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

2. Acute Chronic

3. Acute liver failure Fast and potentially reversible impairement of liver function in the patients without earlier disease of the liver. Without treatment it’s course is progressive < 4 weeks from the onset of symptoms Hyperacute < 10 days Fulminant 10-30 days

4. Causes Viral hepatitis Drugs – paracetamol, izoniazid, sulphonamids, phenytoin, statins, also herbs Toxins – alpha-amanitine Other – shock, liver ischaemia, Wilson’s disease, AIH, sepsis, Budd-Chiari syndrome, portal vain thrombosis

5. Symptoms Encephalopathy – key symptom Jaundice Bleeding tendency Epileptic seasures – brain injury due to the same causes as encephalopathy and/ or increased ICP

6. Laboratory tests AST, ALT  increased serum bilirubin elongation of PT, thrombocytopaenia hypoglycaemia lactate  ammonia  renal failure (creatinine rather than urea)

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

8. Treatment ICU i.v. fluids diuresis Glucose levels Haemodynamic, biochemical parameters control CBC, PT Antibiotic and antifungal prophylaxis Stress gastric ulcers prophylaxis

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

10. Treatment - coagulopathy Vit. K Cyclonamine FFP KKP

11. Treatment – haemodynamics and kidneys Fluid resuscitation; koloids (albumins) Mean arterial BP 50-60 mmHg; pressors (NA, dopamine) if needed Carefully with contrast media; N- acetylocystein before Dialysis

12. In severe cases, when farmacological treatment is not enough and there is no other option – liver transplantation

13. Chronic liver failure As in liver cirrhosis

14. Symptoms Weakness, fatigue Slight temperature elevation Lack of apetite, weigh loss, nausea, vomiting Discomfort in right upper abdominal quadrant Pruritus Menstruation disorders, infertility, gynaecomastia Painful muscle spasms Bleeding from gums and nose

15. Symptoms Ascites Gynaecomastia in men Hirsutism in women Splenomegaly Hepatomegaly or small liver Jaundice Spider angiomas Erythaema in palms Excessive skin pigmentation Xanthelasma Palmar contracture (Dupuytren’s) Collateral circulation (caput medusae

17. Diagnosis CBC PT Electrolytes Glucose level AST, ALT, ALP, GGTP, bilirubin, albumins Creatinin, urea Ammonia Blood type (2x) Hypertrigliceridaemia,hypercholesterolaemia Amylase, lipase AFP (>200)

18. Diagnosis USG CT Gastrofiberoskopy