Liver Failure Flashcards
What is acute Liver failure?
Rapid development of hepatic dysfunction without prior liver disease with <6 months duration
What are causes of acute liver failure?
Viral hepatitis Drugs (paracetamol) Schock liver Cholangitis Alcohol Malignances Chronic liver disease
What are rare causes of acute liver failure?
Budd-Chiari
AFLP
Cholestasis of pregnancy
What does AFLP stand for?
Acute fatty liver of pregnancy
What happens in paracetamol overdose?
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
Which antibiotics can cause acute liver failureß
Flucoxacillin and co-amoxiclav
Besides paracetamol and antibiotics, which drugs can cause acute liver failure?
NSAIDs
Statins rarely
What are the possible outcomes of acute liver failure?
Death
Recovery
Chronic liver disease
How does acute liver failure present?
Acute onset of jaundice
What is pre-haptic jaundice
Too much haem to break down
What are causes of pre-hepatic jaundice?
Haemolysis of all causes: haemolytic anaemias, unconjugated bilirubin
What are intra-hepatic causes of jaundice?
Acute liver failure (virus, drugs, alcohol), alcoholic hepatitis, cirrhosis (decompensated), bile duct loss (atresia, PBC, PSC), pregnancy
What is post-hepatic jaundice?
Bile can’t escape into bowel
What are causes of post-hepatic jaundiceß
Congenital biliary atresia
Gallstones
CBD strictures
Tumours
How do you investigate acute liver failure?
LFTs + albumin/bilirubin PT DHx and O/E USS including vascular Virology Ix of chronic liver disease (Rarely liver biopsy)
What are complications of acute liver failure?
Fulminant Hepatic Failure (FHF)
How do you manage acute liver failure?
Consider hypermabolic state Rest for up to 3 months No alcohol Fluids Increase calories (not high-fate foods) Treat itch
How can you treat the itch in acute liver failure?
Sodium bicarbonate bath, Cholestyramine or Ursodeoxycholic acid
What is fulminant hepatic failure (FHF)?
Jaundice and encephalopathy in a patient with a previously normal liver
What are common causes of FHF?
Paracetamol
Fulminant viral
Drugs
HBV
What are rare causes of FHF?
AFLP Mushrooms Malignancy Wilson's Budd-Chiari HAV
What are clinical features of FHF?
Encephalopathy Hypoglycaemia Coagulopathy Circualtory failure Renal failure infection
How do you treat FHF?
Supportive
Transplant
What is meant by supportive management of FHF?
Inotropes and fluids, renal replacement, manage raised ICP
