Please enable JavaScript.
Coggle requires JavaScript to display documents.
Acute liver failure in children (Aetiology (Infection HSV Hepatitis…
Acute liver failure
in children
Pathophysiology
Trigger
Usually infection or metabolic condition
Present hrs-weeks
Mechanism
Sudden reduction in liver function
Reduced bilirubin excretion - jaundice
Encephalopathy - high bilirubin levels
Reduced clotting factor synthesis - coagulopathy
Aetiology
Infection
HSV
Hepatitis viruses
Metabolic
Metabolic disease
Mitochondrial disease
Wilsons disease
Drugs
Drug induced
Paracetamol OD
Autoimmune
AIH
Clinical
presentation
Confusion
Bruising
Jaundice
Diagnosis
Examination
Abdo
Jaundice, tender RUQ, may have hepatomegaly
Neuro
Confusion, irritability, drowsiness
Investigations
Bloods
Blood gas, FBC, U+E (may be deranged),
LFTs (deranged), clotting (deranged), glucose (low)
Imaging
Abdo USS: hepatitis
CT abdo: inflamed liver
EEG: hepatic encephalopathy
CT head: cerebral oedema
Bedside
Obs
Measurements
History
PC/HPC
Jaundice, confusion, bruising, recent infection
POH
Scans, bloods, growth, gestation,
delivery, weight, complications
PMH
Known medical conditions,
growth and development, vaccinations
DH
Recent meds, allergies
FH
Metabolic disease, liver disease
SH
Living arrangements, school/nursery
Management
Initial ABCDE
Definitive
Medical
IV fluids
Indication: stabilise BM
E.g. IV dextrose
MOA: use conservatively to prevent oedema
Abx
Indication: all patients for prophylaxis
E.g. broad spec abx, antifungals
Vitamin K
Indication: coagulopathy
PPIs
Indication: coagulopathy
MOA: protect from UGI bleed
Manitol
Indication: cerebral oedema
Surgery
Liver transplant
Indication: worsening liver profile, coagulopathy, coma
Conservative
Referral to paediatric liver centre ASAP
Fluid restriction to prevent cerebral oedema
Complications
Haemorrhage
Pancreatitis
Cerebral oedema
Sepsis
Definition
Sudden onset necrosis of the
liver and loss of function
Epidemiology
Uncommon
High mortality