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acute liver failure Flashcards

1
Q

Aetiology of acute liver failure (6)

A
  • Viral: Viral hepatitis, Cytomegalovirus, EBV
  • Autoimmune hep (more chronic)
  • Drugs: paracetamol overdose, alcohol, ecstasy
  • hepatocellar carcinoma
  • Metabolic: Wilson’s, haemochromatosis, Alpha-1 antitrypsin deficiency
  • Budd Chiari syndrome

most common in europe - DILI:
- paracetamol overdose
- non-paracetamol DILI eg statins
but said in lecture non alcoholic fatty liver disease

most common worldwide:
- hep A, B, E

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2
Q

budd chiari syndrome

A
  • rare
  • blood flow is blocked in the hepatic veins
  • leading to liver congestion and damage
  • usually caused by a blood clot in the hepatic veins
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3
Q

Bloods for acute liver failure (4)

A
  • LFTs show liver damage (High bilirubin, low albumin, high PT/INR)
  • High serum AST + ALT
  • High NH3
  • Low glucose
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4
Q

Alpha 1 antitrypsin deficiency

A

liver produces AAT, in AATD, it accumulates in hepatocytes
leads to liver inflammation, cirrhosis, and failure
- Neonatal jaundice and liver disease - common presentations of AATD in infants

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5
Q

Diagnosis of acute liver failure (3)

A
  • Bloods
  • Imaging
  • Microbiology
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6
Q

Pathophysiology of acute liver failure (3)

A
  • Declined liver function
  • Liver loses regeneration/repair ability -> irreversibly damaged
  • In patient with previously normal liver
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7
Q

Imaging for acute liver failure (2)

A
  • EEG to grade HE
  • Abdominal ultrasound to check for Budd Chiari syndrome
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8
Q

Presentation of acute liver failure and their diagnosis (4+4)

A
  • Jaundice - hyperbilirubinaemia
  • Coagulopathy - raised PT/INR >1.5
  • Hepatic encephalopathy - EEG
  • Extent of liver damage: biopsy GOLD STANDARD

Top 3 are main characteristics

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8
Q

Tell me about Fulminant liver failure

A

Rapid multiacinar necrosis most commonly caused by paracetamol overdose

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9
Q

Treatments for complications of liver failure (3)

A
  • HE: 1st line - Lactulose (increases NH3 excretion)
  • Coagulopathy: Vit K
  • Ascites: Diuretics, esp spironolactone
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9
Q

Treatment of acute liver failure (2)

A
  • ITU, ABCDE, fluid, analgesia
  • Treat underlying cause and complications
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10
Q

West Haven criteria grades 1-4 of hepatic encephalopathy

A
  1. Altered mood, sleep problems
  2. Lethargy, mild confusion, asterixis, jaundice
  3. Marked confusion, somnolence, ataxia
  4. Comatose

Grumpy, Lazy, Sleepy, Sleep

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10
Q

Types of fulminant liver failure (3)

A

Hyperacute - Hepatic encephalopathy within 7 days of jaundice
Acute - Hepatic encephalopathy within 8-28 days of jaundice
Subacute - Hepatic encephalopathy within 5-26 weeks of jaundice

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11
Q

Why is Microbiology testing used for acute liver failure? (2)

A
  • To rule out infections
  • Blood culture, urine cultire, ascitic tap
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12
Q

EEG Interpretation in Hepatic Encephalopathy

A

Grade I (Minimal) - Mild slowing, increased theta waves, subtle changes

Grade II (Moderate) - More pronounced slowing, theta and delta waves; loss of alpha rhythm

Grade III (Severe) - Significant delta waves; prominent slowing of background activity

Grade IV (Coma) - Profound slowing or electrical silence; near-total absence of brain activity

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13
Q

HE

A

This is a neurological condition caused by liver dysfunction. The liver fails to detoxify harmful substances in the blood, such as ammonia, which can then affect the brain. It can be a complication of chronic liver disease, cirrhosis, or acute liver failure.

14
Q

Ascites

A

MORE COMMON IN CHRONIC

Ascites refers to the accumulation of fluid in the peritoneal cavity, which is the space between the abdominal wall and the organs in the abdomen
- most common cause is liver disease

15
Q

presentation

A

malaise
nausea
anorexia
jaundice

rarer:
confusion
bleeding
Liver pain - obstruction (malignancy)

16
Q

hepatocellular carcinoma

A

M>F
most common in those with cirrhosis
distinguished using immunohistochemistry 8/18, HePar1, CD10
50% produce a fetoprotein
Risk: highest for hepatitis B,C, haemochromatosis
limited treatment - Transplantation, resection or local ablative therapies

17
Q

DILI types and lft

A

Hepatocellular - ALT >2 ULN, ALT/Alk Phos ≥ 5
Cholestatic - Alk Phos >2 ULN or ratio ≤ 2
Mixed - Ratio > 2 but < 5

18
Q

pathophysiology of paracetamol overdose

A
  • paracetamol conjugated with glutathione in liver
  • glutathione stores depleted during overdose so paracetamol is then converted by other enzymes into toxic metabolities
19
Q

key presentation

A

Jaundice + Encephalopathy + Coagulopathy,

Abdo Pain
RUQ Tenderness
Malaise

20
Q

complications

A

sepsis
progressive multi-organ failure

21
Q

factors associated with poor prognosis

A
  • encephalopathy
  • extrahepatic organ failure
  • type of presentation - subacute

liver (23 decks)

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