Acute Liver Disease and Fulminant Hepatic Failure Flashcards by Alyx McGregor

what is acute liver disease

rapid development of hepatic dysfunction without prior liver disease

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arterial supply of liver

hepatic artery

portal hepatic vein

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venous drainage of the liver

3 hepatic veins into the inferior vena cava

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functions of the liver

metabolism of;
protein
carbohydrate 
lipid
bile acid
bilirubin 
hormone and drug
immunological defence

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liver function tests

LFTs

true liver function tests

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true liver function tests

bilirubin
albumin
prothrombin time

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LFTs

ALT/AST
ALP
GGT
bilirubin

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onset of acute liver disease

<6 months

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what does acute liver disease cause

encephalopathy

prolonged coagulation

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diagnosis of Wilson’s disease

may allow classification of an acute presentation as acute liver failure

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signs of acute liver disease

may be asymptomatic 
jaundice 
lethargy 
nausea 
anorexia 
pain 
itch
arthralgia (pain in a joint)
abnormal LFTs

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causes of acute liver disease

hepatitis viruses
drugs - paracetamol!!! and antibiotics
shock liver
cholangitis 
alcohol 
malignancy
chronic liver disease

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rare causes of acute liver disease

budd chiari
acute fatty liver of pregnancy (AFLP)
cholestasis of pregnancy

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factors for liver damage

direct toxicity
immunologic
genetic predisposition
nutrition

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direct toxicity causing liver damage

drugs
alcohol
viruses
hypoperfusion

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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 - &amp; 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