1. MOHAMAD HAFIZ BIN MOHAMAD NGARIP
MUHAMMAD KHAIRUL ADHA BIN FUAAD

2. • Acute liver failure – occur suddenly in healthy liver.
• Chronic liver failure – occur as a result of
decompensation of chronic liver disease.
• Fulminant liver failure – clinical syndrome resulting
from massive necrosis of liver and leading to severe
impairment of liver function.
Hyperacute : encephalopathy within 7 days of onset of
jaundice.
Acute : within 8-28 days.
Subacute : within 5-26 weeks.

3. Nitrogenous waste (ammonia) build up in the circulation and
passes to brain (convert to glutamine). Excess glutamine causes
osmotic imbalance-cerebral oedema.
• Grade 1 : Altered mood/behaviour, sleep disturbance.
• Grade 2 : Increasing drowsiness, confusion, slurred speech.
• Grade 3 : Stupor, incoherence, restlessness, significant
confusion.
• Grade 4: Coma.
Rule out other causes – sepsis, trauma, hypoglycemia and
seizure activity.

4. • Infection – viral hepatitis (B, C, CMV), yellow fever,
leptospirosis.
• Drugs – paracetamol overdose, halothane, isoniazid.
• Toxins – carbon tetrachloride.
• Vascular – Budd Chiari syndrome, veno-occlusive
disease.
• Other – alcohol, primary biliary cirrhosis,
hemochromatosis, autoimmune hepatitis, Wilson’s
disease, fatty liver of pregnancy, alpha 1-antitrypsin
deficiency.

5. • Hepatic vein obstruction by thrombosis or tumour causes
ischemia and hepatocyte damage.
• Presentation – liver failure or insidious cirrhosis,
abdominal pain, hepatomegaly, ascites and increase ALT,
portal hypertension occurs in chronic forms.
• Causes – hypercoagulable states
( pregnancy, malignancy, paroxysmal nocturnal
haemaglobinuria, polycythaemia rubra vera,
thrombophilia),
liver tumour, renal tumour, adrenal tumour.

6. • Jaundice
• Hepatic
encephalophaty
• Fetor hepaticus
(smells like pear
drops)
• Asterixis (flapping
tremor)
• Signs of CLD –
Gynaecomastia
Hepatomegaly
Ascites
Loss of axillary hair
Hepatorenal syndrome

7. • FBC – any infection, bleeding.
• Renal profile
• LFT
• Coagulation profile – prothrombin time, INR, APTT.
• CMV and EBV serology.
• Chest x-ray
• Abdominal ultrasound
• Doppler studies of portal vein – in suspected Budd-Chiari
syndrome.
• Abdominocentesis - >250/mm3 neutrophils suggest
spontaneous bacterial peritonitis.

8. • General –
-Secure airway with intubation and insert nasogastrict tube
to avoid aspiration and remove any blood from stomach.
-insert urinary and central venous catheters to assess fluid
status – maintain normal body volume.
-haemofiltration or heamodialysis if renal failure develops.
-avoid sedatives or other drugs with hepatic metabolism.
• Specific – depending on the cause
-N acetylcysteine in PCM overdose.
-Acyclovir – in viral hepatitis
-liver transplant

9. • Management of complications
-cerebral oedema – mannitol.
-bleeding – IV vit K.
-infection – ceftriaxone, avoid gentamicin (incr. risk of renal
failure)
-ascites – fluid restriction, low salt diet, diuretics.
-encephalopathy – avoid sedatives, decrease protein diet.