liver failure general Flashcards
kings college criteria for transplant - paracetamol overdose
- prothrombin time >100s
- creatine >300umol/L
- grade III / IV encephalopathy
ALL 3
alternatively
- arterial PH<7.3 24 hours after ingestion
when is a TIPSS used and what is it
bypass between the portal vein and hepatic veins
- treats portal hypertension
- refractory ascites
- secondary prophylaxis of variceal haemorrhage that’s not responding to treatment
ischaemic hepititis
liver is injured due to reduced blood flow:
- hypoperfusion
- shock
leads to elevated inflammatory markers and liver enzymes
most common complication of acute liver failure
infection - commonly pneumonia
give braod spectrum antibiotics
what should a patient be warned about when recieving TIPS
immediately after it can worsen hepatic encephalopathy
this is bc shunting blood away from liver reduces hepatic clearance of toxins which can accumulate and affect brain fucntion
common cause in pregnancy
budd chiari syndrome
alcoholic hepatitis LFTs
elevated bilirubin
AST:ALT >1.5
neutrophilia
how is lactulose administered
orally
kings college criteria for non-paracetamol overdose transplant
- PT >100s
OR
Any three of: - Drug-induced liver failure
- Age <10 or >40
- 1 week from 1st presentation of jaundice to encephalopathy
- Prothrombin time >50s
- Bilirubin ≥300µmol/L.
spontaneous bacterial peritonitis results for diagnosis
- caused by decompensated liver disease
- confirmed with tap and neutrophil count >250 cells/mm3
drowsiness and confusion
HE
how does lactulose work
reduces absorption of ammonia in the gut
asterixis / hepatic flap
- grade II / III HE
- involuntary tremor
- causes hands to jerk rhythmically
spider naevi
- purple dots on skin
- progressive hepatic fibrosis
- caused by inc of eostrogen
- advanced liver disease - reduction in oestrogen metabolisation
hereditary haemochromatosis
- genetic
- increased intestinal iron absorption - joint pain
- pale grey skin pigmentation
- cirrhosis
- middle aged men
- ferritin level over 1
- transferritin saturation of over 45%
drug to reduce cerebral oedema in HE
IV mannitol
what is TIPS transjugular intrahepatic portosystemic shunt
- form a channel between hepatic vein and intra-hepatic portion of the portal vein
- reducing portal hypertension
- reducing complications associated with this
rifaximin
- reduces reoccurrence of HE
- reduces absorption of ammonia in inestines
urgent referal for transplant in non-paracetamol overdose
PT time >100s
1st line treatment of spontaneous bacterial peritonitis
ceftriaxone
cefotaxime
ciprofloxacin
whats a TAP
where fluid is removed from peritoneal cavity
can be done with:
- ascites
- spontaneous bacterial peritonitis
