Liver failure (GI) Flashcards
Define liver failure.
Rapid decline in hepatic function characterised by jaundice, coagulopathy (INR>1.5) and hepatic encephalopathy in patients (with no evidence of prior liver disease, if acute)
What leads to organ failure in liver failure?
Mostly massive hepatocyte necrosis –> organ failure
Apoptosis also involved
How can we classify liver failure based on length of time between onset of jaundice and development of hepatic encephalopathy? (3)
- hyperacute <7 days)
- acute (1-4 weeks)
- subacute (4-12 weeks)
Define chronic liver disease.
Condition characterised by progressive deterioration of hepatic function over 6 months e.g. cirrhosis
What are the stigmata of chronic liver disease? (4)
- spider naevi
- gynaecomastia
- Dupuytren’s contracture
- palmar erythema
What are the signs of decompensation (acute deterioration) in chronic liver disease? (3)
- ascites
- jaundice
- encephalopathy
What are the causes of liver failure? (6)
- paracetamol overdose (most common)
- viral hepatitis A-E (A or B usually)
- alcohol excess
- acute fatty liver of pregnancy
- malignancy (e.g. lymphoma)
- idiopathic
What is liver failure characterised by?
Jaundice, coagulopathy (INR>1.5) and hepatic encephalopathy
What are the clinical features of liver failure? (7)
- jaundice - decreased secretion of conjugated BR, pruritus occurs too
- coagulopathy (INR>1.5) - can cause life-threatening bleeds
- encephalopathy
- abdominal pain
- nausea and vomiting
- fever, lethargy, malaise
- acute fatty liver of pregnancy - jaundice following abdominal pain and pruritus during pregnancy
Why does hepatic encephalopathy occur in liver failure?
Ammonia and other toxic substances are unable to be removed by body = go to brain
What are the signs of hepatic encephalopathy in liver failure? (3)
- altered level of consciousness (and mood and behaviour)
- cerebral oedema
- asterixis - inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements
- grades 1-4 (where 4 = coma)
What are the signs of acute fatty liver of pregnancy?
Jaundice following abdominal pain and pruritus during pregnancy
What might you find on examination in liver failure? (7)
- jaundice
- encephalopathy - altered consciousness, cerebral oedema, asterixis
- pyrexia
- cerebral oedema - abnormal pupillary reflexes, muscular rigidity, decerebrate posturing
- fetor hepaticus (pear drops smell)
- hepatomegaly (acute viral hepatitis, CHF with hepatic congestion, Budd-Chiari and infiltrative malignancies)
- absence of splenomegaly
What are some risk factors for liver failure? (7)
- chronic alcohol abuse (accidental paracetamol OD)
- poor nutritional status
- female sex
- pregnancy (increased hepE, acute fatty liver of pregnancy, haemolysis)
- chronic hepatitis B
- chronic pain and narcotic use
- Wilson’s disease
What is the first-line investigation in liver failure?
Prothrombin time/INR - raised indicates coagulopathy (defining feature of ALF), best indicator of liver function
