Liver Failure

Question 1

How long does acute LF take to develop?

Answer 1

8-21 days

Question 2

Is acute or chronic LF more common?

Answer 2

Chronic

Question 3

What can cause LF?

Answer 3

Alcohol excess, Budd-Chiari syndrome, haemochromatosis, Wilson’s

Question 4

How does encephalopathy develop?

Answer 4

Nitrogenous waste builds up as ammonia, astrocytes in the brain clear it, this produces glutamine, excess glutamine causes an osmotic imbalance, this causes cerebral oedema

Question 5

How does acute LF present?

Answer 5

Malaise, nausea, anorexia, jaundice

Question 6

What are symptoms of chronic LF?

Answer 6

Malaise, anorexia, pruritis

Question 7

What is included in a LFT?

Answer 7

Serum bilirubin, serum albumin, prothrombin time/INR

Question 8

What hepatic enzymes are there?

Answer 8

Aminotransferases (AST/ALT), Alkaline phosphate (ALP), GGT

Question 9

What would you expect the blood results to show?

Answer 9

Increased PT, AST, ALT

Question 10

What should you do if the patient has ascites?

Answer 10

Peritoneal tap with microscopy and culture

Question 11

What drugs should you avoid?

Answer 11

Sedatives and other drugs with hepatic metabolism like paracetamol, methotrexate and oestrogen

Question 12

What are some complications of liver failure?

Answer 12

Cerebral oedema, ascites, bleeding, hypoglycaemia, encephalopathy, sepsis

Question 13

What is grade I encephalopathy?

Answer 13

Altered mood/behaviour, sleep disturbance, dyspraxia, poor arithmetic

Question 14

What is grade II encephalopathy?

Answer 14

Increasing drowsiness, confusion, slurred speech, inappropriate behaviour/personality change

Question 15

What is grade III encephalopathy?

Answer 15

Incoherent, restless, liver lap, stupor

Question 16

What is grade IV encephalopathy?

Answer 16

Coma

Question 17

What are signs of chronic LF?

Answer 17

Ascites, oedema, Dupuytren’s contracture, palmar erythema, Xanthelasma, spider naevi, hepatomegaly, bleeding, hepatic encephalopathy, jaundice

Question 18

What conservative treatment would you start?

Answer 18

Fluids and analgesia

Question 19

How would you manage ascites?

Answer 19

Diuretics

Question 20

How would you manage cerebral oedema?

Answer 20

Mannitol

Question 21

How would you manage bleeding?

Answer 21

Vitamin K

Question 22

How would you manage encephalopathy?

Answer 22

Lactulose

Question 23

How would you manage sepsis?

Answer 23

Sepsis 6
High-flow oxygen
Blood cultures
IV antibiotics
IV fluid resuscitation
Measure lactate
Measure urine output

Question 24

How would you manage hypoglycaemia?

Answer 24

Dextrose

Question 25

What surgical option is available?

Answer 25

Transplant

Question 26

How does liver failure present?

Answer 26

Asterixis, Dupuytren’s contractures, Leukonychia, Spider naevi