Liver infection and liver failure

Question 1

Define liver failure and what it’s commonly associated issues are?

Answer 1

• an inability of the liver to perform it’s synthetic and metabolic functions. This happens when the liver can no longer successfully regenerate.
• associated with - ascites, hepatic encephalopathy, abnormal bleeding and jaundice

Question 2

What are the 3 types of liver failure?

Answer 2

• acute fulminant - 8 weeks of onset from it’s underlying cause beginning
• late-onset - 8-25 weeks post onset of underlying cause
• decompensated chronic liver failure - 6/12 delay

Question 3

Broad sweeping causing of liver failure?

Answer 3

• toxins
• viral
• metabolic
• neoplastic
• misc other

Question 4

What are some toxin causes of liver failure?

Answer 4

• alcohol
• paracetamol
• ABx - co-amox, mycins
• illicit drugs
• poisoning

Question 5

What are viral causes of liver failure?

Answer 5

• viral hepatitis
• EBV
• CMV
• adeno

Question 6

What are the metabolic causes of liver failure?

Answer 6

• wilson’s
• A1AT deficiency
• haemochromatosis

Question 7

what are the neoplastic causes of liver failure?

Answer 7

• HCC

- metastatic disease

Question 8

What are the miscy other causes of liver failure?

Answer 8

• NAFLD
• pregnancy related fatty liver disease
• vascular - budd-charri

Question 9

Presentation of liver failure?

Answer 9

• hepatic encephalopathy - drowsiness, confusion, agitation
• increased circulating volume w/ end organ failure
• abdominal swelling - ascities
• flapping tremor

Question 10

What bloods would you do in liver failure? expected results too plz.

Answer 10

• FBC - thrombocytopenia
• clotting - INR raised Vit k metabolism interupted
• increased bili
• LFTs - wonky dependent on cause
• amonia high
• glucose low

ABG - metabolic acidosis

Question 11

What imaging may you do for ?liver failure?

Answer 11

• USS - hepatic vein patency
• CT scan - malignancy or other structural pathology
• EEG- encephalopathy

Question 12

How do you treat liver failure?

Answer 12

• Tx underlying cause
• LACTULOSE for encephalopahty increased excretion of amonia/reduces it’s production
• associated Sx control - itching - cholestyramine
• monitor glucose
• liver transplant

Question 13

4 complications of liver failure

Answer 13

• malnutrition - due to decreased bile production
• bleeding
• endocrine disturbance - amenorrhoea, gynaecomastia , ED
• hypoglycaemia

Question 14

3 causes of coma in liver failure?

Answer 14

• hepatic encephalopathy - reduced ammonia processing
• hypoglycaemia
• hyponatraemia - sodium lost in ascites

Question 15

What might precipitate hepatic encephalopathy?

Answer 15

• constipation
• Drugs - analgesia
• GI bleed
• Trans-jugular intrahepatic portosystemic shunt
• infection
• renal failure
• hypokalaemia

Question 16

Other than lactulose and removing precipitants how else can one treat hepatic encephalopathy?

Answer 16

-neomycin - reduces the guts demand for ammonia

Question 17

Why are liver failure patients more susceptible to infection? what infections are they more susceptible to?

Answer 17

• reduced immune function - decreased reticulo-endothelial, macrophages, leucocyte and anti-body function
• more permeable gut wall
• SBP, pneumonia, skin infection, sepsis, UTI

Question 18

Define SBP?

Answer 18

• spontaneous bacterial peritonitis
• usually seen in patients with ascites secondary to cirrhosis
• serious and common condition

Question 19

What are the symptoms for SBP?

Answer 19

VAGUE

• GI bleed
• lethargy
• fever
• change in mental state
• N&V
• chills

Question 20

How do you diagnose SBP?

Answer 20

• paracentesis of ascitic fluid

- neutrophil count = >250 cell/mm3

Question 21

How do treat SBP?

Answer 21

• IV cefotaxime
• prophylaxis abx (ciprofloxacin) thereafter (1 episode, protien >15g/L, child-pugh score 9 or above, hepatorenal syndrome)
• ?liver transplant
• AVOID MYCINS in liver failure