| What is fulminant hepatic failure? | Rapid development of acute liver injury with impaired function and encephalopathy (w/in 8 weeks if healthy liver or 2 weeks with underlying liver disease)
Death is caused by brain edema (which occurs in FLF) |
| What is the difference between FHF and sub FHF? | Cerebral edema in FHF only, Renal failure and HTN portal in sub HFH only. |
| What are the major causes of FHF? | Acetaminophen toxicity (should be directly treated with N-acetylcysteine), hepA, autoimmune (make ANA), hepB,C,D, Wilson's disease, fatty infiltrate, Reye, pregnancy.
Vascular (portal thrombosis, veno-occlusion, ishemic hepatitis)
Miscellanous (sepsis, heat stroke, autoimmune) |
| What are the signs and symptoms of FHF? | Acute liver failure symptoms (malasie, nausea, jaundice, ecchymoses)
Hepatic encephalopathy (stages, 1 ->daynight sleep reverse, 2 slowed response, 3 confusion, 4 coma)
Cerebral edema, sepsis, renal failure, circulatory issues, GI bleed, |
| What are the lab findings of FHF? | CBC, LFT, Viral serology, EEG done.
If INR high and encephalopathy --> transplant |
| What are the treatments of FHF? | Liver transplant (stage 3 or 4)
complication treatments (encephalopathy -->mannitol (ammonia within gut lumen)
Restrict protein diet, abx.
Cerebral edema (astrocyte edema/ neurosymptoms --> treated by elevated head position and manitol 0.5-1g/lg |
| A patient 65 years old is admitted to the ER for cardiogenic shock, we see on labs ALT 2000 and AST 1500, what is the course of action and differential? | This may be liver shock, which is caused by hypotension, hepatocytes get destroyed and liver enzymes are very very high. it is reversible and self-limited resolves after correcting BP (unless pt has chronic liver disease)
If it occurs with CLD --> this may be a cause for liver decompensation. |
| A pt comes to ER with 3000 ALT, what is the course of action? | If INR high and hepatic encephalopathy directly go for transplant as pt will die within 24-48 hours |
