Liver failure

Question 1

Define liver failure

Answer 1

Inability of the liver to repair or regenerate. Can be chronic or acute

Question 2

Causes of liver failure (10)

Answer 2

1. Infection
2. Drugs
3. Toxins
4. Vascular disease
5. Alcohol fatty liver disease
6. Primary biliary cholangitis
7. Primary sclerosing cholangitis
8. Autoimmune hepatitis
9. Haemochromatosis
10. Malignancy

Question 3

Infections causing liver failure (3)

Answer 3

1. Viral hepatitis
2. Yellow fever
3. Leptospirosis

Question 4

Drugs causing liver failure (3)

Answer 4

1. Paracetamol
2. Halothane
3. Isoniazid

Question 5

Vascular disease causing liver failure

Answer 5

1. Budd-Chiari syndrome - hepatic vein obstruction by thrombosis or tumour causes congestive ischaemia and hepatocyte damage
2. Veno-occlusive disease

Question 6

Pathophysiology of liver failure

Answer 6

1. Destruction of hepatocytes
2. Development of fibrosis in response to chronic inflammation
3. Destruction of architecture of liver to the point where it can no longer perform functions adequately or repair and regenerate

Question 7

Signs of liver failure (7)

Answer 7

1. Jaundice
2. Ascites
3. Abnormal bleeding
4. Hepatic encephalopathy
5. Fetor hepaticus - breath has strong musty smell due to toxins
6. Construction apraxia
7. Mental state confusion, drowsiness - cerebral oedema

Question 8

Investigations for liver failure

Answer 8

1. Bloods - FBC, LFTs, clotting, hepatitis, paracetamol, ferritin. Raised bilirubin and low glucose
2. Microbiology - blood cultures, urine dipstick
3. Radiology - CXR, abdominal US, doppler studies of hepatic vein

Question 9

Management of liver failure

Answer 9

1. Protect airway with intubation and insert tube to prevent aspiration, remove blood from stomach
2. Insert urinary and central venous catheters to assess fluid balance
3. Treat the cause
4. Treat seizures with phenytoin
5. Haemofiltration/haemodialysis
6. Liver transplant

Question 10

Complications of liver failure + treatment

Answer 10

1. Ascites - restrict fluids, low salt, weigh daily, diuretics
2. Encephalopathy - correct electrolytes, rifaximin (antibiotic)
3. Bleeding - vit K
4. Cerebral oedema - mannitol IV

Question 11

Define hepatitis

Answer 11

Inflammation of the liver. Acute <6months

Question 12

Clinical features of acute hepatitis

Answer 12

Can be asymptomatic

1. General malaise
2. Myalgia
3. Jaundice (pale stools, dark urine)
4. GI upset
5. Abdominal pain
6. Tender hepatomegaly

Question 13

Causes of hepatitis

Answer 13

1. Hepatitis A,B,C,D,E
2. Non-viral: spirochaetes, parasites, mycobacteria, bacteria
3. Non-infection: alcohol, toxins/poisoning, autoimmune