease?
Symptoms.
Duration
Drugs including OTC, herbal and “food suppliments”, fat burner tablets
Possible toxins: alcohol, environmental toxins
Alcohol history: Go beyond “None”.
What investigations are done?
LFT’S (including Albumin & Bilirubin) Prothrombin time HISTORY & EXAMINATION Ultra-sound inc. vascular, including hepatic veins Virology Investigations of chronic liver disease RARELY liver biopsy
What is the treatment for acute liver disease?
Rest, up to 3 months for recovery may be 6
Fluids, NO alcohol
Increase calories, high fat foods poorly tolerated
For itch- sodium bicarbonate bath, cholestryamine or Uresodeoxycholic acid
Observation for fulminant hepatic failure
Why are energy requirements raised in patients with acute liver disease?
What may be required to aid these increased requirements?
They are hypermetabolic
Oral nutritional supplements or NG feeding may be required as patients usually have a poor appetite and intake
What biochemical markers should be monitored in patients with acute liver disease?
Phosphate, potassium and magnesium levels are frequently low and should be monitored frequently and supplemented if necessary
Hypoglycaemia is common as the liver is unable to mobilise glycogen and gluconeogenesis is impaired therefore careful monitoring is required. Should consider transplant.
What may drug induced liver injury be due to?
Injury to the liver cells (hepatocellular)
- that is pathologically indistinguishable from viral hepatitis
Problems with bile production or excretion (cholestatic)
Give examples of drugs that can cause drug induced liver disease
Antibiotics Co-amoxiclav Flucloxacillin NSAID Statins: Often blamed, rarely cause May use euphomisms “fat burners”, “Protein powders” May be imported or have no label Paracetamol
What is fulminant hepatic failure defined as?
Jaundice and encephalopathy in a patient with a previously normal liver
What are common causes of FHF?
Paracetamol Fulminant viral Drugs HBV Non A-E
What are uncommon causes of FHF?
AFLP Mushrooms Malignancy Wilsons Budd Chiari HAV
What can FHF cause, including complications?
Encephalopathy Hypoglycaemia Coagulopathy Circulatory failure Renal Failure Infection
What is treatment for FHF?
Supportive Inotropes & Fluids Renal replacement Management of raised ICP (intracranial pressure) Transplantation Survival 65% Life long immunosupression Organ availability Ethics
