Acute Liver Injury and Failure Flashcards
T/F Most patients with acute hepatic injury will recover? What is the most common cause of fulminant hepatic failure in the US?
T
tylenol
Define acute hepatic injury.
sudden onset of severe hepatocellular damage in a previous healthy liver
usually with elevation in liver aminotransferases
What is the key symptom of fulminant hepatic failure?
altered mental status due to encephalopathy, severe coagulopathy, cerebral edema
Name general causes of acute hepatic injury.
viral, toxins/meds, ischemia, autoimmune, metabolic (Wilson’s), mushrooms, acute fatty liver, malignancy (lymphoma)
Describe the mechanism of acetaminophen hepatotoxicity.
secondary for metabolism of tylenol by p450 creates NAPQI toxic product that leads to macromolecule adducts
in overdose there is a shortage of glutathione to neutralize the toxic product, administration of NAC (n- acetyl-cysteine can replenish glutathione (given as soon as possible)
What are poor prognostic factors of fulminant hepatic failure?
slow onset extremes of age drug induced (except acetaminophen) idiopathic acidosis kidney failure clinical context
When should you admin NAC?
any time after suspected overdose of tylenol with liver damage, the sooner the better