Liver failure Flashcards
What is the definition of liver failure?
This is development of coagulopathy INR >1.5 and encephalopathy
What time period counds as acute liver failure?
In less than 21 days
What are the signs of liver failure?
Jaundice
Ascites
Encephalopathy
Liver flap
What are the causes of liver failure?
Infective: -Hepatitis -leptospirosis Toxins Vascular: -Budd-chiari syndrome (hepatic vein obstruction by thrombus) -Veno-occlusive disease Others: -Alcohol -Fatty liver disease -Autoimmune hepatitis -Alpha 1 antitrypsin deficiency -Wilson's disease -Malignancy
What are the tests that should be done for liver failure?
Bloods: FBC, U and E, LFT, INR, Glucose, Paracetamol levels, hepatitis serology, ferritin, autoantibodies
Microscopy: urine dip and culture, blood culture, ascitic tap
Radiology: CXR, abdo ultrasound for portal vein
What is the management of liver failure?
Nurse with head tilted at 20 degrees in ITU
Protect airway with intubation and insert NG tube to avoid aspiration
Measure urine output with catheter
Treat underlying cause e.g. paracetamol poisoning
Check bloods daily
Give IV glucose to avoid hypoglycaemia
Haemodialysis if renal failure develops
Liase early with transplant services
What is the management of cirrhosis?
Good nutrition and alcohol abstinence
Fluid restiction and salt restriction
Give spironolactone to maximum tolerated dose
Aim for daily weight loss of <1/2kg/d
Add furosemide if response poor but watch Na+
How do you treat spontaneous bacterial peritonitis?
Piperacilli with tazobactam
Consider prophylaxis in those with high risk
What are the grades of hepatic encephalopathy?
Grade 1 - Sleep disturbance
Grade 2 - Inreasing drowsiness, confusion
Grade 3 - Stupor, incoherence, significant confusion
Grade 4 - Coma
How should hepatic encephalopathy be treated?
The encephalopathy is caused by build up of nitrogenous waste products.
Aim to lower these by:
-reduce protein intake
-Lactulose and bowel enemas to reduce nitrogen producing bacteria
Aim for 2-4 soft stools per day
