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A - MSRA Gastrointestinal [7] > [37] Liver Failure > Flashcards

[37] Liver Failure Flashcards

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?

A

Type 1 and 2

23
Q

What happens in type 1 hepatorenal syndrome?

A

Rapidly progressive deterioration

24
Q

What is the prognosis of type 1 hepatorenal syndrome?

A

Survival <2 weeks

25
Q

What happens in type 2 hepatorenal syndrome?

A

Steady deterioration

26
Q

What is the prognosis of type 2 hepatorenal syndrome?

A

About 6 months

27
Q

How is hepatorenal syndrome managed?

A

IV albumin and splanchnic vasoconstrictors
Haemodialysis as supportive treatment
Liver transplant is treatment of choice

28
Q

Give an example of a splanchnic vasoconstrictor

A

Terlipressin

29
Q

Where should patients with acute liver failure be managed?

A

ITU

30
Q

How should acute liver failure be managed?

A

Management of underlying cause
Good nutrition
Thiamine supplements
Prophylactic PPIs

31
Q

Why are prophylactic PPIs required in acute liver failure?

A

Prevent stress ulcers

32
Q

What monitoring should be done in acute liver failure?

A

Fluids
Blood
Glucose

33
Q

How should fluid be monitored in acute liver failure?

A

Urinary and central venous catheters

34
Q

How should bloods be monitored in acute liver failure?

A

Daily FBC, U&E, LFT, INR

35
Q

How should glucose be monitored in acute liver failure?

A

1-4 hourly

36
Q

Should glucose be administered in the management of acute liver failure?

A

Yes, 10% dextrose IV 1L/12 hours

37
Q

What are the complications of acute liver failure?

A 
Bleeding
Sepsis
Ascites 
Hypoglycaemia
Encephalopathy
Seizures
Cerebral oedema
38
Q

How can you manage bleeding as complication of acute liver failure?

A

Vit K
Platelets
FFP
Blood

39
Q

How can you manage sepsis as a complication of acute liver failure?

A

Tazocin

40
Q

Which antibiotic should be avoided in sepssi caused by acute liver failure?

A

Gentamicin

41
Q

Why should you avoid gentamicin in acute liver failure?

A

Nephrotoxic

42
Q

How can you manage ascites as a complication of liver failure?

A 
Fluid and salt restriction
Furosemide 
Spironolactone
Tap 
Daily weight measurement
43
Q

How can you manage hypoglycaemia as a complication of liver failure?

A

Regular BMs

IV glucose if <2mM

44
Q

How can you manage encephalopathy as a complication of liver failure?

A

Avoid sedatives
Lactulose, with or without enemas
Rifaximin

45
Q

How can you manage seizures as a complication of liver failure?

A

Lorazepam

46
Q

How can you manage cerebral oedema as a complication of liver failure?

A

Mannitol

47
Q

What drugs should be avoided when prescribing in acute liver failure?

A

Opiates
Oral hypoglycaemics
Na-containing IV fluids

48
Q

What happens to the effects of warfarin in liver failure?

A

Increases

49
Q

What drugs are hepatotoxic?

A 
Paracetamol
Methotrexate
Isoniazid
Salicylates 
Tetracycline
50
Q

What are the poor prognostic factors for acute liver failure?

A 
Grade 3/4 hepatic encephalopathy
Age >40 years
Albumin <30g/L
Increased INR
Drug-induced liver failure
51
Q

What are the types of liver transplant?

A

Cadaveric

Live

52
Q

What are the types of cadaveric liver transplant?

A

Heart-beating

Non-heart beating

53
Q

What part of the liver is transplanted in live transplants?

A

Right lobe

A - MSRA Gastrointestinal [7] (44 decks)

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