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[37] Liver Failure Flashcards

(53 cards)

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1
Q

What are the categories of causes of acute liver failure?

A 
Infection
Toxins
Vascular
Obstetric
Other
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2
Q

What infections can cause acute liver failure?

A

Hep A/B
Cytomegalovirus
Epstein-Barr Virus
Leptospirosis

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3
Q

What toxins can cause acute liver failure?

A

EtOH
Paracetamol
Isoniazid
Halothane

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4
Q

What are the vascular causes of acute liver failure?

A

Budd-Chiari

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5
Q

What are the obstetric causes of acute liver failure?

A

Eclampsia

Acute fatty liver of pregnancy

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6
Q

What are the signs of acute liver failure?

A 
Jaundice
Oedema and ascites
Bruising
Encephalopathy
Fetor hepaticus
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7
Q

How might encephalopathy caused by acute liver failure present?

A 
Aterixis (tremor)
Constructional apraxia (inability or difficulty to build, assemble, or draw objects)
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8
Q

How should acute liver failure be investigated?

A

Bloods
Microbiology
Imaging

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9
Q

What bloods should be done in acute liver failure?

A 
FBC
U&E
LFT
Clotting
Glucose 
ABG
Bloods to look for cause
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10
Q

What might be found on FBC in acute liver failure?

A

Signs of infection
Signs of GI bleed
Decreased MCV

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11
Q

Why might there be a decreased MCV in acute liver failure?

A

Due to ethanol

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12
Q

What might be found on U&Es in acute liver failure?

A

Decreased urea and increased creatinine, indicating hepatorenal syndrome

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13
Q

How can LFTs be used to differentiate between EtOH and viral causes of acute liver failure?

A

AST:ALT > 2 indicates alcohol as the cause
AST:ALT <1 indicates viral as the cause

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14
Q

How can LFTs be used to determine if chronic or acute liver failure?

A

Albumin is decreased in chronic liver failure

Prothrombin is increased in acute liver failure

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15
Q

What may be found on clotting in acute liver failure?

A

Increased INR

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16
Q

What may be found on ABG in acute liver failure?

A

Metabolic acidosis

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17
Q

What tests to determine the cause should be done in acute liver failure?

A 
Ferritin
Alpha-1AT
Caeruloplasin
Antibodies 
Paracetamol levels
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18
Q

What microbiology tests should be done in acute liver failure?

A

Hep, CMV, and EBV serology
Blood and urine culture
Ascites MCS and SAAG

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19
Q

What imaging should be done in acute liver failure?

A

CXR

Abdominal US and portal vein duplex

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20
Q

What is hepatorenal syndrome?

A

Renal failure in patients with advanced chronic liver failure

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21
Q

What is the pathophysiology of hepatorenal syndrome?

A

Cirrhosis leads to splanchnic arterial vasodilation, which decreases effective circulatory volume, causing RAS activation and leading to renal arterial vasoconstriction. Persistent underfilling of the renal circulation leads to failure

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22
Q

What are the classifications of hepatorenal syndrome?

23
Q

What happens in type 1 hepatorenal syndrome?

Study These Flashcards
A

Rapidly progressive deterioration

24
Q

What is the prognosis of type 1 hepatorenal syndrome?

Study These Flashcards
A

Survival <2 weeks

25
What happens in type 2 hepatorenal syndrome?
Steady deterioration
26
What is the prognosis of type 2 hepatorenal syndrome?
About 6 months
27
How is hepatorenal syndrome managed?
IV albumin and splanchnic vasoconstrictors Haemodialysis as supportive treatment Liver transplant is treatment of choice
28
Give an example of a splanchnic vasoconstrictor
Terlipressin
29
Where should patients with acute liver failure be managed?
ITU
30
How should acute liver failure be managed?
Management of underlying cause Good nutrition Thiamine supplements Prophylactic PPIs
31
Why are prophylactic PPIs required in acute liver failure?
Prevent stress ulcers
32
What monitoring should be done in acute liver failure?
Fluids Blood Glucose
33
How should fluid be monitored in acute liver failure?
Urinary and central venous catheters
34
How should bloods be monitored in acute liver failure?
Daily FBC, U&E, LFT, INR
35
How should glucose be monitored in acute liver failure?
1-4 hourly
36
Should glucose be administered in the management of acute liver failure?
Yes, 10% dextrose IV 1L/12 hours
37
What are the complications of acute liver failure?
``` Bleeding Sepsis Ascites Hypoglycaemia Encephalopathy Seizures Cerebral oedema ```
38
How can you manage bleeding as complication of acute liver failure?
Vit K Platelets FFP Blood
39
How can you manage sepsis as a complication of acute liver failure?
Tazocin
40
Which antibiotic should be avoided in sepssi caused by acute liver failure?
Gentamicin
41
Why should you avoid gentamicin in acute liver failure?
Nephrotoxic
42
How can you manage ascites as a complication of liver failure?
``` Fluid and salt restriction Furosemide Spironolactone Tap Daily weight measurement ```
43
How can you manage hypoglycaemia as a complication of liver failure?
Regular BMs | IV glucose if <2mM
44
How can you manage encephalopathy as a complication of liver failure?
Avoid sedatives Lactulose, with or without enemas Rifaximin
45
How can you manage seizures as a complication of liver failure?
Lorazepam
46
How can you manage cerebral oedema as a complication of liver failure?
Mannitol
47
What drugs should be avoided when prescribing in acute liver failure?
Opiates Oral hypoglycaemics Na-containing IV fluids
48
What happens to the effects of warfarin in liver failure?
Increases
49
What drugs are hepatotoxic?
``` Paracetamol Methotrexate Isoniazid Salicylates Tetracycline ```
50
What are the poor prognostic factors for acute liver failure?
``` Grade 3/4 hepatic encephalopathy Age >40 years Albumin <30g/L Increased INR Drug-induced liver failure ```
51
What are the types of liver transplant?
Cadaveric | Live
52
What are the types of cadaveric liver transplant?
Heart-beating | Non-heart beating
53
What part of the liver is transplanted in live transplants?
Right lobe

ANKI GI (43 decks)

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