Acute Liver Disease

Question 1

what is it

Answer 1

Any insult to the liver causing damage in the absence of previous disease
Less than 6 months duration

Question 2

what is acute liver failure

Answer 2

Acute liver failure defined as causing encephalopathy and prolonged coagulation

Question 3

what are the symptoms?

Answer 3

Can be none- and the person will just feel fluey 
Lethargy - but abnormal fatigue
Nausea
Jaundice 
Anorexia 
May complain of pain
Itchy
Arthralgia 
Abnormal LFTs

Question 4

what are the viral causes of acute liver disease

Answer 4

Viral A,B,C,D,E,CMV EBV & Toxoplasmosis

Question 5

what are the other common causes of acute liver disease?

Answer 5

• Drugs
• Shock liver
• Cholangitis - bile duct infection
• Alcohol
• Malignancy
• Chronic Liver Disease

Question 6

what is shock liver?

Answer 6

• this is ischaemic hepatitis caused by insufficient blood supply

Usually shock is due to low BP from sepsis as the liver is a very low pressure system anyway

Question 7

what are the rare causes of ALD?

Answer 7

Budd chiari
AFLP
Cholestasis of pregnancy

Question 8

what is budd chiari?

Answer 8

• venous infarction of the hepatic veins - they have a very low flow so can get a thrombus

Question 9

what is specifically of interest in the history

Answer 9

Drugs including OTC, herbal and ‘food supplements’
Possible toxins
Alcohol history

Question 10

what other investigations do you want to do?

Answer 10

LFTs (including albumin and bilirubin)

• prothrombin time
• USS
• Virology
• investigation for chronic liver disease
• rarely liver biopsy

Question 11

what does a VERY high ALT signify?

Answer 11

paracetamol

Question 12

what is the treatment

Answer 12

rest , fluids, no alcohol
increase calories
- monitor K, PO4 and Mg

Question 13

what is the treatment for the itch?

Answer 13

sodium bicarbonate bath, cholestryamine or Uresodeoxycholic acid

Question 14

which antibiotics can cause acute liver disease?

Answer 14

Co-amoxiclav
Flucloxacillin
NSAID