Acute Liver Failure Flashcards
1
Q
Causes of acute liver failure?
A
- paracetamol overdose
- alcohol
- viral hepatitis (usually A or B)
- acute fatty liver of pregnancy
2
Q
Features of acute liver failure?
A
- jaundice
- coagulopathy: raised prothrombin time
- hypoalbuminaemia
- hepatic encephalopathy
- renal failure is common (‘hepatorenal syndrome’)
- remember that ‘liver function tests’ do not always accurately reflect the synthetic function of the liver. This is best assessed by looking at the prothrombin time and albumin level.
- Fetor hepaticus, sweet and fecal breath, sign of liver failure
3
Q
Why look at albumin in liver failure?
A
- most abundant protein produced by the liver
- low in liver failure
- most useful in assessment of chronic liver failure (long half life of 2-3 weeks)
- can also be reduced in many non-hepatic causes such as malnutrition, chronic kidney disease, and chronic inflammatory diseases.
- serum albumin can also be low when its excretion is increased (albuminuria, malabsorption)
4
Q
Why look at prothrombin time (PT) or INR (international normalised ratio)?
A
- liver produces majority of coagulation proteins needed in blood clotting cascade
- severe liver injury leads to reduction of liver synthesis of clotting factors and prolonged PT or an increased INR
- Clotting factors have a shorter half-life than albumin, so PT (or INR) is useful in assessing presence of both acute and chronic liver failure
- high PT or INR can also be due to non-hepatic causes such as: vitamin K deficiency, malabsorption and genetic clotting disorders
5
Q
A 28-year old pregnancy lady presents to the ED in confused and agitated state. She is itching her arms vigorously and on examination, the patient complains of right side abdominal pain during palpation. As she tries to speak, doctor notes her breath has a sweet fecal smell. Likely diagnosis
A
Acute liver failure
Fetor hepaticus, sweet and fecal breath is a sign of liver failure
