Acute Liver Failure Flashcards
What triad of symptoms define acute liver failure?
Jaundice
Coagulopathy
Encephalopathy
In addition to the triad of defining symptoms of acute liver failure, what other symptoms/signs may exist?
Abdominal pain RUQ tenderness Splenomegaly Ascites Nausea and vomiting Malaise Spider nevi Palmar erythema
What are the potential causes of acute liver failure?
Paracetamol overdose Other drugs / toxins - alcohol, antifreeze, salicylate etc. Viral hepatitis (A + B) Autoimmune hepatitis Budd-chiari syndrome Acute Wilson's / haemochromatosis Ischaemic hepatitis Idiopathic
What investigations should be conducted for acute liver failure?
LFTs FBC U+Es Coag Group and save (pre-emptive) CRP / ESR VBG Glucose Iron studies Serum ceruloplasmin Viral hepatitis serologies Urine toxicology CXR USS + doppler of liver Pregnancy test
The grade of severity of which symptom of acute liver failure is used as a prognostic marker?
Encephalopathy
Which set of criteria is used to grade hepatic encephalopathy in acute liver failure?
West Haven criteria
Describe the general management of acute liver failure
ICU admission - fluids, minimise ICP elevations, manage airway, monitoring of neurological system, glucose, electrolytes and cultures
Early consideration of liver transplant
Treat underlying cause
What are the potential complications of acute liver failure?
Renal failure Rapidly progressing encephalopathy GI bleeding Haemodynamical instability Cerebral oedema Coagulopathy Infection Metabolic disorders
What is the specific management of acute liver failure caused by acute fatty liver of pregnancy?
Expedient delivery of the foetus
What is the specific management of acute liver failure caused by amanita phalloides mushroom posioning?
Gastric lavage
Activated charcoal
Acetylcysteine
Benzylpenicillin
What is the specific management of acute liver failure caused by autoimmune hepatitis?
Methylprednisolone
What is the specific management of acute liver failure caused by acute hepatitis B?
Oral nucleoside or nucleotide analogue
What is the specific management of acute liver failure caused by acute Budd-chiari syndrome?
Anticoagulation and TIPS
