Acute Liver Failure

Question 1

definition

Answer 1

rare syndrome caused by severe liver injury with declining hepatic function
causes jaundice, coagulopathy
in individuals with no prior liver disfunction symptoms

Question 2

classifications of ALF

Answer 2

classified as hyeracute, acute and subacute based of interval since onset
hyperacute: 0-1 week, severe coagulopathy, low severity of other conditions such as jandice, good chance of recovery

acute: 1-4 weeks, moderate coagulopathy, moderate severity of other conditions, moderate chance of recovery

subacute: 4-12 weeks, low coagulopathy, high severity of other conditions, low chance of recovery

Question 3

presentation of ALF

Answer 3

most cases in healthy adults in 20-30s
over half cause multi-organ failure
hepatic dysfunction, abnormal liver, impaired blood clotting
jaundice
nausea/vomiting
confusion
drowsiness leading to coma in worst cases
pain and tenderness of upper right abdomen

Question 4

causes of ALF

Answer 4

globally viral infection- hep A,B,E, herpes simplex, adenovirus
hepatic viral infection (less common)
drug induced liver injury- includes paracetamol (very common in USA and UK), chemo, statins

sepsis
pregnancy
acute ischaemic hepatocellular injury
autoimmune hepatitis

Question 5

management

Answer 5

history and exam to exclude cirrhosis, alcohol induced liver injury or malignant infiltration
early consider liver transplant
assess hepatic encephalopathy
determine cause
decide if need transplant
transfer to specialised unit

maintain blood vol to reduce organ failure
IV antibiotics infusion
check for sepsis

N.Acetyl cysteine very useful in treatment especially for paracetamol induced ALF, always give

Question 6

treatment algorithm

Answer 6

if have encephalopathy- take to ICU
assess for liver transplant
nuerological status
monitor vitals - blood glucose, electrolytes, urine, O2, blood pressure, heart rate

Question 7

hepatic encephalopathy

Answer 7

starts with mild confusion can lead to full coma
heaptic flap, heptaic foetor (acetone on breath)
cerebral oedema causes hypertension and degrades neurological state which can lead to quick death

Question 8

treatment of encephalopathy and cerebral oedema

Answer 8

moderate hypothermia
prevention of infection
prophylactic osmotherapy with intravenous hypertonic fluids