Tuesday, March 31, 2020

Acute Liver Failure in a nutshell.

Acute Liver Failure is defined as the acute onset of severe liver injury with encephalopathy and ↓ synthetic function (INR ≥ 1.5 ) in a patient without  cirrhosis or underlying known liver disease.

Acute Liver Failure.

Diagnostic triad: 1) elevated aminotransferases (often  > 1000 U/L)

                            2) Hepatic encephalopathy

                            3) INR ≥ 1.5


Causes: mnemonic - Mr. Wilson Died In Vehicle Accident.

                                        Malignant infiltration

                                        Wilson's disease

                                        Drugs (especially Acetaminophen overdose/ idiosyncratic)

                                        Ischemia (Shock liver, Budd-Chiari syndrome)

                                        Viral hepatitis (Hep. A, B, D, E; HSV; CMV)

                                        Autoimmune hepatitis

Symptoms, signs:  RUQ pain' tenderness, anorexia, nausea, vomiting, jaundice, fatigue, lethargy, flapping tremor (asterixis) and other signs of hepatic encephalopathy.

Also common in ALF:  Raised portal pressure,

                                           Decreased urine output due to low intravascular volume,

                                           Hypoglycemia,

                                           Reactive thrombocytopenia.

That's all!

(Happy studying :D)

-Suneet

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