acute liver failure W5

Question 1

what does failure to clear bilirubin lead to

Answer 1

jaundice

Question 2

what does failure to clear gut-derived toxins lead to

Answer 2

encephalopathy

Question 3

what does failure to produce clotting factors lead to

Answer 3

coagulopathy on blood tests

Question 4

what does failure to produce albumin lead to

Answer 4

oedema, impaired binding of drugs

Question 5

what does failure to store or release glucose lead to

Answer 5

hypoglycaemia

Question 6

what does failure to utilise carbohydrate lead to

Answer 6

muscle breakdown

Question 7

time scales of acute vs chronic liver failure?

Answer 7

acute <2-3 months
chronic >2-3 months

Question 8

what is albumin? functions?

Answer 8

key circulating protein, binds to many things, helps with fluid balance

Question 9

acute liver failure defining features?

Answer 9

rapid onset, no underlying chronic liver disease

Question 10

features of acute liver injury?

Answer 10

acute liver injury = high ALT
common

Question 11

features of severe acute liver injury?

Answer 11

severe acute liver injury = high ALT + jaundice/coagulopathy
uncommon

Question 12

what is ALT?

Answer 12

alanine transaminase. enzyme found in liver. when hepatocytes are damaged, ALT is released into the bloodstream

Question 13

features of acute liver failure?

Answer 13

acute liver failure = high ALT + jaundice/coagulopathy + encephalopathy
rare

Question 14

common causes of ALF?

Answer 14

paracetamol (80-90% of cases)
other drugs (antibiotics, antiepileptics, herbal remedies, ecstasy)
acute viral infections (hep B/A/E)
autoimmune hepatitis
seronegative hepatitis

Question 15

rare causes of ALF?

Answer 15

vascular diseases (Budd-Chiari)
metabolic diseases (Wilson’s, acute fatty liver of pregnancy)
cancer
ischaemia (hypotension)
toxins (amanita phalloides mushroom, carbon tetrachloride)

Question 16

what can help reduce oxidative stress caused by paracetamol overdose

Answer 16

N-acetyl cysteine infusion

Question 17

what is vitamin K treatment used to correct in ALF?

Answer 17

correction of coagulopathy

Question 18

how does vitamin K correct coagulopathy in ALF?

Answer 18

vitamin K is a substrate required for certain clotting factor synthesis.
if dietary deficiency, clotting will look worse than liver function really is so give vitamin K.
replacement will not mask liver dysfunction.

Question 19

what is FFP?
what is it used for?
should it be given for ALF? why/why not?

Answer 19

fresh frozen plasma
blood product containing clotting factors
correct clotting in the situation of bleeding
replacement will prevent use of clotting times as a marker of liver function so try to avoid giving for ALF

Question 20

what is IV dextrose given for? (ALF)

Answer 20

given for low blood sugar to prevent confusion, drowsiness, coma

Question 21

anuria as a symptom of ALF?

Answer 21

not producing any urine
due to renal dysfunction

Question 22

why may low BP be a symptom of ALF? how is this treated?

Answer 22

response to systemic inflammation because of dead liver producing inflammatory response
treated with vasopressors, noradrenaline

Question 23

what causes agitation and confusion in ALF?

Answer 23

encephalopathy

Question 24

what criteria is used to decide prognosis in paracetamol ALF?

Answer 24

unlikely to recover spontaneously if
PT >100 and
anuric/creatinine >300 and
grade 3-4 encephalopathy (stupor/coma)

Question 25

stupor meaning?

Answer 25

state of near unconsciousness

Question 26

contraindications for transplant for paracetamol ALF?

Answer 26

alcohol?
previous overdoses?
depressed?

Question 27

what is falling ALT in acute liver injury a sign of?

Answer 27

either hepatocyte injury improving or because there’s not enough healthy liver left to produce it

Question 28

what is seronegative hepatitis?

Answer 28

non A-E hepatitis
unexplained agent causing significant damage, no treatment option.

Question 29

possible outcomes of seronegative hepatitis?

Answer 29

liver regenerates and recovers fully
liver fails to regenerate and needs transplant

Question 30

factors to determine prognosis in non-paracetamol ALF?

Answer 30

3/5 of following = unlikely to recover spontaneously

age <10 or >40
aetiology = drug/seronegative
PT>50 or INR>3.5
bilirubin>300
time from jaundice to encephalopathy <7d

Question 31

ALF management - treating underlying cause?

Answer 31

NAC for paracetamol
antivirals for hep B
steroids for autoimmune hepatitis