Acute Liver Disease and Fulminant Hepatic ailure Flashcards
What is acute liver disease and what can it cause
The rapid development of hepatic dysfunction without prior liver disease with less than 6 months duration
It can cause encephalopathy and prolonged coagulation
How quickly can acute liver disease present
Over a matter of hours, days or weeks
What is the main treatment of acute liver disease and why
Eating well, remove the cause of the failure - mostly supportive treatment with reassurance
The liver can repair itself with no scarring
How much of the liver’s blood comes from the hepatic artery?
10-20%
What happens if the blood pressure of the liver drops
It can cause hepatic shock
Name 7 liver function
Protein metabolism Carbohydrate metabolism Lipid metabolism Bile acid metabolism Bilirubin metabolism Hormone and drug metabolism Immunological defence
What is the most pointless LFT and why?
GGT - it is a non specific test as lots of factors can cause it to be elevated
What is the significance of raised ALT/ AST
They should be held within the liver but they are released into the blood stream when the liver is stressed or damaged and the cells die
Where is alkaline phosphatase (ALP) also produced
In the bone
What is bilirubin made from
Processeed RBCs
What is albumin and when is it low
An acute phase protein
If the patient is malnourished
What does prothrombin time indicate
How long it takes for blood to clot in the lab
It is a test of how good the integral blood clotting factors are
What happens to the prothrombin time if the liver is not working properly
The coagulation time will be longer
What is the most important LFT
Prothrombin time
What are some clinical features of acute liver disease
Asymptomatic Jaundice Lethargy Nauseated Anorecia Pain Itch Arthraligia ABNORMAL LFTs
what are some causes of acute liver disease
Drugs (paracetamol) Shock liver Cholangitis Alcohol Malignancy Chronic liver disease Budd Chiaria AFLP Cholestatsis of pregnancy
What is Budd Chiari and who is most likely to present with it
Clotting of the hepatic veins
young woman on the oral contraceptive
Why do we rarely do liver biopsies
Often it won’t tell you anything - the hepatoytes are often dead due to the underlying cause so it is pointless
What is the treatment for Acute Liver DIsease
Rest for 3-6 months Fluids No alcohol Increase calories Sodium bicarbonate bath for itch Reassurance
What should be monitored frequently during recovery of acute liver disease
Phosphate, potassium and magnesium
What is a very serious clinical sign in acute liver disease and what does this indicate
Hypoglycaemia - the liver is unable to movblise glycogen and therefore gluconeogenesis is impaired
When do hepatic drug reactions first appear
6 weeks after exposure
What drugs can cause drug induced liver disease
Co-amoxiclav
Flucloxacilin
NSAID
“Fat burners” - those with no label
What is fulminant hepatic failure
Fulminant hepatic failure (FHF) is usually defined as the severe impairment of hepatic functions or severe necrosis of hepatocytes in the absence of preexisting liver disease
What are the 2 main symptoms of fulminant hepatic failure
Jaundice and encephalopathy
What are 4 common causes of FHF
Paracetamol
Fulminant viral
Drugs
HBV
What are 4 rare causes of FHF
AFLP mushrooms malignancy Wilson's Budd Chiari
What are 6 complications of FHF
Encephalopathy Hypoglycaemia Coagulopathy Circulatory failure Renal Failure Infection
What are the 5 ways to treat an FHF patient
Supportive Inotropes and FLuids Renal replacement Managemnt of raised ICP Transplantation
