Fulminant/sub-fulminant liver failure

Question 1

What is liver failure?

Answer 1

recognised by the development of coagulopathy: INR>1.5, and encephalopathy

Question 2

What are the 2 broad types of liver failure and the subtypes within them?

Answer 2

1. Acute liver failure
   
   • hyperacute: onset <7 days
   • Acute: 8-21 days
   • Subacute: 4-26 weeks
2. Chronic liver failure

Question 3

What is hyperacute liver failure?

Answer 3

onset 7 days or less

Question 4

What is acute liver failure?

Answer 4

onset 8-21 days

Question 5

What is subacute liver failure?

Answer 5

4-26 weeks

Question 6

What is chronic lvier failure?

Answer 6

liver failure on a background of cirrhosis

Question 7

What causes fulminant hepatic failure?

Answer 7

clinical syndrome resulting from massive necrosis of liver cells leading to severe imapirment of liver function

Question 8

What are 7 examples of causes of liver failure?

Answer 8

1. Infection; Viral hepatitis (B, C, CMV), yellow fever, leptospirosis
2. Drugs: Paracetamol overdose, halothane, isoniazid
3. Alcohol
4. Non-alcoholic fatty liver disease
5. Autoimmune: PBC, PSC, AIH
6. Haemochromatosis
7. Vascular: Budd-Chiari syndrome, venoocclusive disease

Question 9

What are 5 signs of liver failure?

Answer 9

1. Jaundice
2. Hepatic encephalopathy
3. Fetor hepaticus (smells like pear drops)
4. Asterixis/flap
5. Constructional apraxia (cannot copy 5-pointed star)

Question 10

What is a definition of fulminant hepatic failure?

Answer 10

rapid development of acute liver injury with severe impairment of hte synthetic function and hepatic encephalopathy in a patient without obvious, previous liver disease

onset of encephalopathy within 8 weeks

Question 11

How does fulminant hepatic failure differ from subfulminant hepatic failure?

Answer 11

fulminant: encephalopathy onset within 8 weeks, subfulminant: onset after 8 weeks but before 26 weeks