Fulminant Liver Failure Flashcards
1
Q
definition of FLF
A
- presence of acute liver failure, including the development of hepatic encephalopathy, within 8 weeks after the onset of jaundice in a patient without a previous history of liver disease
2
Q
common causes of FLF
A
- acetaminophen toxicity is most common
- idiosyncratic drug reactions
- hepatitis A and B
- ischemia
- CCl4
3
Q
presenting symptoms of FLF
A
- acute hepatitis: including malaise, nausea, jaundice
- portal systemic encephalopathy is a required feature of the syndrome - may range from subtle mental status changes to come
4
Q
difference between FLF and cirrhotic encephalopathy
A
- cerebral edema is associated with FLF
- in cirrhotic you cannot clear N, urea and NH3
5
Q
mechanism of encephalopathy in FLF
A
- development of cerebral edema involves disruption of BBB and interference with mechanisms of cellular osmolarity leading to increased ICP and Cushings triad
6
Q
Cushings triad
A
- HTN
- bradycardia
- irregular breathing patterns
7
Q
hypoglycemia and FLF
A
- frequent manifestation of FLF
- likely due to both inadequate degradation of insulin and diminished production of glucose by the diseased liver
8
Q
infections and FLF
A
- common cause of death with FLF
- typically staph and strep
9
Q
renal and electrolyte abnormalities
A
- renal dysfunction seen with acetaminophen toxicity
- monitor sodium, potassium, bicarb, magnesium and phosphorus
10
Q
cause of lactic acidosis in FLF
A
- hypoperfusion of the liver and the inability of the diseased liver to clear lactate
- acidosis is risk factor for poor outcome
11
Q
prothrombin time
A
- usually prolonged in patients with FLF
12
Q
treatment of stage II encephalopathy
A
- admit to ICU
- avoid sedatives
13
Q
treatment of stage III encephalopathy
A
- consider risk of developing cerebral edema
- ICP monitoring is instituted
- endotracheal intubation and mechanical ventilation
- goal is to maintain pressure 40 mmHg and cerebral perfusion pressure between 60 and 100 mmHg
14
Q
ICP maneuvers
A
- avoid straining, including tracheal suctioning
- sudden decrease of ICP may indicate brain hernation
15
Q
MELD score
A
- determines sickest patients
- worse the MELD score, increased mortality
