HEPATIC FAILURE

:PRESENTED BY ABEER YOUSUF ASIMA JAVED

Liver Failure can be

ACUTE CHRONIC

A 15 years old girl had a flu like illness n 3 days later noticed marked weakness n she was passing dark coloured urine n vomited few times. Her mother noticed that her eyes were yellow. Next day she was drowsy, looked weak,exhausted,jaundiced and was brought to the hospital with a pulse of 110/min,BP 90/70,RR 22/min.No hepatosplenomegaly.Her condition further deteriorated and by the evening she was deeply comatosed.

HOW TO REACH A ??DIAGNOSIS

HISTORY

CLINICAL ASSESSMENT

INVESTIGATIONS

CAUSES

INFECTIVE: Hepatitis A,B,C,D,TTV,Herpes simplex DRUG REACTIONS AND TOXINS:Paracetamol overdose,AD,NSAIDS,Mushroom Poisoning,INH,RIF,Halothane,Herbal Remedies ISCHAEMIC Hepatitis, Surgical Shock METABOLIC: Wilson's Disease, Fatty liver of pregnancy, Reye's syndrome MISC Severe Bacterial Infection, Heat Stroke, Massive Malignant Infiltration.

Classification Of Acute Liver Failure

Type
Time: Jaundice to encephalopa thy Cerebral oedema Common Causes

Hyper acute Acute

days 7> days 8-28

Common Viral,paracet amol Common Cryptogenic, drugs drugs

Sub acute days-12 29 Uncommon Cryptogenic ,

weeks

 In

inflammatory/infective conditionsCM sustains the main damageleakage of cytoplasm contents causes inc in ALT n AST activities.

In

infiltrative disorders damage to both mitochondrial and cytoplasm membrane, there is proportionally greater inc in plasma AST activity than ALT.

MANAGEMENT

Treat the cause and if symptoms appears treat them as such Infection..culture,Antibiotics Bleeding..H2 Blocker,Fresh frozen plasma and platelets Hypotension..Albumin,Vasoconstrictors Hypocalcemia..10 ml 10% Calcium Gluconate IV daily Respiratory Failure..Intubation,Ventilate,oxygenation Check Cerebral Edema n Hypoglycaemia

1. 2. 3. 4. 5. 6.

Mrs.Anam 54 yrs old presented with abdominal distention for 10 days. She looked pale with the following vitals: pulse 90/min,BP 100/70 temp100 F RR 22/min.O/E Spleen was palpable. shifting dullness +ve.examination of other systems were unremarkable. Few months later she was brought to ER severely dehydrated, disoriented with a dropped BP n inc pulse. Again few months back she was brought in a collapsed state with a pulse of 125/min BP 65/40.ALPHA FETOPROTEIN was markedly raised.

:Hepato cellular failure may follow

Viral Hepatitis Cirrhosis Fatty Liver Ligation of hepatic artery Occlusion of hepatic veins Jaundice Neurological changes Ascities Skin and endocrine changes Fever and septicaemia

?How the condition deteriorate

If there is electrolyte imbalance..Diuretics,Diarrhea,Vomiting Bleeding Drugs Infections Disturbance of the bowel habits

Clinical Grades Of Hepatic Encephalopathy

Grade 1 Grade 2 Grade 3 Grade 4

Principles of Management
Identify

Precipitating Factors Stop Hges Restricted Diet Maintain electrolyte imbalance Stop diuretics Abs If symptoms worsen start regime for acute coma

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