Liver Failure & Cirrhosis Flashcards
What is liver failure?
A complication of acute liver injury or chronic liver injury and cirrhosis
What is fulminant hepatic failure?
A clinical syndrome resulting from massive necrosis of liver cells leading to sever impairment of liver function
What are the causes of acute liver failure?
Viral hepatitis
Paracetamol overdoes
Isoniazid
Rifampicin
Ecstasy
Magic mushrooms
Alcohol abuse
What are the causes of Chronic liver failure?
Chronic viral hepatitis
Haemachromatosis
Alcohol abuse
AIH, PBC, PSC
a1-antitrypsin deficiency
Wilson’s disease
Malignancy
What are the signs of liver failure?
Jaundice
Hepatic encephalopathy
Fetor hepaticus
Asterixis/flap
What is hepatic encephalopathy?
A loss of brain function as a result of failure in the removal of toxins from the blood due to liver damage
Graded I-IV
What is Grade I of hepatic encephalopathy?
Altered mood/behaviour
Sleep disturbance
Dyspraxia
Poor arithmetic
No liver flap
What is Grade II of hepatic encephalopathy?
Increasing drowsiness
Confusion
Slurred speech
Liver flap
Inappropriate behaviour
What is Grade III of hepatic encephalopathy?
Incoherent
Restless
Live flap
Stupor (near unconsciousness)
What is Grade IV of hepatic encephalopathy?
Coma
What is Fetor hepaticus?
Chronic odour in the breath
What is asterixis/liver flap?
Inability to maintain a fixed posture
What blood tests are done in liver failure?
FBC
U&E
LFT
Clotting
Glucose
Paracetamol level
Hepatitis
Ferritin
a1- antitrypsin
What imaging is done for liver failure?
CXR
Abdominal ultrasound
Doppler flow studies of portal vein
What is Cirrhosis?
A degenerative disease of the liver resulting in irreversible damage.
What are the causes of cirrhosis?
Alcohol
HBV/HCV infection
Genetics: hemochromatosis, a1-antitrypsin deficiency, Wilson’s disease, CF
Autoimmune disease: AIH, PBC, PSC
Drugs
Vascular problems
What pathological changes occur in the liver in cirrhosis?
- Infiltrating lymphocyte
- ECM proteins
- Apoptotic hepatocyte
- Activated Kupffer cell
- Sinusoid lumen with increased resistance to blood flow
What is the clinical presentation of cirrhosis?
Ascites
Variceal bleeding
Hepatorenal syndrome
Hepatic encephalopathy
What is ascites?
An abnormal accumulation of fluid in the abdominal cavity, which can lead to a very large distended abdomen
What causes ascites?
Portal HTN
Low serum albumin causing reduced plasma oncotic pressure
Hypoperfusion of kidneys leading to activation of RAAS leading to salt and water retention
What are the treatment options for ascites?
Diuretics
Large volume paracentesis
Sodium restriction
Fluid restriction
Antibiotics to prevent bacterial peritonitis
TIPSS (transjugular intrahepatic portosystemic shunts)
Discontinuation of drugs causing fluid retention (NSAIDs, steroids)
What is variceal bleeding?
A condition in which the veins enlarge due to malfunction of their valves causing improper flow of blood, and pooling as a result.
Sometimes the swollen veins may rupture and bleed.
What is the management of variceal haemorrhage?
Dedicated bleeding unit
Fluid resuscitation
Blood transfusion
Vasconstrictors- terlipressin
Emergency endoscopy
What is hepatorenal syndrome?
Impaired kidney function due to liver disease
Cirrhosis + ascites + renal failure = HRS
What are the other signs of cirrhosis?
Leukonychia- from hypalbuminaemia
Clubbing
Palmar erythema
Spider naevi
Xanthelasma
Gynecomastia (enlarged male breasts)
Hepatomegaly
Splenomegaly
What are the facial signs of CLD?
Jaundice
Parotid gland enlargement
Xanthelasma
What are the chest signs of CLD?
Gynaecomastia
Breast atrophy
What are the hands signs of CLD?
Leukonychia
Palmar erythema
Clubbing
Dupuytren’s contracture
Hepatic flap
What are the general signs of CLD?
Skin pigmentation
Loss of body hair
Bruising
Cachexia
What are the upper body signs of CLD?
Spider naevi
What are the abdominal signs of CLD?
Splenomegaly
Hepatomegaly
Dilated collateral vessels around umbilicus
Ascites
What are the genital signs of CLD?
Testicular atrophy
What are the leg signs of CLD?
Oedema
Hair loss
Scratch marks
