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Gastrointestinal > Liver failure > Flashcards

Liver failure Flashcards

1
Q

Define liver failure

A

Severe liver dysfunction leading to jaundice, encephalopathy & coagulopathy

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2
Q

Classification of liver failure

3

A

Classified based on time interval between onset of jaundice & development of hepatic encephalopathy
Hyperacute = <7 days
Acute = 1-4 weeks
Subacute = 4-12 weeks

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3
Q

Define acute-on-chronic liver failure

A

Acute deterioration (decompensation) in patients w/ chronic liver disease

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4
Q

Causes of liver failure

1 + 2 + 7

A

Viral
Hepatitis A, B, C, D, E

Drugs
Paracetamol overdose
Idiosyncratic drug reactions

Less common
Autoimmune hepatitis
Budd-Chiari syndrome
Pregnancy related
Malignancy (e.g. lymphoma)
Haemochromatosis 
Mushroom poisoning (Amanita phalloides) 
Wilson’s disease
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5
Q

Pathogenesis of liver failure

1 jaundice, 2 encephalopathy, 3 coagulopathy

A

Jaundice
Due to decreased secretion of conjugated bilirubin

Encephalopathy
Nitrogenous waste products (e.g. ammonia) absorbed in gut go via portal circulation to liver
Failing liver dose not extract toxic products so they go through to the brain to exert effects

Coagulopathy
Reduced synthesis of clotting factors
Reduced platelets
Platelet functional abnormalities associated w/ jaundice or renal failure

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6
Q

Epidemiology of liver failure

cause

A

Paracetamol overdose counts for 50% acute liver failure in UK

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7
Q

Presenting symptoms of liver failure

general + 3

A

May be ASYMPTOMATIC

Fever
Nausea
Jaundice (not always)

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8
Q

Signs of liver failure on physical examination

8

A 
Jaundice
Encephalopathy
Asterixis
Fetor hepaticus
Ascites & splenomegaly (mostly in subacute)
Bruising or bleeding 
Signs of secondary causes (e.g. bronze skin, Kayser-Fleischer rings)
Pyrexia (infection/necrosis)
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9
Q

Investigations for liver failure

6

A 
Identify cause
Bloods
Liver US/CT
Ascitic tap
Doppler scan of hepatic/portal veins
EEG
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10
Q

Investigations for liver failure - cause

5

A 
Viral serology
Paracetamol levels
Autoantibodies (ASM, anti-LKM)
Ferritin (haemochromatosis)
Caeruloplasmin & urinary copper (Wilson’s disease)
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11
Q

Investigations for liver failure - bloods

8

A 
FBC
low Hb (if bleed), high WCC (if infection)
U&Es
may show renal failure (hepatorenal syndrome)
Glucose
LFTs
high bilirubin, AST, ALT, ALP, GGT, low albumin
ESR/CRP
Coagulation screen
ABG
to determine blood pH
Group & save
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12
Q

Investigations for liver failure - ascitic tap

2

A

Send for MC&S

If neutrophils >250/mm^3 = spontaneous bacterial peritonitis

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13
Q

Investigations for liver failure - doppler scan of hepatic/portal veins

A

Check for Budd-Chiari syndrome

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14
Q

Investigations for liver failure - EEG

A

Monitor hepatic encephalopathy

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15
Q

Management of liver failure

5

A 
Resuscitation 
Treat cause if possible 
Treat/prevent complications
Renal failure
Surgical
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16
Q

Management of liver failure - resus

A

ABC

17
Q

Management of liver failure - cause

A

N-acetylcysteine for paracetamol overdose

18
Q

Management of liver failure - complications

9

A

Invasive ventilation & cardiovascular support often required
Monitor - vital signs, PT, pH, creatinine, urine output, encephalopathy
Manage encephalopathy - lactulose & phosphate enemas
Antibiotic & antifungal prophylaxis
Hypoglycaemia treatment
Coagulopathy treatment - IV vitamin K, FFP, platelet infusions
Gastric mucosa protection - PPIs or sucralfate
AVOID sedatives or drugs metabolised by liver
Cerebral oedema - decrease ICP w/ mannitol

19
Q

Management of liver failure - renal failure

2

A

Haemodialysis

Nutritional support

20
Q

Management of liver failure - surgical

A

Liver transplant

21
Q

Complications of liver failure

8

A 
Infection
Coagulopathy
Hypoglycaemia
Disturbance of electrolyte & acid base balance
Disturbance of cardiovascular system
Hepatorenal syndrome
Cerebral oedema (causing raised ICP)
Respiratory failure
22
Q

Prognosis of liver failure

A

Depends on severity & aetiology

Gastrointestinal (52 decks)

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