Liver failure

Question 1

Fulminant hepatic failure

Answer 1

massive necrosis of liver cells –> severe impairment of liver function

Question 2

Hepatic encephalopathy a.k.a postosystemic encephalopathy

Answer 2

Toxic substances normally detoxified by the liver bypass the liver via the collaterals and gain access to the brain.

Pt becomes increasingly drowsy + eventually comatose

(excess glutamine –> cerebral oedema)

Question 3

causes

categories

Answer 3

infections
drugs e.g. paracetamol overdose
toxins e.g. tetrachloride
vascular e.g. budd-chiari syndrome, veno-occlusive disease
others e.g. autoimmune

Question 4

presentation

Answer 4

jaundice
hepatic encephalopathy
fetor hepaticus - foul breath/like pear drops
flapping tremor

Question 5

what causes acute-on-chronic hepatic failure?

Answer 5

decompensation of chronic liver disease

Question 6

what is hepatic failure that occurs suddenly in a previously healthy liver?

Answer 6

acute hepatic failure

Question 7

what imagining investigations would you perform

Answer 7

AXR - abnormal

Doppler flow studies of portal vein

Question 8

what does neutrophils >250 on an ascitic tap indicate?

Answer 8

spontaneous bacterial peritonitis

Question 9

Tx cerebral oedema

Answer 9

ITU
20% mannitol
hyperventilate

Question 10

Tx ascites

Answer 10

restrict fluid
low salt diet
weigh daily
diuretics

Question 11

what drugs do you want to avoid?

Answer 11

sedatives
drugs with hepatic metabolism
those that constipate (opiates, diuretics- increased risk of encephalopathy)

Question 12

hepatotoxic drugs

Answer 12

include paracetamol
methotrexate
isoniazid
azathioprine