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Liver > Liver failure > Flashcards

Liver failure Flashcards

1
Q

What is hepatic failure?

A

When the liver loses its ability to regenerate and repair so that decompensation occurs

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2
Q

What is acute hepatic failure?

A

Acute liver injury with encephalopathy and deranged coagulation (INR > 1.5) in a patient with a previously normal liver

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3
Q

What are the markers of liver failure?

A
  • Hepatic encephalopathy
  • Abnormal bleeding
  • Ascites
  • Jaundice
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4
Q

What is fulminant hepatic failure?

A

A clinical syndrome resulting from massive necrosis of liver cells leading to sever impairment of liver function

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5
Q

How is fulminant hepatic failure classified?

A
  • Hyperacute: Encephalopathy within 7 days of jaundice onset
  • Acute within 8-28 days
  • Subacute with 5 - 26 weeks
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6
Q

What is fulminant hepatic failure a result of?

A

Scute hepatitis from many causes.

Paracetamol overdoe is responsible for 50% of the cases in the UK

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7
Q

What can you see histologically in fulminant hepatic failure?

A

Multiacinar necrosis involving a substantial part of the liver

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8
Q

What are the man causes of liver failure?

A
  • Drugs
  • Virus
  • Hepatocarcinoma
  • Genetic diseases
  • Acute fatty liver of pregnancy
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9
Q

What viruses can cause liver failure?

A
  • Hep A and B
  • Cytomegalovirus
  • EBV
  • Herpes simplex virus
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10
Q

What drugs can cause liver failure?

A
  • Paracetamol
  • Alcohol
  • NSAIDS
  • Ecstasy or cocaine
  • Antibiotics
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11
Q

What two genetic diseases can cause liver failure?

A
  • Wilsons disease

- Alpha-1-antitrypsin deficiency

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12
Q

What are the signs of Liver failure?

A
  • Jaundice
  • Small liver
  • Hepatic encephalopathy
  • Fetor hepaticus
  • Fever, vomiting and hypertension
  • Spasticity, hyper-reflexia shown in neuro exam
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13
Q

What signs would suggest acute-on-chronic hepatic failure

A
  • Bruising
  • Clubbing
  • Dupuytren’s contracture - when one or more fingers bend in towards your palm.
  • Ascites is RARE
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14
Q

What investigations would you do in suspected Liver failure?

A
  • Bloods
  • Imaging
  • Microbiology
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15
Q

What would you see on the blood test in someone with liver failure?

A
  • Hyperbilirubinaemia
  • High serum ALT & AST
  • Low levels of coagulation factors and raising prothrombin time
  • Low glucose (since liver is glucose store, in form of glycogen)
  • Ammonia levels high
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16
Q

What would an ultrasound show in liver failure?

A

Will define the size of the liver

17
Q

Why would you use microbiology tests in suspected liver failure?

A

To rule out infection

18
Q

How should you treat liver failure?

A

Treat the cause e.g paracetamol poisoning give N-Acetyl-Cyteine

19
Q

What is the main treatment for irreversible live damage?

A

Liver transplant

Liver (6 decks)

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