Liver Failure Flashcards
Define Liver Failure?
Severe liver dysfunction leading to jaundice, encephalopathy and coagulopathy
What is Liver Failure classifed based on?
The time interval between the onset of jaundice and the development of hepatic encephalopathy
What is the classification of Liver Failure?
Hyperacute = < 7 days Acute = 1-4 weeks Subacute = 4-12 weeks
What is Acute-on-Chronic Liver Failure?
Acute deterioration (decompensation) in patients with chronic liver disease
What are the viral causes of Liver Failure?
Hepatitis A, B, C, D and E
What drugs can cause Liver Failure?
Paracetamol Overdose
Idiosyncratic drug reactions
What are some of the less common causes of Liver Failure?
Autoimmune hepatitis Budd-Chiari syndrome Pregnancy-related Malignancy (e.g. lymphoma) Haemochromatosis Mushroom poisoning (Amanita phalloides) Wilson's Disease
What is the pathogenesis of Jaundice in Liver Failure?
Due to decreased secretion of conjugated bilirubin
What is the pathogenesis of Encephalopathy in Liver Failure?
Nitrogenous products (e.g. ammonia) is absorbed in the gut and goes via the portal circulation to the liver
A normal liver would be able to extract these harmful substances
However, if the liver is failing, these toxic products can go through the liver and reach the brain and exert its effects
What is the pathogenesis of Coagulopathy in Liver Failure?
Reduced synthesis of clotting factors
Reduced platelets
Platelet functional abnormalities associated with jaundice or renal failure
What is the epidemiology of Liver Failure?
Paracetamol overdose counts for 50% of acute liver failure in the UK
What are the presenting symptoms of Liver Failure?
May be asymptomatic
Fever
Nausea
Jaundice (not always)
What are the signs of Liver Failure on physical examination?
Jaundice Encephalopathy Asterixis Fetor Hepaticus Ascites and Splenomegaly (less common if acute or hyperacute) Bruising or bleeding Signs of secondary causes Pyrexia
What are some of the signs of secondary causes in Liver Failure?
e.g.
bronze skin colour
Kayser-Fleisher rings
What can Pyrexia indicate if it’s a sign for Liver Failure?
Infection or Liver necrosis
What investigations do we do for Liver Failure?
Investigations to Identify the Cause Bloods Liver US/CT Ascitic Tap Doppler scan of hepatic or portal veins EEG
What investigations do we do to identify the cause of Liver Failure?
Viral serology Paracetamol levels Autoantibodies (e.g. ASM, Anti-LKM) Ferritin (haemochromatosis) Caeruloplasmin and urinary copper (Wilson's Disease)
What bloods do we do for Liver Failure?
FBC U&Es Glucose LFTs ESR/CRP Coagulation screen ABG Group and save
What do we look for on an FBC for Liver Failure?
Low Hb (if GI bleed) High WCC (if infection)
Why do we do U&Es for Liver Failure?
May show renal failure (hepatorenal syndrome)
What are we looking for on LFTs for Liver Failure?
High bilirubin
High AST, ALT, ALP, GGT
Low albumin
Why do we do an ABG for Liver Failure?
To determine blood pH
Why do we do an Ascitic Tap for Liver Failure?
Send for MC&S
If neutrophils > 250/mm^3 = spontaneous bacterial peritonitis
Why do we do a Doppler scan of hepatic or portal veins for Liver Failure?
Check for Budd-Chiari Syndrome
