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Liver failure

Liver failure. lek. Anna Skubała Department of Infectious , Tropical Diseases and Parasitoses . Infectious Diseases and Hepatology Clinic. Acute Chronic.

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Liver failure

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  1. Liverfailure lek. Anna Skubała Department of Infectious, TropicalDiseases and Parasitoses. InfectiousDiseases and HepatologyClinic

  2. Acute • Chronic

  3. Fast and potentiallyreversibleimpairement of liverfunctioninthepatientswithoutearlierdisease of theliver. Withouttreatmentit’scourseis progressive < 4 weeksfromtheonset of symptoms Hyperacute < 10 days Fulminant 10-30 days Acuteliverfailure

  4. Viralhepatitis • Drugs – paracetamol, izoniazid, sulphonamids, phenytoin, statins, alsoherbs • Toxins – alpha-amanitine • Other – shock, liverischaemia, Wilson’sdisease, AIH, sepsis, Budd-Chiarisyndrome, portal vain thrombosis Causes

  5. Encephalopathy – key symptom • Jaundice • Bleedingtendency • Epilepticseasures – braininjurydue to the same causes as encephalopathy and/ orincreased ICP Symptoms

  6. AST, ALT  • increased serum bilirubin • elongation of PT , thrombocytopaenia • hypoglycaemia • lactate • ammonia  • renalfailure (creatinineratherthanurea) Laboratorytests

  7. PT • Electrolytes • Glucose • AST, ALT, ALP, GGTP, bilirubin, albumins • Creatinin, urea • Gasometry • Lactate • Ammonia • Bloodtype(2x) • Paracetamol level • Toxicological test(urine) • Viralantibodies and antigenes • Ceruloplasmin • Pregnancy test • ANA, SMA, Ig • Anty-HIV • Amylase, lipase Diagnosis

  8. ICU • i.v. fluids • diuresis • Glucoselevels • Haemodynamic, biochemicalparameterscontrol • CBC, PT • Antibiotic and antifungalprophylaxis • Stressgastriculcersprophylaxis Treatment

  9. Lactulosis p.o., gastrictube • Deep enema • Checking for increased ICP • Ornitin (Hepa-Merz) Treatment - encephalopathy

  10. Vit. K • Cyclonamine • FFP • KKP Treatment - coagulopathy

  11. Fluid resuscitation; koloids (albumins) • Meanarterial BP 50-60 mmHg; pressors (NA, dopamine) ifneeded • Carefullywithcontrast media; N-acetylocysteinbefore • Dialysis Treatment – haemodynamics and kidneys

  12. In severecases, whenfarmacologicaltreatmentis not enoughand thereis no otheroption – livertransplantation

  13. As inlivercirrhosis Chronicliverfailure

  14. Weakness, fatigue • Slighttemperatureelevation • Lack of apetite, weighloss, nausea, vomiting • Discomfortinrightupperabdominalquadrant • Pruritus • Menstruationdisorders, infertility, gynaecomastia • Painfulmusclespasms • Bleedingfromgums and nose Symptoms

  15. Ascites • Gynaecomastiain men • Hirsutisminwomen • Splenomegaly • Hepatomegalyorsmallliver • Jaundice • Spiderangiomas • Erythaemainpalms • Excessive skin pigmentation • Xanthelasma • Palmarcontracture (Dupuytren’s) • Collateralcirculation (caputmedusae Symptoms

  16. CBC • PT • Electrolytes • Glucoselevel • AST, ALT, ALP, GGTP, bilirubin, albumins • Creatinin, urea • Ammonia • Bloodtype (2x) • Hypertrigliceridaemia,hypercholesterolaemia • Amylase, lipase • AFP (>200) Diagnosis

  17. USG • CT • Gastrofiberoskopy Diagnosis

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