Liver Flashcards
Functions of the liver
Metabolites breakdown - drugs, endogenous products, ammonia Conjugates bile Produces bile Produces clotting factors Produces proteins, albumin, transferrin Produces CRP immune function Fat metabolism Stores glucose as glycogen Vitamin ADEK EPO/TPO
What is liver failure
Development of coagulopathy INR above 1.5
And encephalopathy
How can liver failure occur
Time line and background of
Occur acutely on the background of a normal healthy liver - acute liver failure Can be Hyperacute <7days Acute 8-21 days Subacute 4-26weeks Or on the background of cirrhosis - chronic liver failure Or fulminant hepatic failure Clinical syndrome resulting in massive necrosis of liver cells leading to severe impairment of liver function
Cause of liver failure
Infective - A-E, CMV, EBV, yellow fever , Drugs - paracetamol overdose, halothane, isoniazid Vascular budd chari syndrome Alcohol Fatty liver disease PBC, PSC, AIH Haemochromatosis A1AT Wilson Malignancy
Signs of liver failure
Jaundice Hepatic encephalopathy Fetor hepaticus Asterixis Constructional apraxia Signs of chronic liver disease - acute on chronic hepatic failure
Complications of chronic liver disease
Cirrhosis Varices Portal hypertension HCC Ascites Hepatorenal syndrome Deranged clotting Encephalopathy
What is hepatorenal syndrome
Combination of
Cirrhosis
Ascites
Renal failure
What is hepatorenal syndrome caused by
Inc portal hypertension causing a hyper dynamic circulation in the splanchnic veins which means they are vasodilator due to bacterial translocation, cytokines and mesenteric angiogenesis
Causing pooling of blood in the splanchnics
This also causes altered renal auto reg causing renal vasoconstriction causing kidney injury
What are the types of hepatorenal failure
HRS1 rapidly progressive deterioration in circulatory and renal function may need haemodialysis and terlipressin
HRS2 more steady deterioration TIPSS may be needed
Criteria used to asses prognosis of acute liver failure
Kings college criteria
Fulfill the criteria poor outcome and prompt consideration for a liver transplant
What is the kings college criteria for acute liver failure
Paracetamol induced ABG pH <7.3 Or all of these PT >100 Creatinine > 300 Grade 3 or 4 encephalopathy Non paracetamol induced PT >100 Or 3/5 Drug induced Age <10 >40 1 week from first jaundice to encephalopathy PT >50 Bilirubin >300
What is cirrhosis
Irreversible liver damage
Get loss of hepatic architecture
Bridging fibrosis and nodular regeneration
Causes of cirrhosis
Chronic alcohol use Chronic HBV HCV Genetic - A1AT, Wilson’s, haemochromotosis Hepatic vein events - budd Chiari NASH PBC,PSC, AIH drugs - methotrexate
Management of cirrhosis
Conservative - nutrition, abstain from alcohol, avoid NSAIDS,opiates, sedatives
Medical - itch colestyramine
Screen USS +- alpha feta protein
Definitive treatment transplant
Ascites management
Conservative - fluid and salt restriction
Medical - spironolactone
Surgical paracentesis, permanent
