Liver failure Flashcards
what are causes of acute liver failure?
paracetamol overdose
alcohol
acute fatty liver of pregnancy
viral hepatitis B
what are features of acute liver failure?
coagulopathy: bruising, petechiae
hypoalbuminaemia: ascites, pleural effusion, peripheral oedema
conjugated jaundice
hepatic encephalopathy: confusion, irritability, coma
what is the first line treatment of hepatorenal syndrome?
terlipressin
what’s the difference between type 1 and type 2 hepatorenal syndrome?
type 1
- occurs within 14 days
- doubling serum creatinine to > 221 or halving of creatinine clearance to < 20ml/min
- poor prognosis
type 2
- slowly progressive
- prognosis poor but patients may live longer
what are management options for hepatorenal syndrome?
vasopressin anologues drugs i.e. terlipressin
volume expansion 20% albumin
TIPSS
what’s the underlying pathology of hepatorenal syndrome?
vasoactive mediators cause splanchic dilatation which decreases systemic peripheral vascular resistance
= under perfusion of kidneys which trigger juxtoglomuerlar apparatus activating RAAS
= renal vasoconstriction