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Gastro > Acute Liver Disease and Fulminant Hepatic ailure > Flashcards

Acute Liver Disease and Fulminant Hepatic ailure Flashcards

1
Q

What is acute liver disease and what can it cause

A

The rapid development of hepatic dysfunction without prior liver disease with less than 6 months duration
It can cause encephalopathy and prolonged coagulation

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2
Q

How quickly can acute liver disease present

A

Over a matter of hours, days or weeks

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3
Q

What is the main treatment of acute liver disease and why

A

Eating well, remove the cause of the failure - mostly supportive treatment with reassurance
The liver can repair itself with no scarring

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4
Q

How much of the liver’s blood comes from the hepatic artery?

A

10-20%

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5
Q

What happens if the blood pressure of the liver drops

A

It can cause hepatic shock

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6
Q

Name 7 liver function

A 
Protein metabolism
Carbohydrate metabolism
Lipid metabolism
Bile acid metabolism
Bilirubin metabolism
Hormone and drug metabolism 
Immunological defence
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7
Q

What is the most pointless LFT and why?

A

GGT - it is a non specific test as lots of factors can cause it to be elevated

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8
Q

What is the significance of raised ALT/ AST

A

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

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9
Q

Where is alkaline phosphatase (ALP) also produced

A

In the bone

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10
Q

What is bilirubin made from

A

Processeed RBCs

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11
Q

What is albumin and when is it low

A

An acute phase protein

If the patient is malnourished

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12
Q

What does prothrombin time indicate

A

How long it takes for blood to clot in the lab

It is a test of how good the integral blood clotting factors are

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13
Q

What happens to the prothrombin time if the liver is not working properly

A

The coagulation time will be longer

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14
Q

What is the most important LFT

A

Prothrombin time

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15
Q

What are some clinical features of acute liver disease

A 
Asymptomatic 
Jaundice 
Lethargy 
Nauseated
Anorecia
Pain
Itch
Arthraligia
ABNORMAL LFTs
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16
Q

what are some causes of acute liver disease

A 
Drugs (paracetamol)
Shock liver 
Cholangitis
Alcohol
Malignancy 
Chronic liver disease
Budd Chiaria AFLP
Cholestatsis of pregnancy
17
Q

What is Budd Chiari and who is most likely to present with it

A

Clotting of the hepatic veins

young woman on the oral contraceptive

18
Q

Why do we rarely do liver biopsies

A

Often it won’t tell you anything - the hepatoytes are often dead due to the underlying cause so it is pointless

19
Q

What is the treatment for Acute Liver DIsease

A 
Rest for 3-6 months 
Fluids 
No alcohol
Increase calories 
Sodium bicarbonate bath for itch 
Reassurance
20
Q

What should be monitored frequently during recovery of acute liver disease

A

Phosphate, potassium and magnesium

21
Q

What is a very serious clinical sign in acute liver disease and what does this indicate

A

Hypoglycaemia - the liver is unable to movblise glycogen and therefore gluconeogenesis is impaired

22
Q

When do hepatic drug reactions first appear

A

6 weeks after exposure

23
Q

What drugs can cause drug induced liver disease

A

Co-amoxiclav
Flucloxacilin
NSAID
“Fat burners” - those with no label

24
Q

What is fulminant hepatic failure

A

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

25
Q

What are the 2 main symptoms of fulminant hepatic failure

A

Jaundice and encephalopathy

26
Q

What are 4 common causes of FHF

A

Paracetamol
Fulminant viral
Drugs
HBV

27
Q

What are 4 rare causes of FHF

A 
AFLP
mushrooms
malignancy 
Wilson's 
Budd Chiari
28
Q

What are 6 complications of FHF

A 
Encephalopathy
Hypoglycaemia
Coagulopathy
Circulatory failure
Renal Failure 
Infection
29
Q

What are the 5 ways to treat an FHF patient

A 
Supportive 
Inotropes and FLuids 
Renal replacement 
Managemnt of raised ICP 
Transplantation

Gastro (67 decks)

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