Acute Liver Disorders Will Gelson Consultant Hepatologist Addenbrookes

Acute Liver Disorders Will Gelson Consultant Hepatologist Addenbrooke’s Hospital April 2020

Principles Causes Presentations Management Prognosis Principle of acute liver disease Insult Normal liver Liver injury • Inflammation (hepatitis) • Necrosis

Principles Causes Presentations Management Prognosis Causes of acute liver disease Insult Drugs (paracetamol) Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease Normal liver Liver injury • Inflammation (hepatitis) • Necrosis

Principles Causes Presentations Management Prognosis Presentations of acute liver disease Abnormal liver tests Liver enzymes, jaundice Liver Injury Liver impairment Liver failure Hyperacute Enceph < 1/52 Acute 1 -4/52 Subacute 4 -24/52

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of acute liver disease • Remove and treat cause – – – Paracetamol Viruses Ischaemia Autoimmune Budd chiari Wilson’s disease • Monitor/support • Usually resolves • Occasionally leads to death or liver transplantation

Principles Causes Presentations Management Prognosis Management of Acute Liver Failure • Acute liver failure is a multisystem disorder Na balance ICP measures Fluid balance Inotropes Fluid balance Haemofiltration Electrolyte correction Early haemfiltration Liver transplantation Glucose Broad spectrum antimicrobials Fluid balance Inotropes Ventilation Blood products https: //easternliver. net

Principles Causes Presentations Management Prognosis Progosis of Acute Liver Failure • Creatinine, INR, bilirubin, encephalopathy, p. H, lactic acidosis • http: //odt. nhs. uk/pdf/liver_selection_policy. pdf

Principles Causes Presentations Management Summary • • • Principles Clinical presentations Causes Management Prognosis

Principles Causes Presentations Management Questions and “Wiki” • william. gelson@addenbrookes. nhs. uk • Hepatology “wiki” • Power point files https: //easternliver. net Prognosis