Acute Liver Failure

Question 1

what is the difference between decompensated cirrhosis and acute liver failure?

Answer 1

etiologyyyyy~

cirrhosis there is an element of chronic liver disease

acute liver failure has no underlying liver disease

Question 2

what is acute liver failure?

Answer 2

complex clinical syndrome with elevated liver biochemistry, coagulopathy, and hepatic encephalopathy

with no underlying liver disease

Question 3

what are the 3 O’Grady classes for acute liver failure

Answer 3

based on the interval between developing jaundice and encephalopathy

1. hyperacute - within 7 days
2. acute - interval of 1-4 weeks
3. subacute - 5-12 weeks

Question 4

what is the most common cause of acute liver failure in developped countries

Answer 4

drug-induced liver injury - acetaminophen

Question 5

what is the most common cause of acute liver failure in developing countries?

Answer 5

hep a and hep e infections

Question 6

besides drug induced and hepatitis virus caused acute liver failure, what other etiologies are there

Answer 6

ischemic hepatitis ➔ iatrogenic, there is reduced blood flow and hypoperfusion of hte hepatocytes

maligancy

HELLP syndrome

budd-chiari syndrome

Question 7

what is the main physiologic result of acute liver failure?

Answer 7

massive hepatic necrosis and apoptosis

Question 8

what are common s/s of acute liver failure?

Answer 8

jaundice, RUQ pain, abdominal swelling, nausea, vomiting, malaise, dehydration

Question 9

what cx should i be concerned about with acute liver failure?

Answer 9

1. Cerebral edema, intracranial pressure >20 mmHg
2. coagulopathy (GI bleeding)
3. hepatitis-associated aplastic anemia
4. infection
5. renal failure
6. nutritional and metabolic
7. pulmonary cx (edema, pneumonia, tracheobronchitis)

Question 10

what are your main goals during the work up of a potential acute liver failure pt?

Answer 10

1. determine the underlying cause using a series of bloodwork
   - liver biochemistry, albumin, bilirubin
   - PT/INR
   - creatinine and urea
   - electrolytes
   - CBC
   - HIV/hepatitis viral serology and autoimmune markers
   - toxicology screen
   - acetaminophen levels
   - VBG
2. imaging

Question 11

what would you do management wise if an acute liver failure pt showed up in ED?

Answer 11

1. admit to ICU
2. treat underlying cause
   - N-acetylcysteine for acetaminophen poisoning
   - lactulose for hepatic encephalopathy
3. preventative vs cerebral edema ➔ head elevation, mannitol, hyperventillation, monitor intracranial pressure
4. general supportive measures ➔ avoid MOF until able to recover and get transplant