wk 7 3 acute liver disease

Question 1

functions of liver 7

Answer 1

protein metabolism 
carb metabolism 
lipid metabolism 
bilirubin metabolism 
bile acid metabolism 
hormone / drug metabolism 
immunological defence

Question 2

define acute liver disease

Answer 2

any insut causing liver damage, less than 6 months

causing encephalopathy and prolonged coagulation

Question 3

t/f wilsons can be classified as acute or chronic presentation of liver disease

Answer 3

true

Question 4

clinical features of acute LD

Answer 4

none
jaundice
lethargy
pain 
anoxeria
itch
arthralgia 
nausea

Question 5

causes of ALD

Answer 5

viral a,b,c,d,e,CMV,EBV, toxoplasmosis (traveller) 
drugs
shock liver
cholangitis 
alcohol
malignancy
chronic liver disease
ask about paracetamol (doesnt need mad amounts) 

rare
budd chiari
acute fatty liver disease
cholestasis of pregnancy

Question 6

2 factors for liveer damage in nutrition

Answer 6

MASH

malnutrition

Question 7

other than drugs and alcohol, give 2 toxic causes of liver damage

Answer 7

viruses

hypoperfusion

Question 8

immunological factors predisposing to liver damage

Answer 8

PBC (primary biliary cholangititis)

Autoimmune hepatitis

Question 9

important acute liver disease investigations

Answer 9

LFTS (inc albumin nd bilirubin) 
PT time 
history + exam 
ultrasound inc vascular
virology 
investigations of chronic liver disease

Question 10

unlikely investigation in acute liver disease

Answer 10

liver biopsy- only if conflicting/stuggling

Question 11

treatment for acute liver disease

Answer 11

rest 3-6months
fluids, no alcohol
incr calories - high fat foods poorly tolerated
itch - sodium bicarbonate bath, cholestyramine or uresodeoxycholic acid

Question 12

incr calories is recommended, why

Answer 12

hypermetabolic
35-40 kcal/kg/day
1.2-1.5g protein/kg/day
oral nutrition/ NGfeeeding may be required

Question 13

what needs to be monitored in acute liver disease patients

Answer 13

K, PO4 and mg

sugar levels

Question 14

paracetamol can be toxic to liver, when it is conjugated to……

Answer 14

NAPQI

Question 15

which antibiotics can cause drug induced liver disease

Answer 15

co-amoxiclav 
flucloxacillin 
NSAID 
statins - raise ALT, rare
(paracetamol)

Question 16

fulminant hepatic failure is caused by

Answer 16

paracetamol 
fulminant viral 
drugs 
Hep B 
Hep E (commoner than B) 
undistinct entity (20%)

rare
AFLP 
mushrooms
malignancy 
wilsons
budd chairi 
HAV

Question 17

likely complications of FHF

Answer 17

encephalopathy
hypoglycaemia 
coagulopathy 
circulatory failure 
renal failure 
infection

Question 18

treatment of FHF

Answer 18

supportive
inotropes and fluids
renal replacement
management oof raised ICP

Question 19

t/f life long immunosuppression is required for transplantation patients

Answer 19

truue

Question 20

if suspected FHF, what to do

Answer 20

refer quickly - 24hr consultant on call at transplant units
repeat bloods and tell someone to check them
short window of opportunity