XXXX27. Acute liver failure. Hepatic encephalopathyXXXX

Question 1

what is the defintion of acute liver failure ?

Answer 1

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

Question 2

what is the classification of acute liver failure

Answer 2

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

Question 3

what are the causes for fulminant liver ?

Answer 3

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

Question 4

what are the grades of hepatic encephalopathy

Answer 4

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

Question 5

how can we diagnose acute liver failure

Answer 5

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

Question 6

what is the histology of ALF?

Answer 6

pan acinar and multiacinar necrosisi - space between the centra vein and portal triads

and ductular irritation

Question 7

what is the management with such patients

Answer 7

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

Question 8

what is the treatment for acetaminophen related acute liver damage ?

Answer 8

within 4 hours of presentation give activated charcoal

give sac as soon as possible
N - acetyl cysteine (also for parectamol overdose)

Question 9

how does the mortality range change depending on the cause

Answer 9

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

Question 10

what is the major cause of morbidity and mortality with alf?

Answer 10

cerebral edema