Liver failure

Question 1

Which of the following is the most accurate marker of acute liver failure?

A. Prothrombin time
B. Albumin
C. Platelet count
D. GGT
E. ALT

Answer 1

Prothrombin time (shorter half-life than albumin)

Question 2

What are the criteria for liver transplant iin the context of paracetamol overdose?

Answer 2

Grade III or IV hepatic encephalopathy
PT time > 100s
Creatinine > 300umol
Arterial pH < 7.2 24h after ingestion

Question 3

What tests would you do to assess the synthetic function of the liver?

Answer 3

Prothrombin time

Albumin

Question 4

What is the name of the criteria for liver transplant evaluation for paracetamol overdose?

Answer 4

King’s College Criteria

Question 5

What is the definition of acute liver failure?

Answer 5

Hepatic encephalopathy
Coagulation INR > 1.5
Illness of less than 26 weeks duration

Question 6

What are some causes of liver failure? Give 4 different types.

Answer 6

Viral: viral hepatitis, EBV, CMV, HSV
Drug: Amiodarone, methotrexate, isoniazid
Alcohol: alcoholic hepatitis
Autoimmune: autoimmune hepatitis, PBC, PSC
Other: Wilson’s Disease, a1-antitrypsin deficiency
Vascular: Budd-chiari syndrome, ischaemic hepatitis

Question 7

Prevention/Treatment of hepatic encepalopathy

Answer 7

Lactulose
Rifaximin

Question 8

Scoring system to quantify degree of cirrhosis

Answer 8

Child-Pugh classification

Question 9

Medical treatment of acute liver failure?

Answer 9

Treat the underlying cause
Cefotaxime if suspect SBP
Spironolactone if suspect ascites
Vit K for coagulopathy

Question 10

Conservative Mx for acute liver failure?

Answer 10

Fluid restrict (reduces oedema)
Encourage good nutrition (for albumin)
Encourage bed rest
Low salt diet (reduces oedema)
Stop hepatotoxic drugs