MED Liver failure

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Information about MED Liver failure
Health & Medicine

Published on May 31, 2014

Author: ooijianmin



• Acute liver failure – occur suddenly in healthy liver. • Chronic liver failure – occur as a result of decompensation of chronic liver disease. • Fulminant liver failure – clinical syndrome resulting from massive necrosis of liver and leading to severe impairment of liver function. Hyperacute : encephalopathy within 7 days of onset of jaundice. Acute : within 8-28 days. Subacute : within 5-26 weeks.

Nitrogenous waste (ammonia) build up in the circulation and passes to brain (convert to glutamine). Excess glutamine causes osmotic imbalance-cerebral oedema. • Grade 1 : Altered mood/behaviour, sleep disturbance. • Grade 2 : Increasing drowsiness, confusion, slurred speech. • Grade 3 : Stupor, incoherence, restlessness, significant confusion. • Grade 4: Coma. Rule out other causes – sepsis, trauma, hypoglycemia and seizure activity.

• Infection – viral hepatitis (B, C, CMV), yellow fever, leptospirosis. • Drugs – paracetamol overdose, halothane, isoniazid. • Toxins – carbon tetrachloride. • Vascular – Budd Chiari syndrome, veno-occlusive disease. • Other – alcohol, primary biliary cirrhosis, hemochromatosis, autoimmune hepatitis, Wilson’s disease, fatty liver of pregnancy, alpha 1-antitrypsin deficiency.

• Hepatic vein obstruction by thrombosis or tumour causes ischemia and hepatocyte damage. • Presentation – liver failure or insidious cirrhosis, abdominal pain, hepatomegaly, ascites and increase ALT, portal hypertension occurs in chronic forms. • Causes – hypercoagulable states ( pregnancy, malignancy, paroxysmal nocturnal haemaglobinuria, polycythaemia rubra vera, thrombophilia), liver tumour, renal tumour, adrenal tumour.

• Jaundice • Hepatic encephalophaty • Fetor hepaticus (smells like pear drops) • Asterixis (flapping tremor) • Signs of CLD – Gynaecomastia Hepatomegaly Ascites Loss of axillary hair Hepatorenal syndrome

• FBC – any infection, bleeding. • Renal profile • LFT • Coagulation profile – prothrombin time, INR, APTT. • CMV and EBV serology. • Chest x-ray • Abdominal ultrasound • Doppler studies of portal vein – in suspected Budd-Chiari syndrome. • Abdominocentesis - >250/mm3 neutrophils suggest spontaneous bacterial peritonitis.

• General – -Secure airway with intubation and insert nasogastrict tube to avoid aspiration and remove any blood from stomach. -insert urinary and central venous catheters to assess fluid status – maintain normal body volume. -haemofiltration or heamodialysis if renal failure develops. -avoid sedatives or other drugs with hepatic metabolism. • Specific – depending on the cause -N acetylcysteine in PCM overdose. -Acyclovir – in viral hepatitis -liver transplant

• Management of complications -cerebral oedema – mannitol. -bleeding – IV vit K. -infection – ceftriaxone, avoid gentamicin (incr. risk of renal failure) -ascites – fluid restriction, low salt diet, diuretics. -encephalopathy – avoid sedatives, decrease protein diet.

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