Liver Failure

Question 1

what 3 features can liver failure be characterised with

Answer 1

jaundice, coagulopathy, encephalopathy

Question 2

classification of liver failure in terms of time intervals

Answer 2

hyperacute; <7 days

acute; 1-4 weeks

subacute; 4-12 weeks

Question 3

what is acute-on-chronic liver failure

Answer 3

someone with chronic hepatic failure has an acute decompensation

Question 4

what are the two main causes of liver failure

Answer 4

viral (hepatitis)

drugs (paracetamol overdose/ idiosyncratic drug reactions)

paracetamol overdose accounts for 50% of acute liver failure

Question 5

what actually causes jaundice in liver failure

Answer 5

decreased secretion of conjugated bilirubin

Question 6

what causes encephalopathy

Answer 6

nitrogenous waste products such as ammonia are absorbed through the gut and is not converted to urea which is less toxic

more ammonia reaches the brain and exerts toxic effects

Question 7

what causes coagulopathy

Answer 7

reduced synthesis of clotting factors,

reduced platelets

Question 8

presenting symptoms of liver failure

Answer 8

(CAN BE ASYMPTOMATIC)

fever, nausea, jaundice

encephalopathy, ascites, splenomegaly, hepatomegaly

coagulopathy (bleeding, bruising)

pyrexia (if viral/hepatic infection or liver necrosis)

Question 9

what is the principal of investigations for liver failure

Answer 9

to identify the cause

Question 10

what investigations will be done for suspected liver failure

Answer 10

Bloods (FBC, U&Es, LFTs, glucose, CRP, coagulation screen, ABG)

imaging (liver ultrasound and CT)

do an EEG for encephalopathy

ascitic tap sent for microscopy, culture and sensitivity to identify any neutrophils if the cause of deterioration is an infection

Question 11

LFT results in someone with liver failure

Answer 11

high bilirubin, high AST,ALT, GGT, ALP

low albumin

Question 12

management of liver failure

Answer 12

Resuscitation- ABCDE

treat cause- manage encephalopathy, give Abx, hypoglycaemia treatment

treat coagulopathy with clotting factors, blood transfusion and vitamin K injection

Question 13

what to avoid in the management of a patient with liver failure

Answer 13

drugs/ sedatives that are metabolised in the liver

Question 14

other things to consider in treating patient with liver failure

Answer 14

renal failure (dialysis/ transplant/ nutritional support)

liver transplant