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Gastrointestinal > Liver Failure > Flashcards

Liver Failure Flashcards

1
Q

Define Liver Failure?

A

Severe liver dysfunction leading to jaundice, encephalopathy and coagulopathy

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2
Q

What is Liver Failure classifed based on?

A

The time interval between the onset of jaundice and the development of hepatic encephalopathy

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3
Q

What is the classification of Liver Failure?

A 
Hyperacute = < 7 days
Acute = 1-4 weeks 
Subacute = 4-12 weeks
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4
Q

What is Acute-on-Chronic Liver Failure?

A

Acute deterioration (decompensation) in patients with chronic liver disease

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5
Q

What are the viral causes of Liver Failure?

A

Hepatitis A, B, C, D and E

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6
Q

What drugs can cause Liver Failure?

A

Paracetamol Overdose

Idiosyncratic drug reactions

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7
Q

What are some of the less common causes of Liver Failure?

A 
Autoimmune hepatitis 
Budd-Chiari syndrome
Pregnancy-related 
Malignancy (e.g. lymphoma)
Haemochromatosis 
Mushroom poisoning (Amanita phalloides)
Wilson's Disease
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8
Q

What is the pathogenesis of Jaundice in Liver Failure?

A

Due to decreased secretion of conjugated bilirubin

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9
Q

What is the pathogenesis of Encephalopathy in Liver Failure?

A

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

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10
Q

What is the pathogenesis of Coagulopathy in Liver Failure?

A

Reduced synthesis of clotting factors
Reduced platelets
Platelet functional abnormalities associated with jaundice or renal failure

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11
Q

What is the epidemiology of Liver Failure?

A

Paracetamol overdose counts for 50% of acute liver failure in the UK

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12
Q

What are the presenting symptoms of Liver Failure?

A

May be asymptomatic
Fever
Nausea
Jaundice (not always)

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13
Q

What are the signs of Liver Failure on physical examination?

A 
Jaundice 
Encephalopathy
Asterixis 
Fetor Hepaticus 
Ascites and Splenomegaly (less common if acute or hyperacute)
Bruising or bleeding 
Signs of secondary causes 
Pyrexia
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14
Q

What are some of the signs of secondary causes in Liver Failure?

A

e.g.
bronze skin colour
Kayser-Fleisher rings

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15
Q

What can Pyrexia indicate if it’s a sign for Liver Failure?

A

Infection or Liver necrosis

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16
Q

What investigations do we do for Liver Failure?

A 
Investigations to Identify the Cause
Bloods 
Liver US/CT
Ascitic Tap
Doppler scan of hepatic or portal veins
EEG
17
Q

What investigations do we do to identify the cause of Liver Failure?

A 
Viral serology
Paracetamol levels
Autoantibodies (e.g. ASM, Anti-LKM)
Ferritin (haemochromatosis)
Caeruloplasmin and urinary copper (Wilson's Disease)
18
Q

What bloods do we do for Liver Failure?

A 
FBC 
U&Es
Glucose 
LFTs
ESR/CRP
Coagulation screen 
ABG
Group and save
19
Q

What do we look for on an FBC for Liver Failure?

A 
Low Hb (if GI bleed)
High WCC (if infection)
20
Q

Why do we do U&Es for Liver Failure?

A

May show renal failure (hepatorenal syndrome)

21
Q

What are we looking for on LFTs for Liver Failure?

A

High bilirubin
High AST, ALT, ALP, GGT
Low albumin

22
Q

Why do we do an ABG for Liver Failure?

A

To determine blood pH

23
Q

Why do we do an Ascitic Tap for Liver Failure?

A

Send for MC&S

If neutrophils > 250/mm^3 = spontaneous bacterial peritonitis

24
Q

Why do we do a Doppler scan of hepatic or portal veins for Liver Failure?

A

Check for Budd-Chiari Syndrome

25
Q

Why do we do an EEG for Liver Failure?

A

Monitor Encephalopathy

26
Q

What is the general management plan for Liver Failure?

A 
Resuscitation - ABC 
Treat the cause
Treatment/prevention of complications (invasive ventilation and cardiovascular support is often required)
Treatment of Renal Failure 
Surgical
27
Q

What is the treatment for Paracetamol Overdose?

A

N-acetylcysteine

28
Q

What is some of the steps taken to treat and prevent complications of Liver Failure?

A 
Monitoring 
Manage encephalopathy 
Antibiotic and antifungal prophylaxis 
Hypoglycaemia treatment 
Coagulopathy treatment 
Gastric mucosa protection
Avoid sedatives or drugs metabolised by the liver 
Cerebral Oedema
29
Q

What do we monitor in the prevention of compliations of Liver Failure?

A 
Vital Signs 
PT 
pH
Creatinine 
Urine output 
Encephalopathy
30
Q

How do we manage encephalopathy as a complication of Liver Failure?

A

Lactulose and phosphate enemas

31
Q

How do we treat Coagulopathy as a complication of Liver Failure?

A

IV Vitamin K
FFP
Platelet infusions

32
Q

How do we protect Gastric Mucosa in Liver Failure?

A

PPIs

Sucralfate

33
Q

How do we manage/prevent cerebral oedemas in Liver Failure?

A

Decrease ICP with mannitol

34
Q

How do we manage Renal Failure as a complication of Liver Failure?

A

Haemodialysis

Nutritional Support

35
Q

What is the surgical management plan for Liver Failure?

A

Liver transplant

36
Q

What are the possible complications of Liver Failure?

A 
Infection
Coagulopathy
Hypoglycaemia 
Disturbance of electrolyte balance and acid-base balane 
Disturbance ofCVS
Hepatorenal syndrome
Cerebral Oedema (causing raised ICP)
Respiratory Failure
37
Q

What is the prognosis for patients with Liver Failure?

A

Depends on severity and aetiology

38
Q

What is Pyrexia?

A

Raised body temperature (fever)

39
Q

What is Fetor Hepaticus?

A

Your breath has a strong, musty smell

Gastrointestinal (61 decks)

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