Liver failure Flashcards

(37 cards)

1
Q

causes of acute liver failure

A

alcohol
HELLP syndrome
drugs (paracetamol overdose, isoniazid)
hepatitis A or B (extremely uncommon in C), EBV, CMV

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2
Q

causes of chronic liver failure

A
PBC
Wilson's
alcohol
haemochromatosis
alpha 1 antitrypsin deficiency
NAFLD
HBV
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3
Q

symptoms of acute liver failure

A
  • hepatic encephalopathy
  • cerebral oedema
  • coagulopathy
  • hyponatraemia
  • jaundice
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4
Q

what causes hepatic encephalopathy

A

build up of nitrous waste. astrocytes clear it. excess glutamine produced by astrocytic clearing leads to osmotic shift which causes cerebral oedema

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5
Q

sx chronic liver failure

A
clubbing
spider naevia
gynaecomastica
anaemia
jaundice
ascites 
peripheral oedema
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6
Q

what happens in alcoholic liver disease

A

inflammation of heptocytes (hepatitis) -> fibrosis -> eventually cirrhsis

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7
Q

LFTs in alc liver disease

A

AST:ALT ratio >2:1
serum GGT raised
bilirubin and alk phos can be raised
(FBC high MCV)

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8
Q

what can be seen on biopsy in alc liver disease

A

mallory bodies

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9
Q

med used for para overdose

A

n acetylcysteine (NAC)

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10
Q

how can cirrhosis be divided

A

micronodular

macronodular

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11
Q

drugs to avoid in cirrhosis

A

aspirin

NSAIDs

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12
Q

inheritance pattern of haemochromatosis

A

AR (but one type is AD)

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13
Q

what organs does haemochromatosis affect?

A
deposition of iron in
joints
heart
liver
pancreas
skin
adrenals
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14
Q

symptoms of haemochromatosis

A

arthralgia
fatigue
slate grey skin
signs of chronic liver disease

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15
Q

rx haemochromatosis

A

regular venesection

low iron diet

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16
Q

what stain is used on liver biopsy to show haemochromatosis

17
Q

when may secondary haemochromatosis occur

A

pts who have received >40L of blood transfusion in short time

18
Q

what is wilson’s disease

A

rare AR disorder of biliary copper excretion

copper builds up in liver and CNS

19
Q

CNS symptoms in wilson’s

A

tremor, dyskinesia, dystonia, mood distrubance, memory problems

20
Q

treatment of wilson’s

A

penicillamine

low copper diet

21
Q

what are the name of the rings in the eye in Wilson’s

A

kayser-fleischer rings

22
Q

what disease if emphysema, cirrhosis and cholestatic jaundice

A

alpha 1 antitrypsin deficiency

23
Q

symptoms of liver abscess

A

RUQ pain
tender large liver
tachycardia
fever

-how interesting!

24
Q

two types of liver abscess

A

pyogenic - bacteria from other infections via portal blood

amoebic - from bowel to liver (entamoeba histolytica)

25
what pyogenic organissm
``` staph strep e coli klebsiella anaerobes ```
26
treatment of liver abscess
abx, possibly drainage | amoebic: metronidazole
27
causes of portal HTN
- pre hepatic: portal vein thrombosis - hepatic: cirrhosis - post hepatic: hepatic vein thrombosis, right heart failure
28
signs of portal HTN
ascites jaundice splenomegaly
29
diagnosis of portal HTN
measure hepatic venous pressure gradient
30
most common causes of portal hypertension worldwide?
schistosomiasis
31
what may portal hyptertension lead to the formation of
oesophageal varices (collaterals)
32
what classification for acute liver failure
o'grady | jaundice to encelphalopathy time (hyperacute is within 7 days, actue 8-28 days, subacute 29days-12wk)
33
rare causes of ALF
``` ischaemic heaptitis autoimmune hep acute fatty liver of preg wilson's budd chiari ```
34
when assessing paracetamol use, what to consider?
could be ACCIDENTAL e.g. taking cocodamol, lemsip and cold and flu remedy
35
what value is used to assess coagulopathy
INR (nb 1 is normal because it's a ratio!)
36
factors increasing risk of hepatotoxicity
``` staggered overdose excessive alc consumption malnutrtion HIV cancer chronic liver disease on antiepileptics, rifampicin, spirinolactone ```
37
rx paracetamol overdose
n-acetylcysteine (NAC). GIVE BEFORE PARA LEVELS COME BACK AS THERE'S NO HARM! IV fluids