Acute Liver Failure Flashcards
What happens to the liver when it fails? What can’t it do?
Liver loses regeneration/repair ability, irreversibly damaged, decompensated
What is the definition of acute liver failure?
Liver injury accompanied with HE, JAUNDICE & COAGULOPATHY (& ascites) in a patient with previously normal liver
What does HE stand for?
What is it?
Hepatic encephalopathy
Accumulation of NH3 crossing BBB and accumulates in CNS
What is the coagulopathy for someone in acute liver failure?
> 1.5 INR
What is a fulminant live failure?
Rare syndrome of massive hepatocyte necrosis
What is seen on histology for Fulminant liver failure?
Multiacinar necrosis
What is the duration of hyperacute, acute and subacute HE within jaundice?
Hyperacute = HE within 7 days of jaundice
Acute = 8-28 days HE within jaundice
Subacute = 5-26 weeks
What is the most common cause of fulminant liver failure?
Paracetamol overdose (50% cases in UK)
What is acute onset of chronic liver failure?
Abrupt decline in Px with chronic liver symptoms
What Is chronic liver failure?
Patient with progressive history of liver disease
Hepatitis –> fibrosis –> Conpensated cirrhosis –> Decompensated cirrhosis (ESLF)
Causes of Acute liver failure?
Viral = Hep A,B,E ; CMV; EBV
Autoimmune Hep
Drugs = paracetamol, alcohol, ecstasy
HCC (hepatocellular carcinoma)
Metabolic = Wilsons, haemochromatosis, A1ATD
Budd Chiari syndrome = obstruction of hepatic venous outflow
Symptoms of ALF
Acute presentation?
Jaundice
Coagulopathy
HE
What is used to grade HE?
West Haven criteria
grade 1-4
What is West haven criteria?
- Altered mood/behaviour, sleep issues
- Lethargy, mild confusion, ASTERIXIS (liver flap, hand flap like bird)
- Marked confusion, somnolent (very quiet)
- Coma
What are some other symptoms of acute liver failure? (more seen in chronic)
Spider Naevi (cluster of small red BV under skin)
Fetor hepaticus (musty sweet rotten egg and garlic breath)
Caput medusae (distended abdo BVs)
Dupuytren’s contracture
Diagnosis of Acute liver failure
tests and what’s seen?
Bloods:
LFTs (high bilirubin, low albumin, high PT/INR)
High serum AST + ALP, High NH3, low glucose
Imaging:
EEG to grade HE
Abdominal US to check Budd chiari
(Biopsy usually not required)
Microbiology to rule out infections:
Blood culture
Urine culture
Ascitic tap
What would be seen in bloods if symptoms due to paracetamol overdose or hep?
High paracetamol levels if paracetamol overdose
or serology for hep
Acute treatment for acute liver failure?
ITU
ABCDE
Fluid
Analgesia
Treat underlying cause + complication
What would be used to treat a paracetamol overdose?
Activated charcoal then N Acetyl cysteine
What complications of acute liver failure could occur?
High ICP (Increased intracranial pressure)
HE
Ascites
Haemorrhage
Sepsis
Treatments for:
High ICP (Increased intracranial pressure)
HE
Ascites
Haemorrhage
Sepsis
IV Mannitol
Lactulose (increased NH3 excretion)
Diuretics (esp spironolactone)
Vit K
Sepsis 6 bundle
