Chronic liver failure

Question 1

What causes it

Answer 1

Infections:

• Viral Hepatits (esp B,C, CMV)
• yellow fever
• leptospirosis.

Drugs: paracetamol O/D;

Toxins: amanita phalloides mushroom, carbon tetrachloride

Other: alcohol, primary biliary cirrhosis, cirrhosis, haemochromatosis, autoimmune hepatitis, alpha-1-antitrypsin deficiency, Wilson’s disease.

Question 2

What are the signs

Answer 2

Jaundice
Hepatic encephalopathy
Fetor hepaticus (smells like pear drops)
Asterixis
Constructional apraxia (can’t draw a 5 point star)

Signs of chronic liver disease suggest an acute-on-chronic failure.

Question 3

What are some complications that can arise

Answer 3

• Encephalopathy as ammonia build up –> brain –> astrocytes convert glutamate –> glutamine –> osmotic imbalance –> cerebral oedema

Question 4

How do you treat

Answer 4

ITU