Liver failure

Question 1

what are causes of acute liver failure?

Answer 1

paracetamol overdose
alcohol
acute fatty liver of pregnancy
viral hepatitis B

Question 2

what are features of acute liver failure?

Answer 2

coagulopathy: bruising, petechiae
hypoalbuminaemia: ascites, pleural effusion, peripheral oedema
conjugated jaundice
hepatic encephalopathy: confusion, irritability, coma

Question 3

what is the first line treatment of hepatorenal syndrome?

Answer 3

terlipressin

Question 4

what’s the difference between type 1 and type 2 hepatorenal syndrome?

Answer 4

type 1

• occurs within 14 days
• doubling serum creatinine to > 221 or halving of creatinine clearance to < 20ml/min
• poor prognosis

type 2

• slowly progressive
• prognosis poor but patients may live longer

Question 5

what are management options for hepatorenal syndrome?

Answer 5

vasopressin anologues drugs i.e. terlipressin
volume expansion 20% albumin
TIPSS

Question 6

what’s the underlying pathology of hepatorenal syndrome?

Answer 6

vasoactive mediators cause splanchic dilatation which decreases systemic peripheral vascular resistance
= under perfusion of kidneys which trigger juxtoglomuerlar apparatus activating RAAS
= renal vasoconstriction