ALF - Management Flashcards
Where should this patient be managed?
ICU or critical care
What drug is given for paracetamol overdose?
N-acetyl cysteine
EARLY FLUID RESUS IS CRITICAL
EARLY FLUID RESUS IS CRITICAL
In regards to the kidneys synthetic function, what must you look out for and manage accordingly?
Glucose (10-20%) infusions for hypoglycaemia
What needs to be done for grade 3/4 HE?
Intubation and ventilation
CVVH can be done for acidosis/ammonia. What is it?.
Continuous Veno-Venous Hemofiltration (CVVH) is a temporary treatment for patients with acute renal failure who are unable to tolerate hemodialysis and are unstable. With CVVH, a dialysis catheter is placed in one of the main veins of the body.
BASICALLY GETTING RID OF TOXINS THE LIVER SHOULD HAVE CONVERTED
Broad spectrum antibiotics and antifungals are given as they are immunosuppressed. Why are they immunosuppressed?
Cirrhosis disrupts the architecture and cellular organization of the liver and diminishes the hepatic ability to synthesize proteins. These events compromise the immune surveillance function of the liver through damage of the reticulo-endothelial system and synthesis of innate immunity proteins and PRRs.
What can be given for hypotension despite resuscitation?
Whats given for possible alcohol withdrawal?
Inotropes
Chlordiazepoxide
Organ specific management:
HE+Cerebral oedema:
- What cells are swelling in the brain?
- Why do they swell?
- How is this managed?
Astrocytes
Hyperammonaemia
Mannitol
SUMMARY:
What is the management for the following:
- Paracetamol toxicity
- Ischaemic/hypoxic (‘shock liver’) - 2
- Pregnancy related (HELLP, AFLP)
- Hepatitis B
- Hepatitis E
- HSZ/VZV
- Wilson disease
- Autoimmune hepatitis
- Drug induced liver injury - 2
- Budd-Chiari syndrome - 3
- N-acetylcysteine
- Circulatory support
Statin1 - Early delivery
- Nucleos(t)ide analogues
- Ribavirin
- Aciclovir
- Transplant
- Steroids (if no HE)
- Withdraw offending drug
Steroids if DRESS - TIPSS
Hepatic vein stenting
Thrombolysis
TRANSPLANT SHOULD BE THOUGHT ABOUT IF THE PROGNOSIS IS NOT GOOD.
What criteria can you use to assess the need for a transplant?
Kings College Criteria
Medical contraindications for transplant? - read
Untreated or progressive infection
Clinically apparent extrahepatic or metastatic malignancy
Progressive hypotension, resistant to vasopressor support
Clinically significant ARDS, FiO2 > 0.8
Fixed dilated pupils > 1 hour in the absence of thiopentone
Severe coexistent cardiopulmonary disease
HIV?
Psychiatric contraindications for transplant?
Multiple episodes of self harm (>5) within an established pattern of behaviour (esp. if non-drug methods used)
Active intravenous drug abuse or oral polydrug use
Alcohol dependence or abuse
Established pattern of non-compliance with treatment
What score is used to grade cirrhosis and risk of variceal bleeding? - CP
Child Pugh Score
