Hepatic Flashcards
What is acute liver failure?
complex multisystemic illness which occurs after insult to liver resulting in jaundice, coagulopathy (INR>1.5) and hepatic encephalopathy
In the absence of chronic liver disease within 12 weeks
What are the 3 types of acute liver failure?
Hyperacute - within 7 days
Acute - 8-28 days
Sub-acute - 29 days - 12 weeks
What is the mortality of acute liver failure without transplant?
10-90%
What are the common causes of the 3 types of acute liver failure?
Hyperacute - paracetamol, drugs, viral hepatitis
Acute - viral hepatitis, ischaemic hepatitits
Sub-acute - seronegative hepatitis, autoimmune hepatitis
How would you treat acute liver failure caused by paracetamol?
find cause IV N-acetylcestine IV fluids - crystilloids braod spectrum antibiotics call liver transplant team
At what INR level would you call the liver transplant team?
INR > 1.5
Name 5 complications of acute liver disease?
encephalopathy, hypotension, ARDS, pneumonia, renal failure, sepsis, malnutrition
What are the normal causative agents for bacterial meningitis in different age groups?
0-3 months: group B strep, E.coli, L. monocytogenes
3 months - 60 years: n. meningitis, S. pneumonia, H. influenza
> 60 years: N. meningitis, S. pneumoniae, L. monocytogenes
Immunosurpressed: L. monocytogenes
What are some causes of enlarged liver?
alcoholic liver disease malignancy congestive cardiac failure inflammatory and infective liver disease glycogen storage disease haemochromatosis
What are some causes of jaundice?
obstructive - gall stones, pancreatic cancer hepatitis haemolysis cirrhosis liver malignancy Wilson's disease haemochromatosis Gilbert's disease
What blood tests would indicate hepatitis picture?
elevated ALT, AST, GGT
What blood results would indicate cholestasis picture?
elevated ALP, GGT +/- bilirubin
What blood results would indicate cirrhosis?
hypoalbuminemia, prolonged PT
What are some causes of chronic hepatitis?
viral alcohol NAFLD/NASH autoimmune haemochromatosis A1AT Wilson's
What are some causes of acute hepatitis?
viral
alcohol
drugs and toxins
What are some causes of intrahepatic cholestasis?
hepatitis, PBC, drugs, pregnancy
What are some causes of extrahepatic cholestasis?
stones and strictures
Ca head of pancreas
portal hepatic LN metastases
sclerosing cholangitis
What are some causes of cirrhosis?
chronic alcohol intake persistent hep B&C autoimmune inhertied metabolic (e.g. Wilson's)
What are some differentials of elevated alkaline phosphatase?
bone e.g. osteomalacia, malignancy
Which antibody is associated with primary biliary cholangitis?
antimitochondrial antibodies
How would acute liver injury present?
malaise, nausea, anorexia, jaundice
How would chronic liver disease present?
asymptomatic fatigue, anorexia, wasting itching (duct disease) bruising, haematemesis amenorrhoea, infertility, impotence ascites, oedema renal failure encephalopathy infection
What type of monitoring does a patient with cirrhosis need?
LFTs - liver decompensation
6 monthly US/ MRI/CT - hepatocellular carcinoma
2-3 yearly gastroscopy - oesophageal-gastric varices
What causes people with chronic liver disease to ‘go off’?
constipation, drugs, GI bleed, infection, hypo - natraemia, kalaemia, glycaemia, alcohol withdrawal
