Acute Liver Injury and Failure

Question 1

T/F Most patients with acute hepatic injury will recover? What is the most common cause of fulminant hepatic failure in the US?

Answer 1

T

tylenol

Question 2

Define acute hepatic injury.

Answer 2

sudden onset of severe hepatocellular damage in a previous healthy liver

usually with elevation in liver aminotransferases

Question 3

What is the key symptom of fulminant hepatic failure?

Answer 3

altered mental status due to encephalopathy, severe coagulopathy, cerebral edema

Question 4

Name general causes of acute hepatic injury.

Answer 4

viral, toxins/meds, ischemia, autoimmune, metabolic (Wilson’s), mushrooms, acute fatty liver, malignancy (lymphoma)

Question 5

Describe the mechanism of acetaminophen hepatotoxicity.

Answer 5

secondary for metabolism of tylenol by p450 creates NAPQI toxic product that leads to macromolecule adducts

in overdose there is a shortage of glutathione to neutralize the toxic product, administration of NAC (n- acetyl-cysteine can replenish glutathione (given as soon as possible)

Question 6

What are poor prognostic factors of fulminant hepatic failure?

Answer 6

slow onset
extremes of age
drug induced (except acetaminophen)
idiopathic
acidosis
kidney failure
clinical context

Question 7

When should you admin NAC?

Answer 7

any time after suspected overdose of tylenol with liver damage, the sooner the better