Liver Failure

Question 1

what test result would you look at to Dx liver failure?

Answer 1

^INR by 1.5 +/- hepatic encephalopathy

Question 2

name some hepatotoxic drugs?

Answer 2

paracetamol

methotrexate

Question 3

what is hepatic encephalopathy?

Answer 3

Hepatic encephalopathy (as liver fails, nitrogenous waste (ammonia) builds up and passes to brain where astrocytes clear it (by processes involving conversion of glutamate to glutamine) excess glutamine causes an osmotic imbalance and cerebral oedema.

Grading of hepatic encephalopathy:
o I – altered mood, reversal of sleep pattern.
o II - ^Drowsy, confusion, slurred speech +/- liver flap.
o III – Incoherent, restless, liver flap
o IV – Coma

Question 4

signs of liver failure other than hepatic encephalopathy?

Answer 4

jaundice
liver flap
increased PT time
low albumin

Question 5

why is renal failure common with liver failure?

Answer 5

hepatorenal syndrome

Question 6

what tests do you do to look at liver failure?

Answer 6

not LFTs

low albumin and increased PT

Question 7

Management of liver failure?

Answer 7

caheters to assess fluid status
10% glucose IV to avoid hypoglycaemia
treat cause

Question 8

how do you overcome the following complications?

• bleeding
• ascites
• ## blind Tx for infection?

Answer 8

• bleeding (give Vit K IV for 3 days)
• ascites (restrict fluid, low salt diet, diuretics)
• ceftriaxone NOT gentamicin as it increases risk of renal failure

Question 9

what is hepatorenal syndrome?

Answer 9

cirrhosis + ascites + renal failure