Liver failure Flashcards

1
Q

define liver failure?

A

severe liver dysfunction leading to jaundice, encephalopathy and coagulopathy

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2
Q

how is liver failure catagorised?

A

• It is classified based on the time interval between the onset of jaundice and the development of hepatic encephalopathy
o Hyperacute = < 7 days
o Acute = 1-4 weeks
o Subacute = 4-12 weeks

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3
Q

what is • Acute-on-Chronic Liver Failure?

A

acute deterioration (decompensation) in patients with chronic liver disease

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4
Q

what are the causes of liver failure?

A
•	Viral 
o	Hepatitis A, B, C, D and E  
•	Drugs 
o	Paracetamol overdose  
o	Alcohol 
•	Less common causes 
o	Autoimmune hepatitis  
o	Budd-Chiari syndrome  
o	Pregnancy-related  
o	Malignancy (e.g. lymphoma) 
o	Haemochromatosis  
o	Mushroom poisoning (Amanita phalloides) 
o	Wilson's disease
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5
Q

why does liver failure present with jaundice?

A

due to decreased secretion of conjugated bilirubin

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6
Q

why does liver failure present with encephalopathy?

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 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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7
Q

why does liver failure present with coagulopathy ?

A
  • Reduced synthesis of clotting factors
  • Reduced platelets
  • Platelet functional abnormalities associated with jaundice or renal failure
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8
Q

epidemiology of liver failure?

A

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

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9
Q

presenting symptoms of liver failure?

A
  • May be asymptomatic
  • Fever
  • Nausea
  • Jaundice
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10
Q

signs of liver failure?

A
  • Jaundice
  • Encephalopathy
  • Asterixis
  • Pruritis
  • Fetor hepaticus (breath has musty smell)
  • Ascites and splenomegaly (less common if acute or hyperacute)
  • Bruising or bleeding
  • Signs of secondary causes (e.g. bronze skin colour)
  • Pyrexia - may indicate infection or liver necrosis
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11
Q

main investigations for liver failure?

A
•	Identify the cause 
o	Viral serology  
o	Paracetamol levels  
o	Autoantibodies (e.g. ASM, Anti-LKM) 
o	Ferritin (haemochromatosis) 
o	Caeruloplasmin and urinary copper (Wilson's disease) 
•	Bloods
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12
Q

what might the bloods show for liver failure?

A
o	Coagulation screen  - best way of assessing liver function 
o	FBC 
•	Low Hb (if GI bleed) 
•	High WCC (if infection) 
o	U&Es 
•	May show renal failure (hepatorenal syndrome)  
o	Glucose  
o	LFTs 
•	High bilirubin 
•	High AST, ALT, ALP, GGT 
•	Low albumin  
o	ESR/CRP 
o	ABG - to determine blood pH
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13
Q

what could an ascitic tap show?

A

o If neutrophils > 250/mm3 = spontaneous bacterial peritonitis

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14
Q

what is a Doppler scan of hepatic or portal veins checking for?

A

check for Budd-Chiari syndrome

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15
Q

what is budd chiari syndrome and what does it present with?

A

occlusion of the hepatic veins draining the liver -> triad of RUQ abdominal pain, painful ascites, liver enlargement.

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16
Q

how to treat paracetamol overdose?

A

o N-acetylcysteine

17
Q

how to prevent complications of liver failure?

A

o Monitor - vital signs, PT, pH, creatinine, urine output, encephalopathy
o Manage encephalopathy: lactulose and phosphate enemas
o Antibiotic and antifungal prophylaxis
o Hypoglycaemia treatment
o Coagulopathy treatment - IV vitamin K, FFP, platelet infusions
o Gastric mucosa protection - PPIs or sucralfate
o AVOID sedatives or drugs metabolised by the liver
o Cerebral oedema - decrease ICP with mannitol

18
Q

how to treat renal failure?

A

o Haemodialysis

o Nutritional support

19
Q

how to surgically treat liver failure?

A

o liver transplant

20
Q

what are the complications of liver failure?

A
  • Infection
  • Coagulopathy
  • Hypoglycaemia
  • Disturbance of electrolyte balance and acid-base balance
  • Disturbance of cardiovascular system
  • Hepatorenal syndrome
  • Cerebral oedema (causing raised ICP)
  • Respiratory failure
21
Q

what is the prognosis of patients with liver failure?

A

• Depends on severity and aetiology