Acute Liver Injury and Failure Flashcards

1
Q

T/F Most patients with acute hepatic injury will recover? What is the most common cause of fulminant hepatic failure in the US?

A

T

tylenol

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2
Q

Define acute hepatic injury.

A

sudden onset of severe hepatocellular damage in a previous healthy liver

usually with elevation in liver aminotransferases

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3
Q

What is the key symptom of fulminant hepatic failure?

A

altered mental status due to encephalopathy, severe coagulopathy, cerebral edema

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4
Q

Name general causes of acute hepatic injury.

A

viral, toxins/meds, ischemia, autoimmune, metabolic (Wilson’s), mushrooms, acute fatty liver, malignancy (lymphoma)

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5
Q

Describe the mechanism of acetaminophen hepatotoxicity.

A

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)

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6
Q

What are poor prognostic factors of fulminant hepatic failure?

A
slow onset
extremes of age
drug induced (except acetaminophen)
idiopathic
acidosis
kidney failure
clinical context
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7
Q

When should you admin NAC?

A

any time after suspected overdose of tylenol with liver damage, the sooner the better

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