acute liver disease II Flashcards
risk factors for liver damage ?
NASH malnutrition drugs alcohol viruses hypo perfusion PBC Autoimmune hepatitis Wilson's (copper build up) Haemochromatosis (iron build up)
investigations for acute liver disease ?
>history = main >LFTs >prothrombin >examination >ultra-sound >virology >investigations for chronic liver disease >liver biopsy
treatment ?
- rest for up to 3 months, for recover maybe 6 months
- no alcohol, just fluids
- increase calories - high fatty foods are poorly tolerated
- for itch = sodium bicarbonate bath, cholestryamine or uresodeoxycholic acid
- observe in case of fulminant hepatic failure
what are the metabolic considerations for acute liver failure ?
- in a hypermetabolic state but they don’t take food very well but need to be eating more calories than normal
- may need an NG feeding tube
- hypoglycaemia is a very serious clinical sign
what’s interesting about hepatic drug reactions ?
- 6 weeks exposure to effect ie first effect might not have been noticed, liver may not have been normal
- any drug
- multiple mechanisms ie lots of different LFT patterns and symptoms may overlap with other toxic effects
what is the toxic state of paracetamol ?
NAPQI
what do you need to break down NAPQI ?
glutathione
-paracetamol can be such a toxic drug if you don’t have enough glutathione
what other drugs can cause liver disease ?
NSAIDs co-amoxiclav flucloxacillin 'fat burners' - protein powders that might have steroid paracetamol as an ingredient ie lemsip night nurse / nurofen
what is fulminant hepatic failure ?
jaundice and encephalopathy in a patient with a previously normal liver
most common causes of FHF ?
paracetamol
fulminant viral infection
drugs
Hep B
Non Hep A-E
rarer causes of FHF ?
AFLP
mushrooms
malignancy
Wilsons
Budd Chiari
Hep A
complications of FHF ?
encephalopathy
hypoglycaemia
coagulopathy
circulatory failure
renal failure
infection
what treatment is available for FHF ?
its mainly supportive:
inotropes and fluids
renal replacement
management of raised ICP (intracranial pressure)
transplantation:
