Liver failure Flashcards
define liver failure?
severe liver dysfunction leading to jaundice, encephalopathy and coagulopathy
how is liver failure catagorised?
• It is classified based on the time interval between the onset of jaundice and the development of hepatic encephalopathy
o Hyperacute = < 7 days
o Acute = 1-4 weeks
o Subacute = 4-12 weeks
what is • Acute-on-Chronic Liver Failure?
acute deterioration (decompensation) in patients with chronic liver disease
what are the causes of liver failure?
• Viral o Hepatitis A, B, C, D and E • Drugs o Paracetamol overdose o Alcohol • Less common causes o Autoimmune hepatitis o Budd-Chiari syndrome o Pregnancy-related o Malignancy (e.g. lymphoma) o Haemochromatosis o Mushroom poisoning (Amanita phalloides) o Wilson's disease
why does liver failure present with jaundice?
due to decreased secretion of conjugated bilirubin
why does liver failure present with encephalopathy?
- Nitrogenous products (e.g. ammonia) is absorbed in the gut and goes via the portal circulation to the liver
- A normal liver would be able extract these harmful substances
- However, if the liver is failing, these toxic products can go through the liver and reach the brain and exert its effects
why does liver failure present with coagulopathy ?
- Reduced synthesis of clotting factors
- Reduced platelets
- Platelet functional abnormalities associated with jaundice or renal failure
epidemiology of liver failure?
• Paracetamol overdose counts for 50% of acute liver failure in the UK
presenting symptoms of liver failure?
- May be asymptomatic
- Fever
- Nausea
- Jaundice
signs of liver failure?
- Jaundice
- Encephalopathy
- Asterixis
- Pruritis
- Fetor hepaticus (breath has musty smell)
- Ascites and splenomegaly (less common if acute or hyperacute)
- Bruising or bleeding
- Signs of secondary causes (e.g. bronze skin colour)
- Pyrexia - may indicate infection or liver necrosis
main investigations for liver failure?
• Identify the cause o Viral serology o Paracetamol levels o Autoantibodies (e.g. ASM, Anti-LKM) o Ferritin (haemochromatosis) o Caeruloplasmin and urinary copper (Wilson's disease) • Bloods
what might the bloods show for liver failure?
o Coagulation screen - best way of assessing liver function o FBC • Low Hb (if GI bleed) • High WCC (if infection) o U&Es • May show renal failure (hepatorenal syndrome) o Glucose o LFTs • High bilirubin • High AST, ALT, ALP, GGT • Low albumin o ESR/CRP o ABG - to determine blood pH
what could an ascitic tap show?
o If neutrophils > 250/mm3 = spontaneous bacterial peritonitis
what is a Doppler scan of hepatic or portal veins checking for?
check for Budd-Chiari syndrome
what is budd chiari syndrome and what does it present with?
occlusion of the hepatic veins draining the liver -> triad of RUQ abdominal pain, painful ascites, liver enlargement.
