Liver failure

Question 1

What is liver failure?

Answer 1

Acute liver failure (ALF) is a rare syndrome defined by a rapid decline in hepatic function characterised by jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy in patients with no evidence of prior liver disease.

Question 2

What are the risk factors of liver failure?

Answer 2

> Alcohol
> Poor nutrition
> Female
> Age >40
> Pregnancy
> Chronic Hep B/C
> Chronic pain and narcotic use
> Hepatotoxicity

Question 3

What is the epidemiology of liver failure?

Answer 3

ALF is a rare event. In the US it has an incidence of approximately 2000 cases annually, yet it accounts for up to 6% of all liver-related deaths

Question 4

What are the signs and symptoms of liver failure?

Answer 4

> Jaundice
> Hepatic encephalopathy
> Abdominal pain
> Nausea
> Vomiting
> Malaise
> Cerebral oedema
> RUQ tenderness
> Hepatomegaly
> Absence of Splenomegaly, palmar erythema, ascites

Question 5

What are appropriate investigations for liver failure?

Answer 5

Bloods
CXR
Abdominal US with doppler

Question 6

What are the complications of liver failure?

Answer 6

Rapidly progressing hepatic encephalopathy
Coagulopathy
Infection
Renal failure and haemodynamic changes
Metabolic disorders
Cerebral oedema
GI bleeding

Question 7

What is the prognosis of liver failure?

Answer 7

ALF carries a substantial risk of mortality and continues to be a major challenge to clinicians as strategies to improve outcomes are developed