GUT- Drugs and The Liver; Liver Failure (Acute and Chronic) Flashcards
what are the symptoms of acute liver failure
feeling unwell nausea vomiting abdominal discomfort tachycardia elevated liver enzymes liver flap
what is acute liver failure
sudden onset of liver dysfunction with no prior liver disease
why is a liver flap a sign of liver disease
liver detoxified ammonia to urea- if the liver is not working properly ammonia accumulates in the blood, crossing the blood brain barrier and causing encephalopathy
what do low INR levels have to do with liver disease
the liver produces clotting factors - a dysfunction of the liver may lead to less production of clotting factors
why does low blood sugar indicate liver failure
the liver is responsible for gluconeogenesis
what are some causes of acute liver failure
paracetamol overdose pregnancy infection malignancy genetic defects
outline some risk factors for ALF
hepatoxic drugs
contaminate food (enteric viruses - Hep A/E)
blood borne viruses (Hep B)
recreational drug use
which drugs can induce liver injury
paracetamol NSAIDS Herbal remedies Statins Ecstasy
outline the pathogenicity of ALF
liver injury liver cell death loss of critical hepatocyte mass failure of liver to perform functions multiorgan dysfunction
how can ALF lead to raised ICP (Intracranial pressure)
when ammonia accumulation crosses the BBB it is detoxified in the astrocytes to glutamine
accumulation of glutamine has an osmotic effect leading to the influx of water and astrocyte swelling
How would you investigate liver failure
Blood tests - FBC, U + E, FLT, GGT, Blood clotting, glucose, Arterial blood gas, blood culture
scans- ultrasound, CT,
Liver biopsy
echocardiogram - check for HF< hepatic Ischaemia, ischaemia-congestion
what is the initial management of liver failure
Resuscitate - ITU, protect the airway, correct hypoglycaemia and blood volume depletion, avoid hypernatremia
if due to drug overdose - give N-acetyl Cysteine
if due to infection- consider empirical antibiotics
what are the causes of chronic liver failure
alcohol related liver disease non- alcoholic associated liver disease autoimmune liver disease hepatitis inherited liver disease budd-chiari drugs
what is the pathogenicity of chronic liver failure
underlying cirrhosis
insidious replacement of hepatocytes with fibrous tissue causing architectural distortion and nodule formation
cirrhosis can be asymptomatic and compensated with no complications and normal liver function
what are the clinical complications of chronic liver failure
Hepatocellular insufficiency - jaundice, encephalopathy, sarcopenia, coagulopathy
portal hypertension - variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatorenal syndrome
hepatocellular carcinoma
