Liver Failure Flashcards
def
severe liver dysfunction leading to
- jaundice
- encephalopathy
- coagulopathy
what are the different classifications of liver failure
1 hyperacute liver failure
-jaundice with encephalopathy occuring in <7days
2 acute
-jaundice with encephalopathy occuring within 1-4wks of onset
3 subacute
-jaundice with encephalopathy occuring within 4-12wks of onset
4 acute-on-chronic
-acute deterioration (decompensation) in patients with CLD
aetiology
1 viral -hep A,B,D,E 2 drugs -paracetamol 3 less common -autoimmune hep -budd-chiari syndrome -haemochromatosis
how does liver failure cause jaundice
decreased secretion of conjugated bilirubin
how does liver failure cause encephalopathy
increased delivery of gut-derived products into systemic circulation + brain from decreased extraction of nitrogenous products by liver + portal systemic shunting
(ammonia)
how does liver failure cause coagulopathy
decreased synthesis of clotting factors
decreased platelets
when would you find decreased platelets in liver failure
hypersplenism if chronic portal hypertension
history
1 may be asymptomatic
2 fever + nausea
3 possibly jaundice
examination
1 jaundice 2 encephalopathy 3 asterixis 4 ascites 5 bruising/bleeding
what is fetor hepaticus
smell of ‘pear drops’
liver failure
what is kayser-fleischer rings
dark rings around the iris due to copper deposition caused by wilsons disease
investigations
1 identify cause -viral serology -paracetamol levels -autoantibodies 2 bloods -FBC (low Hb if GI bleed, high WCC if infection) -UEs (hepatorenal failure) -LFTs (high bilirubin, low albumin) -coagulation (high PT) 3 imaging 4 ascitic fluid 5 doppler scan
what is the most sensitive marker of liver function
PT time
why would ascitic fluid be tapped
to exclude SBP (spontaneous bacterial peritonitis)
>250neutrophil/mm3 indicates SBP
why would a doppler scan of hepatic + portal veins be taken
to exclude budd-chiari syndrome
