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Y1 GI > Acute liver disease and fulminant hepatic failure > Flashcards

Acute liver disease and fulminant hepatic failure Flashcards

1
Q

What is the unique blood supply to the liver

A

Inferior from hepatic portal vein

Oxygenated blood from the hepatic artery

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2
Q

Functions of the liver

A 
Protein metabolism 
Carb metabolism 
Lipid metabolism 
Bile acid metabolism 
Bilirubin metabolism 
Hormone and drug metabolism
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3
Q

Liver function tests

A

ALT/AST
Alkaline phosphate
GGT
Bilirubin

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4
Q

True Liver function tests

A

Bilirubin
Albumin
Prothrombin time

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5
Q

What is acute liver disease

A

Any insult to the liver causing damage in previousy normal liver
<6 moths duration

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6
Q

What is acute liver failure

A

Causing encephalopathy and prolonged coagulation

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7
Q

Clinical features of acute liver disease

A 
None 
Jaundice 
Legthargy 
Nausea 
Anorexia 
Itch 
Pain 
Arthralgial 
Abnormal LFTs
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8
Q

Common causes of acute liver disease

A 
Viral Hep A-E 
Cytomegalovirus 
Epstein-bar virus 
Toxoplasmosis 
Drugs 
Shock liver 
Cholangitis 
Alcohol 
Malignancy 
Chronic liver disease 
Ask about paracetamol - raises LFTs
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9
Q

Rare causes of acute liver disease

A

Budd Chiari
AFLP (acute fatty liver of pregnancy)
Cholestatsis of pregnancy

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10
Q

Factors for liver damage

A

Direct toxicity
Immunologic
Genetic predisposition - Haemochromatosis, Wilsons disease
Nutrition -NASH, malnutrition

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11
Q

Investigations for acute liver disease

A 
History 
LFT's (including albumin and bilirubin) 
Prothrombin time 
Examination 
Ultrasound 
Virology 
Investigations of chronic liver disease 
Rarely - liver biopsy
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12
Q

What questions to ask in the history for acute liver disease

A 
Symptoms 
Duration 
Drugs including OTC, herbal and 'food supplements' 
Possible toxins 
Alcohol history
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13
Q

Treatment for acute liver disease

A

Rest - up to 3 months for recovery maybe 6
Fluids - NO alcohol
Increase calories-high protein intake

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14
Q

Metabolic considerations of acute liver disease

A

Hypermetabolic state therefore increased requirements but with poor intake
35-40 kcal/kg/day

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15
Q

Drug induced mechanisms of liver damager

A

Drug produces
Electrophole
superoxide iron
free radical

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16
Q

What drugs induce liver disease

A 
Co-amoxiclav 
Flucoxacillin 
NSAID 
Statins - rare 
Paracetamol as an ingredient 
Also think about 'fat burners' 'protein powders'
17
Q

FHF (fulminant hepatic failure) common causes

A 
paracetamol 
fulminant viral 
Drugs 
HBV 
Non-A-E
18
Q

Rare FHF (fulminant hepatic failure) causes

A 
AFLP 
mushrooms 
malignancy 
wilsons 
Budd chiari 
HAV
19
Q

Clinical complications of fulminant hepatic failure

A 
Encephalopathy 
Hypoglycaemia 
Coagulation 
Circulatory failure 
Renal failure 
Infection
20
Q

Treatment for fulminant hepatic failure

A

Supportive
Inotropes and fluids
renal replacement
Management of raised ICP

Transplantation
Survival 65%
Life long immunosuppression
Organ availability

21
Q

What is fulminant hepatic failure

A

Can be described as development of encelopathy within 8 weeks of onset of symptoms in a patient with a previously healthy liver

Y1 GI (41 decks)

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