Liver failure Upper GI haemorrhage
LIVER FAILURE
Aetiology A Deterioration of chronic liver impairment
Alcohol
GIT haemorrhage
Infection – bacterial peritonitis, viral hepatitis
Drugs – diuretics, hypnotics, sedatives, narcotics
Metabolic – hypokalaemia, hypoglycaemia
Other – constipation, surgery
B Acute causes
Drugs – paracetamol, idiosyncratic (phenytoin amiodarone,
isoniazid, valproate, sulphonamides)
Viral hapatitis – A, B, C, D, E
Toxins – amanita phalloides, carbon tetrachloride
Vascular events – ischaemia, veno-occlusive disease, heatstroke,
malignancy
Other – Wilson’s (4 seconds)
FBC – infection, low platelets
ABG – lactic acidosis is bad prognostic indicator
Paracetamol level
Blood culture
Urine culture
Ascites for MCS if present
CXR
+ viral hepatitis screen )
+ plasma caeruloplasmin ) in acute failure
+ toxicology )
Management ABC’s
Maintain glucose >3.5mmol/L
10% dextrose 1L 12 hourly and monitor glucose 1 – 4 hourly and if decreased
consciousness
Fluid and electrolyte balance
Maintain K+ >3.5mmolL with supplements
Avoid saline, use 5%, 10% dextrose or colloids
Treat ascites with spironolactone, frusemide and albumin
Low salt diet
Correct coagulation
Vitamin K 10mg IV daily
Folic acid 10mg orally daily
Platelets if 60
Systolic BP 55 or co-morbidity ; > 4 units / 24 hours
<55; 6 – 8 units / 24 hours
Re-bleed (or 2 re-bleeds and low risk)
Carcinoma
Low Risk
Admit to medical unit
Can eat and drink until 6 hours prior to endoscopy
Endoscopy on next routine list
Surgical registrar is to be made aware of the patient