Acute Liver Failure Flashcards
1
Q
Definition of Acute Liver failure
A
The development of hepatic necrosis leading to failure of liver function (coagulopathy and encephalopathy) within 8 weeks of the onset of liver disease (and in absence of pre-existing liver disease)
2
Q
Infective causes of ALF
A
- hepatitis A,B,D,E
- CMV
- EBV
- Varicella
- Measles
- Malaria
- Lassa, Ebola, Marburg
3
Q
Drugs and toxins that can cause ALF
A
- paracetamol
- carbon tetrachloride
- halothane
- Isoniazid
- valproate
- phenytoin
- carbamazapine
4
Q
Inherited causes of ALF
A
- galactosemia
- tyrosinaemia
- fructosaemia
- alpha-1-antitrypsin deficiency
- Wilsons disease
5
Q
Poor prognostic factors with ALF
A
- age <10 years
- infants <1yr with severe coagulopathy due to metabolic disease
- seronegative hepatitis
- severe coagulopathy
- prolonged duration of illness before onset of hepatic encephalopathy
- higher grade of encephalopathy
- shrinking liver size
- associated renal failure
6
Q
Complications of ALF
A
- hypoglycaemia
- coagulopathy and haemorrhage
- encephalopathy/ raised ICP
- convulsions
- renal dysfunction
- CVS problems
- metabolic acidosis
7
Q
Pathophysiology of raised ICP/ encephalopathy in ALF
A
- accumulaiton of toxic substances in the brain
- cerebral oedema due to:
- fluid overload from therapeutic efforts to correct coagulopathy and hypotension
- failure to maintain blood glucose concentrations
- failure to maintain systemic blood pressure
8
Q
Clinical stages of hepatic encephalopathy
A
1 - prodrome
2 - impending coma
3 - stupor
4 - coma
9
Q
Management of stage 3-4 of hepatic encephalopathy
A
- give Mannitol
10
Q
General management of encephalopathy
A
- dietary protein withdrawal
- lactulose
- avoid sedation
- prevent GI bleeding with H2 antagonists
11
Q
Causes of convulsions in ALF
A
- underlying cause of ALF
- electrolyte imbalance
- cerebral oedema
- hypoglycaemia
12
Q
Baseline drugs in ALF
A
- Vit K
- Antacids
- Lactulose
- N-acetylcysteine
- Broad-spectrum antibiotics
- antifuncals
