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Gastrointestinal Conditions (JBR) > Liver Failure > Flashcards

Liver Failure Flashcards

1
Q

What is acute Liver failure?

A

Rapid development of hepatic dysfunction without prior liver disease with <6 months duration

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2
Q

What are causes of acute liver failure?

A 
Viral hepatitis
Drugs (paracetamol) 
Schock liver
Cholangitis
Alcohol
Malignances
Chronic liver disease
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3
Q

What are rare causes of acute liver failure?

A

Budd-Chiari
AFLP
Cholestasis of pregnancy

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4
Q

What does AFLP stand for?

A

Acute fatty liver of pregnancy

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5
Q

What happens in paracetamol overdose?

A

Leads to depletion of glutathionestores (due to NAQP1 detoxification by glutathione and mercaptureic acid) leading to toxic levels of NAQP1 causing widespread hepatocytic damage and death - liver necrosis

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6
Q

Which antibiotics can cause acute liver failureß

A

Flucoxacillin and co-amoxiclav

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7
Q

Besides paracetamol and antibiotics, which drugs can cause acute liver failure?

A

NSAIDs

Statins rarely

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8
Q

What are the possible outcomes of acute liver failure?

A

Death
Recovery
Chronic liver disease

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9
Q

How does acute liver failure present?

A

Acute onset of jaundice

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10
Q

What is pre-haptic jaundice

A

Too much haem to break down

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11
Q

What are causes of pre-hepatic jaundice?

A

Haemolysis of all causes: haemolytic anaemias, unconjugated bilirubin

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12
Q

What are intra-hepatic causes of jaundice?

A

Acute liver failure (virus, drugs, alcohol), alcoholic hepatitis, cirrhosis (decompensated), bile duct loss (atresia, PBC, PSC), pregnancy

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13
Q

What is post-hepatic jaundice?

A

Bile can’t escape into bowel

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14
Q

What are causes of post-hepatic jaundiceß

A

Congenital biliary atresia
Gallstones
CBD strictures
Tumours

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15
Q

How do you investigate acute liver failure?

A 
LFTs + albumin/bilirubin
PT 
DHx and O/E
USS including vascular 
Virology
Ix of chronic liver disease
(Rarely liver biopsy)
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16
Q

What are complications of acute liver failure?

A

Fulminant Hepatic Failure (FHF)

17
Q

How do you manage acute liver failure?

A 
Consider hypermabolic state
Rest for up to 3 months 
No alcohol
Fluids
Increase calories (not high-fate foods) 
Treat itch
18
Q

How can you treat the itch in acute liver failure?

A

Sodium bicarbonate bath, Cholestyramine or Ursodeoxycholic acid

19
Q

What is fulminant hepatic failure (FHF)?

A

Jaundice and encephalopathy in a patient with a previously normal liver

20
Q

What are common causes of FHF?

A

Paracetamol
Fulminant viral
Drugs
HBV

21
Q

What are rare causes of FHF?

A 
AFLP
Mushrooms
Malignancy 
Wilson's 
Budd-Chiari
HAV
22
Q

What are clinical features of FHF?

A 
Encephalopathy
Hypoglycaemia
Coagulopathy
Circualtory failure 
Renal failure 
infection
23
Q

How do you treat FHF?

A

Supportive

Transplant

24
Q

What is meant by supportive management of FHF?

A

Inotropes and fluids, renal replacement, manage raised ICP

Gastrointestinal Conditions (JBR) (33 decks)

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