Acute Liver Failure: Waters Flashcards
Define fulminant hepatic failure.
Subfulminant?
Takes
MC viral causes of acute liver failure?
Hep *B*, A, D, E Herpes CMV EBV Varicella Adenovirus
MC drug and toxin causes of acute liver failure?
Acetaminophen Isoniazid Halothane NSAIDs Herbals
MC ischemic cause of acute liver failure?
Shock
Bud Chiari
MC metabolic cause of acute liver failure?
Other causes?
:: Wilson- Ceruloplasmin low, Cu high—> hemolysis, liver failure
:: Fatty liver of pregnancy,
:: Reye’s syndrome
Other: Malignancy, bacterial infxn
Clinical presentation of acute liver failure.
Vomiting!
HTN, Fever, ^ RR and HR are late signs
Explain the mechanisms of portosystemic encephalopathy.
v glucose, v perfusion, anoxia, changes in electrolytes, edema.
Neurotoxins: ammonia, GABA, benzodiazepine receptor activation.
False neurotransmitters: Aromatic AAs—> serotonin
Describe early and late neuropsychiatric symptoms of hepatic failure.
Early: personality changes, anti-social, restless delerium
Late: Decerebrate rigidity—> spasticity, extension of limbs
Disconjugate gaze, loss of pupillary reflexes
CVS collapse.
Why is there lactic acidosis in acute liver failure?
Inadequate tissue perfusion—>anaerobic respiration, just like all causes of lactic acidosis!
Why are there electrolyte disturbances in acute liver failure?
Hyponatremia reflects cell death. Total body Na is high, but not intravascular.
K+ levels fall due to loss in urine, poor intake, high glucose feeding.
Why respiratory alkalosis in acute liver failure?
Hyperventilation due to direct central chemotactic stimulation.
Name another MAJOR organ failure associated w/ acute hepatic failure.
Renal failure, very quick onset. Need transplant, fast.
Why are pts with acute liver failure bleeding out of every orifice?
Liver makes clotting factors and inhibitors. When it fails, you cannot clot.
Give interferon to a pt w/ Hep B?
Fuck no! IFN will BOOST the immune response, which is the primary cause of pathology to begin with in Hep. infxn!
Give antivirals for SEVERE cases of Hep B?
Sure, why not? The pt is going to die w/o a transplant, may as well exhaust all options.
