Acute Liver Failure

Question 1

What is acute liver failure

Answer 1

It is a rapid decline in hepatic function in the absence of underlying chronic liver disease

Question 2

What are the 3 main characteristics of acute liver failure

Answer 2

jaundice

coagulopathy

hepatic encephalopathy

Question 3

What is the most common cause of acute liver failure in Western Countries

Answer 3

drug induced liver injury e.g. paracetamol overdose

Question 4

What is the most common cause of acute liver failure Worldwide

Answer 4

viral e.g. hepatitis A, B and E

Question 5

Define the term hepatic encephalopathy

Answer 5

Altered levels of consciousness

Question 6

Apart from drug induced and viral.

What are other causes of acute liver failure

Answer 6

Non-paracetamol medications e.g. Statins, Carbamazepine

Acute fatty liver of pregnancy

Autoimmune hepatitis

Wilson’s disease

Question 7

Name the 3 key clinical features of acute liver failure

Answer 7

Jaundice, hepatic encephalopathy and coagulopathy

Question 8

How can you detect coagulopathy

Answer 8

Raised prothrombin time

Bruising

Question 9

LFTs do not always accurately reflect the synthetic function of the liver.

Synthetic function of the liver is best assessed by looking at what?

Answer 9

Prothrombin time

Albumin level

Question 10

Is acute liver injury the same as acute liver failure?

Answer 10

No

Acute liver failure is characterized by acute liver injury, hepatic encephalopathy, and an elevated prothrombin time/international normalized ratio (INR).

Question 11

What blood tests can be used to investigate acute liver failure

Answer 11

• Coagulation
• Liver function tests including conjugated and unconjugated bilirubin
• Lactate dehydrogenase
• Renal function

Question 12

What condition is highly suggestively if there is a positive ANCA?

Answer 12

autoimmune vasculitis

Question 13

What condition is highly suggestively if there is a positive ANA?

Answer 13

A positive ANA test means autoantibodies are present.

By itself, a positive ANA test does not indicate the presence of an autoimmune disease or the need for investigation

Question 14

WHat kind of imaging is used to investigate acute liver failure

Answer 14

Doppler ultrasound - to assess the patency of the hepatic and portal veins

Question 15

Immediate liver transplant should be considered in what group of patients with acute liver failure

Answer 15

All patients

Question 16

Name some of the complications associated with acute liver failure

Answer 16

Sepsis

Cerebral oedema

haemodynamic instability

Renal failure

Question 17

What kind of monitoring is critical in providing optimal care of the patient and to prevent and treat complications (for acute liver failure)

Answer 17

ICU monitoring

Question 18

The management of acute liver failure is intense.

Name the 3 components of the management

Answer 18

o Intensive care unit monitoring

o Specific therapies based on aetiology

o Management of known complications

Question 19

What is used in paracetamol overdose if it occurs within the hour

Answer 19

Activated charcoal

Question 20

Paracetamol overdose management

What should be used if the ingestion of paracetamol is < 1 hour ago + dose <150mg/kg

Answer 20

Activated charcoal

Question 21

Paracetamol overdose management

If the ingestion of paracetamol is >1 hour ago what should be used

Answer 21

IV Acetylcysteine

Question 22

Patients can take paracetamol as a “staggered overdose” as part of paracetamol overdose.

What is a staggered overdose

Answer 22

A staggered overdose involves ingestion of a potentially toxic dose of paracetamol over more than 1 hour

Question 23

Patients whose plasma-paracetamol concentrations are on or above the treatment line should be treated with what?

Answer 23

IV acetylcysteine

Question 24

Name some of the adverse effects of IV acetylcysteine

Answer 24

Stomatitis, nausea, vomiting, fever, rhinorrhea, drowsiness, clamminess, chest tightness and bronchoconstriction