Acute liver failure

Question 1

Define acute liver failure

Answer 1

A potentially reversible condition, the consequence off severe liver injury, with onset of encephalopathy within 8 week of the appearance of first symptoms (usually jaundice) and in the absence of pre-existing liver disease

Question 2

Grade 1 signs and symptoms encephalopathy

Answer 2

Signs: constructional apraxia, dysphagia, +/- asterixis
Symptoms: Altered sleep/mood, apathy, inappropriate condcut

Question 3

Grade 2 signs and symptoms encephalopathy

Answer 3

Signs: asterixis (always), fetor
Symptoms: confusion, disorientation, drowsiness

Question 4

Grade 3 signs and symptoms encephalopathy

Answer 4

Signs: grade 2+ long tract signs, grasping and sucking reflexes, plantar response up
Symptoms: unconscious but rousable, markedly confused

Question 5

Grade 4 signs and symptoms encephalopathy

Answer 5

Signs: flaccid, diminished reflexes
Symptoms: Coma

Question 6

King’s criteria (paracetamol)

Answer 6

pH < 7.3
OR
PT time > 100s and serum Cr > 300 mcmol/L in patients with grade 3 or 4 encephalopathy

Question 7

King’s criteria (non paracetamol)

Answer 7

PT > 100s 
OR
any 3 of the following 
- age <10 or >40
- aetiology hep non-A, non-B, halothane hepatitis, idiosyncratic drug reactions
- duration of jaundice before encephalopathy > 7d
- PT 50s
- serum bili > 300 mcmol/L

Question 8

What to specifically be avoided in managing patients with ALF?

Answer 8

• All sedating agents where possible (unless intubated), NSAIDs, benzos, IM meds
• Correcting clotting

Question 9

How to describe ALF patients in terms of CVS?

Answer 9

High output state with systemic hypotension (ALF causes low TPR, compounded by volume loss e.g. vomiting)