Liver Failure Flashcards
What kind of liver picture fits with raised ALT > AST?
- Hepatocellular necrosis/injury
- Acute viral hepatitis
- Acute drug toxicity
- Ischaemia
What kind of liver picture fits with raised ALP and GGT?
- Cholestasis/obstruction
- Biliary obstruction
- Liver infiltration
- Drug reaction
GGT is also increased with chronic EtOH intake
What kind of liver picture fits with raised ALT, AST, ALP and GGT?
- Mixed
- Alcoholic liver disease
- Fatty liver disease
How is acute liver failure defined?
INR > 1.5
Any encehalopathy
Duration of illness (jaundice) up to 26 weeks
What kinds of things cause acute liver failure?
- Acute paracetamol toxicity
- HBV/HAV
- Drug reaction
What kind of investigations might be required to determine the cause of a suspected acute (or even chronic) liver failure?
- LFTs including albumin, bilirubin, INR
- Hepatitis serology
- Liver ultrasound
- Caeruloplasmin, serum and urine copper
- Hb levels
- CMV/EBV serology
- Paracetamol screening
- Autoantibodies
- CT abdo
How is acute liver failure managed?
- Topical/oral antifungals (immunosuppressed)
- H2 antagonists (gastric ulcer dangerous with decreased clotting)
- Vitamin K supplementation
- Lactulose (clears bowel of bacteria excess - decreases NH3)
- Neurological observations
- Liver transplant?
What are the main causes of chronic liver failure?
- Alcohol, HBV, HCV
- Haemochromatosis, Wilson’s, A1AT deficiency
- Autoimmune liver disease
- NASH, drugs, Budd-Chiari syndrome
What are some complications of liver failure?
- Resp - ARDS, hepatopulmonary syndrome
- Bone marrow suppression and thrombocytopaenia, hypersplenism
- Hepatic encephalopathy
- Hepatorenal syndrome (pre-renal AKI)
- Systemic catabolism
What is the critical intervention for someone with paracetamol toxicity? What other things might you consider with respect to acute liver failure?
- N-acetyl-cysteine infusion (100% effective within 8 hours)
- Coagulation correction
- Dialysis
- IVABs
- Admission at liver transplant unit if required
