Acute liver disease and fulminant hepatic failure Flashcards Preview

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Flashcards in Acute liver disease and fulminant hepatic failure Deck (26):
1

What is acute liver disease?

It is defined as the rapid development of hepatic dysfunction without prior liver disease.

Any insult to the liver causing damage
In previously normal liver
Less than 6 months duration.

2

Why are people with jaundice itchy?

Because the bilirubin is an irritant under the skin

3

What are the LFTs?

ALT/AST
Alkaline Phosphatase(ALP)
GGT

4

What cause a high GGT?

Alcohol abuse
Drug metabolism
Fat in the liver

5

What are the true liver function tests?

Bilirubin
Albumin
Prothrombin time

6

What is acute liver failure defined as?

Causing encephlaopathy and prolonged coagulation

7

What are clinical features of acute liver disease?

None
Jaundice
lethargy
nausea
anorexia
pain
Itch
arthralgia

Abnormal LFTs

8

Which patients with acute liver disease can have no symptoms?

Patients who have taken a paracetamol overdose

9

List viral causes of acute liver disease

Hep A, B, C, D, E
CMV (cytomegalovirus)
Epsein-barr virus
Toxoplasmosis

10

List common causes of acute liver disease

Viral
Drugs
Shock liver
Cholangitis
Alcohol
Malignancy
Chronic Liver Disease
Ask about Paracetamol

11

What is shock liver?

blood pressure in veins much lower than pressure in arteries. If you are unwell, in trauma, etc, and your arterial pressure drops, you will still perfuse your major organs. Because the majority of the liver’s blood supply is venous, it will go into “shock” and lack a sufficient blood supply.

12

What is cholangitis?

Acute inflammation of the biliary tree

13

What are rare causes of acute liver disease?

Budd Chiari
AFLP- acute fatty liver of pregnancy- eclampsia- get the baby out if possible. Condition can be fatal to mother and baby
Cholestasis of Pregnancy

14

What is Budd-Chiari syndrome?

A condition caused by occlusion of the hepatic veins which drain the liver, e.g. thrombosis.

15

What should you ask about in a history of acute liver disease?

Symptoms.
Duration
Drugs including OTC, herbal and “food suppliments”, fat burner tablets
Possible toxins: alcohol, environmental toxins
Alcohol history: Go beyond “None”.

16

What investigations are done?

LFT’S (including Albumin & Bilirubin)
Prothrombin time
HISTORY & EXAMINATION
Ultra-sound inc. vascular, including hepatic veins
Virology
Investigations of chronic liver disease
RARELY liver biopsy

17

What is the treatment for acute liver disease?

Rest, up to 3 months for recovery may be 6
Fluids, NO alcohol
Increase calories, high fat foods poorly tolerated
For itch- sodium bicarbonate bath, cholestryamine or Uresodeoxycholic acid
Observation for fulminant hepatic failure

18

Why are energy requirements raised in patients with acute liver disease?
What may be required to aid these increased requirements?

They are hypermetabolic
Oral nutritional supplements or NG feeding may be required as patients usually have a poor appetite and intake

19

What biochemical markers should be monitored in patients with acute liver disease?

Phosphate, potassium and magnesium levels are frequently low and should be monitored frequently and supplemented if necessary
Hypoglycaemia is common as the liver is unable to mobilise glycogen and gluconeogenesis is impaired therefore careful monitoring is required. Should consider transplant.

20

What may drug induced liver injury be due to?

Injury to the liver cells (hepatocellular)
- that is pathologically indistinguishable from viral hepatitis
Problems with bile production or excretion (cholestatic)

21

Give examples of drugs that can cause drug induced liver disease

Antibiotics
Co-amoxiclav
Flucloxacillin
NSAID
Statins: Often blamed, rarely cause
May use euphomisms “fat burners”, “Protein powders”
May be imported or have no label
Paracetamol

22

What is fulminant hepatic failure defined as?

Jaundice and encephalopathy in a patient with a previously normal liver

23

What are common causes of FHF?

Paracetamol
Fulminant viral
Drugs
HBV
Non A-E

24

What are uncommon causes of FHF?

AFLP
Mushrooms
Malignancy
Wilsons
Budd Chiari
HAV

25

What can FHF cause, including complications?

Encephalopathy
Hypoglycaemia
Coagulopathy
Circulatory failure
Renal Failure
Infection

26

What is treatment for FHF?

Supportive
Inotropes & Fluids
Renal replacement
Management of raised ICP (intracranial pressure)
Transplantation
Survival 65%
Life long immunosupression
Organ availability
Ethics

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