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Liver Failure (Treatment (Treat complications (Antibiotics for infection,…
Liver Failure
Treatment
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Monitor temp, resp rate, pulse, BP, pupils, urine output hourly, daily weight
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Optimise nutrition, give thiamine + folate supplements
Admit patient to ITU - tilt head up 20 degrees, intubate airway, insert NG tube to prevent aspiration, remove blood from stomach
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Avoid sedatives and other drugs with hepatic metabolism e.g. paracetamol, methotrexate, oestrogen
Treat complications
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Bleeding - vitamin K, blood transfusion as needed
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Ascites - salt + fluid restriction, diuretics
If grade III encephalopathy, age>40, albumin <30g/L, high INR, drug induced liver failure then worse prognosis. Consider liver transplant
Investigations
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FBC (GI bleed?), U&E, LFT, clotting, ferritin, α1AT, autoantibodies
Blood culture, urine culture
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Aetiology
Toxins e.g. mushroom, carbon tetrachloride
Vascular e.g. Budd-Chiari syndrome (genetic, blood cannot flow out of the liver), veno-occlusive disease
Drugs e.g. paracetamol overdoe, halothan, isoniazid
Others e.g. alcohol, haemachromatosis, autoimmune hepatitis, Wilson's disease, fatty liver of pregnancy, malignancy, α1-antitrypsin deficiency
Infections e.g. viral hepatitis, yellow fever, leptospirosis
Signs
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Hepatic encephalopathy
Excess glutamine causes an osmotic imbalance and shift of fluid into these cells - this causes cerebral oedema
Grade I = altered mood, sleep disturbance, dyspraxia, no liver flap
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Grade II = increasing drowsiness, confusion, slurred speech, may or may not be a liver flap
As the liver fails, nitrogenous waste (ammonia) builds up in the circulation and passes to the brain
Grade III = incoherent, restless, liver flap, stupor
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Definitions
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Fulminant Hepatic Failure = Clinical syndrome resulting from massive necrosis of the liver cells, leading to severe impairment of liver function
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