Acute Liver Disease and Fulminant Hepatic Failure Flashcards
What is acute liver disease?
Rapid development of hepatic dysfunction without prior liver disease
What are some functions of the liver?
Bile production Plasma proteins Bilirubin metabolism Hormone and drug metabolism Immunological defence
What are the different LFTs?
ALT/AST
Alkaline phosphatase (ALP)
GGT
Bilirubin
What are the true liver function tests?
Bilirubin
Albumin
Prothrombin time
What is the duration to be classed as acute liver disease?
Less than 6 month duration
What does acute liver failure cause?
Encephalopathy and prolonged coagulation
What might be some clinical features of acute liver disease?
none Jaundice Lethargy Nausea Anorexia Pain Itch Arthralgia
Abnormal LFTs
What might cause acute liver disease?
Drugs Shock liver Alcohol Malignancy Chronic liver disease Cholangitis
What best investigation in acute liver disease will almost always give you the diagnosis?
History
What investigations might you do for acute liver disease?
LFTs Prothrombin time History and exam Ultrasound Virology
What is the treatment for acute liver disease?
Resut - up to 3 months, for recovery, maybe 6
Fluids, NO alcohol
Increase calories, hight fat food poorly tolerated
For itch - sodium bicarb bath, cholestryamine or Uresodeoxycholic acid
Observation for FHF
What would you treat an itch in ALF with?
Uresodeoxycholic acid
Sodium bicarb bath
Cholestryamine
What might be required in acute liver failure when considering hyper metabolic patients?
May require oral or NG feeding as there are complication in malnourished patients
Need to monitor and supplement K, PO4 and Mg
What drugs might induce liver disease?
Antibiotics - co-amoxiclav, fluclocacillin, NSAID
Paracetamol as an ingredient
What is fulminant hepatic failure?
Jaundice and encephalopathy in a patient with a perviously normal liver.
What are the causes of FHF?
Paracetamol
Fulminant viral
Drugs
HBV
What are some clinical causes of FHF and complications?
Encephalopathy Hypoglycaemia Coagulopathy Circulatory failure Renal Failure Infection
What are the treatment options for FHF?
Supportive
Inotropes and fluids
Renal replacement
Management of raised ICP
Transplantation
What is encephalopathy?
a disease in which the functioning of the brain is affected by some agent or condition (such as viral infection or toxins in the blood).
Describe Albumin?
It is a plasma protein made in the liver
It has oncotic properties - it draws fluid into the vessels
Insulin stimulates its production
Carries - fatty acids, bilirubin, Ca, Na, thyroid hormones
