Acute Liver Disease and Fulminant Hepatic Failure Flashcards
what is acute liver disease
rapid development of hepatic dysfunction without prior liver disease
arterial supply of liver
hepatic artery
portal hepatic vein
venous drainage of the liver
3 hepatic veins into the inferior vena cava
functions of the liver
metabolism of; protein carbohydrate lipid bile acid bilirubin hormone and drug immunological defence
liver function tests
LFTs
true liver function tests
true liver function tests
bilirubin
albumin
prothrombin time
LFTs
ALT/AST
ALP
GGT
bilirubin
onset of acute liver disease
<6 months
what does acute liver disease cause
encephalopathy
prolonged coagulation
diagnosis of Wilson’s disease
may allow classification of an acute presentation as acute liver failure
signs of acute liver disease
may be asymptomatic jaundice lethargy nausea anorexia pain itch arthralgia (pain in a joint) abnormal LFTs
causes of acute liver disease
hepatitis viruses drugs - paracetamol!!! and antibiotics shock liver cholangitis alcohol malignancy chronic liver disease
rare causes of acute liver disease
budd chiari
acute fatty liver of pregnancy (AFLP)
cholestasis of pregnancy
factors for liver damage
direct toxicity
immunologic
genetic predisposition
nutrition
direct toxicity causing liver damage
drugs
alcohol
viruses
hypoperfusion
immunologic causes liver damage
PBC
AIH
genetic predisposition causing liver disease
Wilsons’s
haemochromatosis
nutritional causes of liver disease
NASH
malnutrition
tests for acute liver disease
history!!! LFT's - & albumin and bilirubin prothrombin time ultrasound virology liver biopsy - rare
treatment for acute liver disease
rest 3-6 months fluids - NO alcohol diet modification itch treatment observe for fulminant hepatic failure
describe diet modifications in acute liver disease
increase calories and protein due to hypermetabolic state - high far foods are poorly tolerated
NG feeding or supplements
itch treatment for acute liver disease
sodium bicarbonate bath
cholestyramine
ursodeoxycholic acid
complications of acute liver disease
hypoglycaemia
cellular damage due to hepatic drug reactions
oxidase stress mitochondrial damage bile acid accumulation endoplasmic reticulum stress cell death (apoptosis or necrosis) DNA damage, epigenetics
why is paracetamol bad for the liver
metabolising product NAPQI is toxic
antibiotics causing liver injury
co-amoxiclav
flucoloxacillin
NSAID
what is fulminant hepatic failure (FHF)
acute episode of severe liver dysfunction (jaundice and encephalopathy) in a patient with previous normal liver
causes of FHF
paracetamol - most common fulminant viral drugs HBV non A-E
rare causes of FHF
AFLP mushrooms malignancy Wilsons budd chiari HAV
complications of FHF
encephalopathy hypoglycaemia coagulopathy circulatory failure renal failure infection
treatment for FHF
supportive inotropes and fluids renal replacement management of raised intracranial pressure liver transplant
considerations for liver transplant in FHF
prediction of survival without transplant
survival potential after transplant
is patient too sick for transplant
indictions for urgent transplant for acute liver failure - paracetamol
low pH
PT>100 + creatinine>300 + grade 3/4 encephalopathy
high lactate
life-threatening deterioration without sepsis
indications for urgent transplant for acute liver failure - non-paracetamol
PT>100 or INR>6.5 any 3 from 5; unfavourable aetiology (not hep A or B) age>40 jaundice to encephalopathy >7 days PT>50 bilirubin>300
Wilsons or budd-chiari
