ACUTE LIVER FAILURE

Question 1

What is acute liver failure?

Answer 1

Rapid decline in Hepatic function

Question 2

What is Severe Acute Hepatitis?

Answer 2

Liver failure with encephalopathy within 28days of Jaundice

Question 3

What are common causes of Acute Liver Failure?

Answer 3

Paracetamol Overdose

Acute Hep. B or C

Autoimmune Hepatitis

Ischaemic Hepatitis

Wilson’s Disease

Question 4

What are the symptoms of Acute Liver Failure?

Answer 4

Nausea
Vomiting
Malaise
Fatigue
Confusion
Weight Loss
Depression (Fulminant)

Question 5

What are the signs of Acute Liver Failure?

Answer 5

Jaundice
RUQ pain
Oedema
Ascites
Bruising (Fulminant)
Asterixis 
Flapping Tremor

Question 6

What are the risk factors of Acute Liver Failure?

Answer 6

Alcohol Abuse
Age >40yo
Poor nutritional status
Chronic Hep. B
Use of multiple analgesics for chronic pain

Question 7

Which blood test would you do for acute liver failure?

Answer 7

FBC: anaemia, decreased platelet count

LFT: high AST, ALT>ALP, high Bilirubin

BLOOD GLUCOSE: hyperglycaemia

U&E: high electrolytes, urea and creatinine

Question 8

What does U&E test for Acute Liver Failure suggest about cause?

Answer 8

Suggest that it may be drug-induced

Question 9

Which scan test would you order for acute Liver Failure? What would the results be?

Answer 9

Abdominal ultrasound w/ Doppler

Results show hepatomegaly, splenomegaly, nodularity of liver surface

Question 10

What additional test would you do for Acute Liver Failure?

Answer 10

PREGNANCY TEST

VIRAL HEPATITIS SÉROLOGIES

PROTHROMBIN/INR (high)

Question 11

How is Acute Liver Failure treated?

Answer 11

Liver transplant

Monitor blood glucose, electrolytes and cultures every 1-2hrs

Axetylcysteine Therapy (paracetamol antedote)

Omeprazole (PPI - protect against stress ulceration)

Phenytoin (for seizure)

Question 12

Why is glucose, electrolytes and cultures monitored in acute liver failure?

Answer 12

To check for sepsis and hypoglycaemia