XXXX27. Acute liver failure. Hepatic encephalopathyXXXX Flashcards
what is the defintion of acute liver failure ?
also called fulminant hepatic failure
occurrence of encephalopathy and coagulopathy with an INR equal to or more than > 1.5 in jaundiced patient
with an illness less than 26 weeks duration
and no preexisting liver disease or cirrhosis
what is the classification of acute liver failure
according to the time taken from jaunidice to enecelaphopathy development
hyper acute less than 7 days
acute : 7-21 days
subacute more than 21 days to less than 26 weeks
what are the causes for fulminant liver ?
virus
A,
B especially concomitant with D = super infection
E
drugs - paracetamol and acetaminophen = dose elated
monoamine oxidase inhibitors
antituberculosis drugs - isoniazid
valproate - anti epileptic
toxins
amanita positioning
halo hydrocarbons
mushroom poisoning
vascular = budd chiari syndrome = hepatic vein thrombosis
acute ischemic heart disease
miscellaneous
wilson disease can cause it under 26 weeks
pregnancy = acute fatty liver and eclampsia
HELLP syndrome
autoimmune hepatits
what are the grades of hepatic encephalopathy
grade 1 = changes in behaviour only
grade 2 = change in disorientation , drowsiness , inappropriate behaviour
grade 3 = marked confusion
incoherent speech
sleeping most of the time
ASTERIXIS = tremor of hand when arm outstretched and wrist extended
symptoms of cerebral edema = nausea , vomitting , seizures
grade 4 = comatose
unresponsive to pain or vocal
how can we diagnose acute liver failure
PT with INR more than 1.5 ALT and AST high bilirubin high platelet count less than 150,000 / mm3 increased serum AMMONIA CT SCAN OF BRAIN AND LIVER ND LIVER BIOPSY
toxicology ,
serology
history taking
family history - wilson disease
what is the histology of ALF?
pan acinar and multiacinar necrosisi - space between the centra vein and portal triads
and ductular irritation
what is the management with such patients
grade 1/2 liver transplant avoid stimulation and sedation if possible giveantiobiotics lactulose vit k given
grade 3/4 all the strategy above intubate elevate head i intracranial pressure is high use mannitol
liver transplant remains the only effective therapy
what is the treatment for acetaminophen related acute liver damage ?
within 4 hours of presentation give activated charcoal
give sac as soon as possible
N - acetyl cysteine (also for parectamol overdose)
how does the mortality range change depending on the cause
acetaminophen intoxication = 30 perent
non acetaminophen = 80 percent
age more than 40 or below 10 years old has also worst outcome
and degree of encephalopathy
grade 1 -2 =65 percent
grade 3-4 = 20 percent
what is the major cause of morbidity and mortality with alf?
cerebral edema
