L3: Acute Hepatitis & Acute Liver Failure Flashcards
Def of Acute Hepatitis
- Acute Inflammation of the hepatic parenchyma or injury to hepatocytes resulting in elevated liver function indices
- Duration → less than 6 months
Etiology of Acute Hepatitis
Compare between HAV,HBV,HCV,HDV,HEV
in terms of:
- Genome
- Transmission
- IP
- Fulminant
- Chronicity
- Prophylaxis
- Serology
CP of Acute Hepatitis
- Asymptomatic
- Non-Icteric Hepatitis
- Icteric Hepatitis
non-icteric Acute Viral Hepatitis
(without jaundice)
- Flu like symptoms: Fever, Headache, Malaise, Anorexia
Icteric Acute Viral Hepatitis
Sequale of Acute Viral Hepatitis
- Complete Recovery
- Complications
Complications of Acute Viral Hepatitis
which virus is related to this complication (Prolonged Cholestasis)?
HAV
which virus is related to this complication (Relapse)?
HAV
which virus is related to this complication (Chronicity)?
B - C - D
which virus is related to this complication (Extrahepatic Complications) ?
- HBV → serum sickness like syndrome (arthralgia, rash, angioedema)
- HCV: → Essential mixed cryoglobulinemia (arthralgia, palpable purpura, weakness, glomerulonephritis )
Investigations for Acute Viral Hepatitis
Prevention of Acute Viral Hepatitis
Managment of Acute Viral Hepatitis
Supportive Measures in Acute Viral Hepatitis
- Diet (high calorie diet)
- Hydration (IV fluid if vomiting is severe)
- Bed rest (or activity as tolerated)
- Avoid drugs metabolized by liver
Symptomatic TTT in Acute Viral Hepatitis
- Vomiting: Anti‐emetics
- Itching: Cholestyramine
Management of Complications in Acute Viral Hepatitis
Acute (fulminant) liver failure: Hospitalization and appropriate management
Specific Therapy in Acute Viral Hepatitis
HCV: spontaneous recovery only (15‐20%)
- Direct acting antivirals
HBV: in special cases (severe acute hepatitis)
- Oral nucleoside
Characters of Acute Hepatitis A
Def of Acute Liver Failure
- Rapid deterioration in liver function characterized by →coagulopathy (INR > 1.5) and encephalopathy, in patients without pre-existing liver disease.
- Duration → < 26 weeks
Other terms of Acute Liver Failure
- Fulminant Hepatic Failure
- Fulminant Hepatitis
Classification of Acute Liver Failure
Etiology of Acute Liver Failure
Viral Causes of Acute Liver Failure
- Hepatitis → B, A, E
- Less frequent → CMV, HSV, VZV, Dengue
Drug Causes of Acute Liver Failure
- Paracetamol (dose dependent)
- INH, chemotherapy, statins
- NSAIDs
Vascular Causes of Acute Liver Failure
- Budd–Chiari syndrome
- Hypoxic hepatitis
Toxin Causes of Acute Liver Failure
- Amanita phalloides
- Phosphorus
Other causes of Acute Liver Failure
- Wilson disease, autoimmune
- Acute fatty liver of pregnancy
what is the does of paracetamol that causes acute liver failure?
> 15 gm
What is The commonest cause of ALF in the UK and the USA?
Paracetamol
…… may influence the liver susceptibility to lower doses of acetaminophen.
Alcohol abuse
what are other hepatotoxic drugs?
Idiosyncratic (not dose dependent)
- Such as: →INH, chemotherapy, statins, NSAIDs
Pathophysiology of Acute Liver Failure
CP of Acute Liver Failure
Investigations of Acute Liver Failure
- Investigations to assess liver functions and complications
- Investigations to diagnose the cause
Investigations to assess liver functions and complications in Acute Liver Failure
Investigations to diagnose the cause of Acute Liver Failure
Managment of Acute Liver Failure
Etiology-specific therapies in Acute Liver Failure
Supportive care in ICU in Acute Liver Failure
- Monitor level of consciousness
- Correct hypoglycemia
- Prevent GI bleeding with PPI
- Monitor for infection and multiorgan failure
What is The only effective therapy for ALF patients who fail to recover spontaneously?
Liver transplantation
