Liver failure Flashcards
causes of acute liver failure
alcohol
HELLP syndrome
drugs (paracetamol overdose, isoniazid)
hepatitis A or B (extremely uncommon in C), EBV, CMV
causes of chronic liver failure
PBC Wilson's alcohol haemochromatosis alpha 1 antitrypsin deficiency NAFLD HBV
symptoms of acute liver failure
- hepatic encephalopathy
- cerebral oedema
- coagulopathy
- hyponatraemia
- jaundice
what causes hepatic encephalopathy
build up of nitrous waste. astrocytes clear it. excess glutamine produced by astrocytic clearing leads to osmotic shift which causes cerebral oedema
sx chronic liver failure
clubbing spider naevia gynaecomastica anaemia jaundice ascites peripheral oedema
what happens in alcoholic liver disease
inflammation of heptocytes (hepatitis) -> fibrosis -> eventually cirrhsis
LFTs in alc liver disease
AST:ALT ratio >2:1
serum GGT raised
bilirubin and alk phos can be raised
(FBC high MCV)
what can be seen on biopsy in alc liver disease
mallory bodies
med used for para overdose
n acetylcysteine (NAC)
how can cirrhosis be divided
micronodular
macronodular
drugs to avoid in cirrhosis
aspirin
NSAIDs
inheritance pattern of haemochromatosis
AR (but one type is AD)
what organs does haemochromatosis affect?
deposition of iron in joints heart liver pancreas skin adrenals
symptoms of haemochromatosis
arthralgia
fatigue
slate grey skin
signs of chronic liver disease
rx haemochromatosis
regular venesection
low iron diet
what stain is used on liver biopsy to show haemochromatosis
perls stain
when may secondary haemochromatosis occur
pts who have received >40L of blood transfusion in short time
what is wilson’s disease
rare AR disorder of biliary copper excretion
copper builds up in liver and CNS
CNS symptoms in wilson’s
tremor, dyskinesia, dystonia, mood distrubance, memory problems
treatment of wilson’s
penicillamine
low copper diet
what are the name of the rings in the eye in Wilson’s
kayser-fleischer rings
what disease if emphysema, cirrhosis and cholestatic jaundice
alpha 1 antitrypsin deficiency
symptoms of liver abscess
RUQ pain
tender large liver
tachycardia
fever
-how interesting!
two types of liver abscess
pyogenic - bacteria from other infections via portal blood
amoebic - from bowel to liver (entamoeba histolytica)
what pyogenic organissm
staph strep e coli klebsiella anaerobes
treatment of liver abscess
abx, possibly drainage
amoebic: metronidazole
causes of portal HTN
- pre hepatic: portal vein thrombosis
- hepatic: cirrhosis
- post hepatic: hepatic vein thrombosis, right heart failure
signs of portal HTN
ascites
jaundice
splenomegaly
diagnosis of portal HTN
measure hepatic venous pressure gradient
most common causes of portal hypertension worldwide?
schistosomiasis
what may portal hyptertension lead to the formation of
oesophageal varices (collaterals)
what classification for acute liver failure
o’grady
jaundice to encelphalopathy time (hyperacute is within 7 days, actue 8-28 days, subacute 29days-12wk)
rare causes of ALF
ischaemic heaptitis autoimmune hep acute fatty liver of preg wilson's budd chiari
when assessing paracetamol use, what to consider?
could be ACCIDENTAL e.g. taking cocodamol, lemsip and cold and flu remedy
what value is used to assess coagulopathy
INR (nb 1 is normal because it’s a ratio!)
factors increasing risk of hepatotoxicity
staggered overdose excessive alc consumption malnutrtion HIV cancer chronic liver disease on antiepileptics, rifampicin, spirinolactone
rx paracetamol overdose
n-acetylcysteine (NAC). GIVE BEFORE PARA LEVELS COME BACK AS THERE’S NO HARM!
IV fluids
